The Long-Term Prozac Side Effects Many People Don't Expect

Fluoxetine (brand name Prozac) is arguably one of the most widely-known medications of its class. It belongs to a group of drugs known as selective serotonin reuptake inhibitors (SSRIs), which includes other medications such as sertraline (Zoloft), escitalopram (Lexapro), and paroxetine (Paxil). First approved by the FDA as a treatment for depression in 1987, Prozac was also the first SSRI on the market. Since then, Prozac has also been prescribed for the treatment of obsessive compulsive disorder, premenstrual dysphoric disorder, and panic attacks. Whether you currently take Prozac or not, you may have heard about some of the medication's more common and temporary side effects, such as upset stomach, headaches, heartburn, nervousness, dry mouth, tiredness, problems sleeping or irregular sleep habits (such as this one that could make you die early), and unusual dreams. Yet you might not be as familiar with some of the long-term side effects of Prozac. While SSRI side effects are highly individual, some of the possibilities can include changes with your cognition, mood, and weight, as well as issues with abnormal bleeding and sexual health.

But first, an important note: You should never stop or decrease your dosage without a doctor's explicit recommendation, as this may lead to setbacks in your mental health treatment, or even withdrawal symptoms known as discontinuation syndrome. It's also worth noting that many SSRIs are generally thought to have similar side effects, but are considered relatively safe overall. Nevertheless, some people might have a better experience with one SSRI over another due to the way their bodies respond to the medication. If side effects are long-term or intolerable with Prozac, then a doctor might recommend another SSRI. Consider the following scientific facts for informational purposes that you might wish to discuss further with a doctor.

Like other types of SSRIs, many of the side effects associated with Prozac are considered temporary. Most ease up within the first few weeks, and it's even possible to experience no side effects at all. Yet it's also important to be aware of some of the possible long-term cognitive and psychiatric effects tied to Prozac, too. First, this medication can cause adverse mood changes, including suicidal thoughts or behaviors. Such effects are most notable when you first start taking the medication or have changed doses in the last few weeks, as well as in people under the age of 25. Sometimes Prozac can cause changes in your mood that last longer than a few weeks, though. Possibilities include worsening depression, anxiety, agitation, or reckless behavior. These must be evaluated by a doctor immediately.

While considered rare, a loss of concentration and confusion are other cognitive-related side effects possible with Prozac. Any connection between SSRIs and negative cognitive impacts are still controversial though, with some researchers arguing that the medications may lead to cognitive improvements. Other rare side effects may cause changes in facial expressions and body movements. These may also be related to a phenomenon known as "emotional blunting," which can cause a decrease in emotional expression and lead to apathy (not to be confused with the obscure phenomenon that affects 10% of the population, alexithymia). Also called antidepressant-induced emotional blunting (AIEB), it's thought that as many as 40% to 60% of people taking SSRIs might experience emotional blunting.

Internal bleeding is yet another long-term side effect of taking Prozac, but the risk is even greater if you take other medications that also thin the blood; gastrointestinal bleeding is considered a serious side effect of taking SSRIs with blood thinning drugs. Warfarin (Coumadin), as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil), aspirin, and naproxen (Aleve) are all examples. Signs of abnormal bleeding can include gums that bleed whenever you brush or floss your teeth, frequent nosebleeds, and easy bruising.

Also, some people who take Prozac may experience symptoms of long-term sexual dysfunction. These can include loss of desire, drive, and ability. It's important to talk with a doctor if you experience any of these types of side effects, as they do not typically improve over time.

Finally, taking Prozac or other SSRIs may be linked with unintentional weight gain. There's some debate as to the exact causes of weight gain during Prozac treatment, but it's thought that an increased appetite might contribute. Furthermore, long-term use of Prozac may also be associated with an increased craving for carbohydrates. While there's the myth about carbohydrates and weight loss people should stop believing, it's likely that researchers are pointing to possible cravings for simple carbs when taking Prozac. As with any of the possible long-term side effects of Prozac, it's important to discuss any concerns with a doctor so you can both determine the benefits versus risks of this medication.