One of the most serious and common medical illnesses is depression which has negative effects on how a person feels, thinks and acts. In its occurrence, depression causes acute feelings of sadness, and suddenly a depressed person loses interest in the activities once enjoyed. Treating depression can be challenging. A variety of options are available in treating depression ranging from counselling and the alternative use of chemicals popularly known as antidepressant drugs. One very effective antidepressant is fluoxetine whose mode of action does not have many side effects on patients and is well compatible with most drugs hence clinical preference over other antidepressants. The paper looks at fluoxetine antidepressant and the reason as to why it is the best choice. It also goes further and explains the side effects of fluoxetine as well as the risks associated with abruptly discontinuing use of fluoxetine.
The Antidepressant Fluoxetine and Its Mode of Action
Mechanism of fluoxetine in depression
When diagnosed successfully, depression is treatable. Different medications or therapies can be prescribed to bring depression under control. Among the most prominent antidepressants is fluoxetine. Fluoxetine is highly recommended as an antidepressant because of its superior reduction of symptoms, tolerability, and acceptability (Jenkins, 2017). Fluoxetine belongs to depressants that are referred to as selective serotonin-reuptake inhibitors. The action of selective serotonin reuptake inhibitors has been an object of extensive study in efforts to treat depression. While sending information to neurons, chemical messengers known as neurotransmitters are actively involved. Chemical messengers are charged with the responsibility of transmitting responses and communication in the body.
In remedying major depressive disorders, fluoxetine is believed to increase the chemical messenger serotonin outside the plasma membranes thus reducing its reuptake into the presynaptic cells. Reducing extracellular levels of neurotransmitter serotonin increases serotonin levels in the synaptic cleft that is free to bind to postsynaptic receptors.
Serotonin is a chemical messenger that is popularly understood to contribute to the feelings of happiness and well-being. Serotonin receptors that are located on the nerve cells membrane mediate the outcomes of serotonin. Jenkins (2017) argues that when fluoxetine influences the levels of serotonin, nerve cells can transmit the perceptions of well-being and happiness creating a clinical effect of mood increases and reduced anxiety. The actions of increasing moods and reducing anxiety are thought to be resultant of adaptive changes in the functions of neurons that improves serotonergic neurotransmission ultimately controlling depression (Aiken & Phelps, 2017).
Numerous studies carried out incline to the fact that fluoxetine significantly influences the presence of synaptic dopamine and norepinephrine which may positively chip in the fluoxetine antidepressant action. Moreover, fluoxetine poses as a modulator in the making hence proving to be a clinically relevant drug for use as an antidepressant.
Fluoxetine as a drug of choice
Fluoxetine is among the drugs of choice in treating depression and also very popular compared to other antidepressants. Studies indicate that fluoxetine, when compared with other drugs, is better tolerated and highly effective. To support this, fluoxetine registers little or no effect on other chemical messengers. When compared to other antidepressants such as placebo, fluoxetine is seen to be more effective. Controlled clinical trials pitting fluoxetine against placebo confirms the efficiency of fluoxetine since patients put under fluoxetine show more improvement in health after a short period of medication compared to placebo (Jenkins, 2017). Therefore fluoxetine has been classified as first-line therapy because of its efficiency.
Controlled studies further reveal that use of fluoxetine in depression therapy is a safer mode of treatment from the onset of treatment (Olianas, Dedoni & Onali, 2017). In light of safety, research has confirmed that while undertaking treatment the rates of early therapy dropouts is reduced with more compliance by patients to take fluoxetine dosages. These facts can only confirm how safe fluoxetine is and thus a drug of choice in depression therapy. When administered to elderly patients as well as pregnant mothers, fluoxetine has proven to be safe in addition to being associated with fewer incidences of suicide from patients. Also, fluoxetine patients have reduced incidences of panic attacks which affirm the safe nature of the drug.
Another favourable factor supporting the wide recommendation of fluoxetine is its ability to be absorbed efficiently in the plasma in shorter time intervals compared to other antidepressants. Efficient absorption can be attributed to the fact that fluoxetine parent compound has an elimination half-life of between one to four days. The active metabolite of the drug, on the other hand, has considerably longer half-life of between seven and ten days thus can protect patients against noncompliance and the effects of withdrawal. This protection is attributed to the fact that fluoxetine is can remain in the body system for a considerable time compared to other antidepressants.
In several cases, depression patients tend to abruptly withdraw from medication resulting in extreme outcomes from withdrawal (Aiken & Phelps, 2017). Unlike other antidepressants, fluoxetine register reduced outcomes from withdrawal giving the drug a popular rating among other anti-depression drugs.
Some clinical drugs tend to inhibit the action of other drugs subsequently making them not compatible. Research has revealed that fluoxetine is highly interactive with other drugs and as such can be used with a wide variety of drugs. In comparison with other drugs that may be administered via intranasal, inhalation and sublingual methods, fluoxetine is administered orally making patients comfortable using it for medical purposes.
Side effects of fluoxetine
Studies carried out have revealed that fluoxetine has accompanying side effects that may be the desired effects or unwanted effects (Busch, Rudden & Shapiro, 2016). These side effects range from psychiatric, gastrointestinal, respiratory, metabolic and genitourinary effects in addition to headaches, asthenia, and insomnia which are most common. A couple of the side effects from fluoxetine intake do not necessarily warrant medical attention, but others need immediate medical care in cases of occurrence.
Fluoxetine just like many antidepressants to an extent contribute to patients undergoing a worsening phase of suicidal thinking and more depression especially in the early stages of medication. Research has shown that agitation, aggressiveness, panic attacks and hostility cases have been reported in young adults and adolescents with short-term use of fluoxetine therapy (Busch et al., 2016).
Side effects associated with fluoxetine in breathing are numerous. Rhinitis which is a nasal inflammation is the most common respiratory side effect related to fluoxetine (Olianas et al., 2017). Other respiratory system related effects are pharyngitis, yawning, asthma hyperventilation and hiccup.
Cases of decreased weight gain have been reported during fluoxetine therapy. Weight gain reduction can be attributed to decreased appetite which is an effect of antidepressants. In other patients, increase in appetite come along with the use of fluoxetine (Kieviet, 2016). There are instances where blood sugar levels in patients are reported and intolerance to alcohol.
Gastrointestinal side effects associated with fluoxetine are nausea, abdominal pains, diarrhoea, flatulence vomiting, and dyspepsia.
Most patients do not freely discuss genitourinary side effects given the stigma associated with them. However, patients under fluoxetine register decreased libido, abnormal ejaculation accompanied by erectile dysfunction.
When fluoxetine is administered to nursing mothers, it can have detectable effects in breastfed infants although such occurrences do not necessarily guarantee discontinuation of breastfeeding. Fussiness and drowsiness are some of the reported effects of fluoxetine in breastfeeding babies where the nursing mother is under therapy (Olianas et al., 2017).
Risks of discontinuing fluoxetine
As discussed earlier in this paper fluoxetine is popular in treating depression when compared to other antidepressants. The reason for the preference of fluoxetine has been indicated as having fewer withdrawal effects in comparison to other major depressant drugs. However, having reduced withdrawal effects does not qualify fluoxetine to be free of withdrawal side effects. In many instances, the associated withdrawal effects may not pose a significant medical risk.
According to (Kieviet, 2016), patients who withdraw from fluoxetine abruptly suffer from extreme weakness of muscle and energy deficiency commonly known as asthenia. In acute cases asthenia renders the body weak where muscle force exerted is less than what would be expected.
Dizziness is a feeling mostly affecting the sensory organs and causes lightheadedness and a feeling of imbalance. Depression patients who suddenly stop taking fluoxetine drugs may suffer from the dizziness.
The involuntary to-and-fro single or multiple muscle movement referred to as tremor is another effect of abrupt discontinuation of fluoxetine. Withdrawing patients suffer from tremor especially in the hands, head, voice and the legs.
Other adverse effects that may result from withdrawing from fluoxetine therapy are nervousness nausea and somnolence in patients (Kieviet, 2016).
The drug fluoxetine is a popular drug in the treatment of depression. Fluoxetine has been widely accepted and used in depression therapy to a great extent because of its efficiency and safety. In its action, the drug fluoxetine employs a mechanism that does not interfere with other chemical messengers. Studies have revealed that fluoxetine has adverse side effects when administered in spite of some effects being so mild that they do not warrant clinical examination. However, compared to other antidepressants fluoxetine is a better option given its chemical composition and efficacy.
In the postmodern world, instances of depression have been on the rise making depression a serious medical illness. It can be concluded that depression, as revealed by research, is not plainly a low mood but it has more in the offing than meets the eye. As a weighty mental health condition, depression has a huge effect on mental and physical health (Busch et al., 2016). It has a significant influence on how a person thinks feels and eventually acts. Depression can result in a myriad of problems with patients even attempting suicide if not well handled. Subsequently, it is crucial to treat depression at the slightest symptom. While treating depression, antidepressant drugs are used to mitigate the reduced feelings of happiness and well-being.
Aiken, C., & Phelps, J. (2017). Bipolar, not so much: Understanding your mood swings and depression.
Busch, F., Rudden, M., & Shapiro, T. (2016). Psychodynamic treatment of depression.
Giraldi, T. (2017). Unhappiness, Sadness and ‘Depression’: Antidepressants and the Mental Disorder Epidemic.
Jenkins, S. R. (2017). Antidepressants: Perspectives, medical uses, and health implications.
Kieviet, N. (2016). Neonatal symptoms after exposure to antidepressants in utero.
Olianas, M. C., Dedoni, S., & Onali, P. (2017). LPA1 is a key mediator of intracellular signalling and neuroprotection triggered by tetracyclic antidepressants in hippocampal neurons. (Journal of neurochemistry.