It is far too common for doctors to prescribe medications to treat a symptom without deep consideration of how it will affect the person as a whole or their overall wellness. Further, they may not consider the repercussions to the patient if they need to change or stop those medications. Chief among these medications are the psychotropic medications often prescribed to address symptoms of mental health disorders like depression and anxiety. While most long-term medications require a thorough plan and a comprehensive support system to cease use, this is especially true of psychiatric medications that influence the brain’s chemistry.
One medication that is often prescribed without a full evaluation of its withdrawal potential is fluoxetine. Patients frequently experience the negative side effects of fluoxetine withdrawal, and many go without the guidance and supervision necessary to achieve a tapering dose instead of simply ending the prescription. Learn more about Fluoxetine and its side effects.
What Is Fluoxetine?
Fluoxetine is a type of medication that falls under the SSRI (selective serotonin reuptake inhibitor) umbrella. In medical literature, it is most often referred to as a psychotherapeutic agent. First introduced into clinical use as a treatment for depression in 1988, it has become one of the most widely-prescribed antidepressant medications in the world. It is available as a capsule, a delayed-release capsule, a tablet, and a solution to take orally.1
Brand names of fluoxetine that may be more familiar include:
What Does Fluoxetine Treat?
Though first introduced as a treatment for depression, it has since been approved by the FDA to address other conditions. The medication has also been prescribed for off-label purposes.
Fluoxetine is FDA-approved to treat:
Major depressive disorder (MDD)
Obsessive-compulsive disorder (OCD)
Panic disorder, with or without agoraphobia
Treatment-resistant depression, when combined with olanzapine
Depressive episodes of bipolar disorder, when combined with olanzapine
When marketed as Sarafem, formulations of fluoxetine are also FDA-approved to treat premenstrual dysphoric disorder (PMDD). It carries the same warnings, particularly suicide warnings, as fluoxetine and other SSRI medications.
Fluoxetine off-label uses include:
Borderline personality disorder
Body dysmorphic disorder
How Does Fluoxetine Work?
Serotonin is a chemical naturally produced within the brain and intestines. It is a neurotransmitter and transports messages between nerve cells within the brain and throughout the body. Once the serotonin has transmitted its neural response, it is reabsorbed into the body. It is thought to play a role in many physical and psychological functions, including mood, sleep, sexual desire, bone health, and wound healing.
Though the exact cause of depression is currently unknown, one theory is that an imbalance of neurotransmitters within the brain contributes to decreased mood, poor sleep, and other symptoms. Due to this theory, SSRIs like fluoxetine are frequently prescribed for depression and other mental health conditions because they prevent the body from reabsorbing serotonin. This allows higher levels of serotonin to circulate through the body.1
Because serotonin cannot pass through the blood-brain barrier, treatments for reduced serotonin levels must focus on increasing levels within the body instead of supplying serotonin supplements. However, elevated levels of serotonin within the blood may not directly correlate to elevated levels within the brain or may artificially elevate levels and cause more risk than benefit.
Since researchers cannot measure levels within the brain, it is currently impossible to know if fluoxetine can affect the brain. Some studies have even questioned how much of the effectiveness attributed to SSRIs like fluoxetine should instead be attributed to the placebo effect.2
Fluoxetine Side Effects
Though fluoxetine is prescribed to treat a psychiatric condition and alleviate the effects the patient experiences, the medication itself also has side effects that range from annoying to harmful. Some fluoxetine side effects will not need medical attention and should be expected to diminish over time. Others may persist the entire time the patient is taking the medications.1
Moderate Side Effects
Side effects that will typically not require medical attention unless they become too bothersome include (from most to least common):
Altered sense of taste
Changes in vision
Breast pain or enlargement
Redness or flushing of the skin
Increased menstrual pain
Stomach pain, cramps, or gas
Serious Side Effects
Alternatively, some side effects should be immediately discussed with your doctor if they arise. From most to least common, these include:
Inability to sit still
Itching, hives, or skin rash
Muscle or joint pain
Chills or fever
Lack of energy
Incomplete or unusual body or facial movements
These side effects are neither common nor uncommon — their incidence rates are unknown.
Continued vomiting or vomiting blood
Severe muscle stiffness
Peeling, blistering, or loosening of the skin
Though the above side effects are likely to arise shortly after beginning the medication, there are also long-term implications of taking SSRIs like fluoxetine. Research has shown that antidepressant users are at a 33% higher risk of death and a 14% higher risk of heart attack and stroke than non-users. Serotonin syndrome and addiction are also concerns for those taking fluoxetine.3
As some of the side effects can be particularly concerning, such as suicidal thoughts or feelings, you should quickly reach out to the prescribing doctor if you experience them. They will help you evaluate your symptoms and create a plan for managing them, alter your fluoxetine dose, or determine whether you should step down from the medication. Even if you are seeking therapeutic effects from fluoxetine, there may be a better option that does not cause as many deleterious side effects.
Fluoxetine has the potential to cause another serious side effect known as serotonin syndrome. Serotonin syndrome is a serious drug reaction caused by medications that increase the levels of serotonin in the body. Though serotonin is naturally produced within the body, too much can cause symptoms that range from mild to severe. Potential symptoms include:
Restlessness or agitation
High blood pressure or rapid heart rate
More serious symptoms that indicate severe serotonin syndrome include:
Serotonin syndrome is most frequently caused by combining medications that increase the levels of serotonin, such as SSRIs and migraine medications. More mild cases of serotonin syndrome can dissipate within a day or two of stopping the causative medication, but measures to block serotonin may be required.4 If you suspect you are experiencing serotonin syndrome, it is vital that you speak with a healthcare provider right away.
15 Years Experience by Professionals Who Understand Your Journey.
Fluoxetine is generally considered safe while trying to get pregnant and during pregnancy. Still, studies show some cause for concern.
If taking fluoxetine while attempting to get pregnant, there may be some issues with lower sexual desire for both men and women. Some men that are taking fluoxetine may also experience issues with ejaculation and lowered sperm quality. Though sperm quality is lower while on fluoxetine, it was still considered within a normal range.5 Fertility in women did not seem similarly impacted.
During pregnancy, research reveals concerns for the fetus. Fluoxetine has not shown any evidence of inducing miscarriages and is unlikely to increase the 3% to 5% background risk for birth defects. However, some studies have suggested an increased chance of cardiovascular defects, reducing oxygen delivery, increasing cortisol levels, and other complications to the unborn child. Fluoxetine passes the placenta and can also decrease uterine blood flow. These and other potential risks for pregnancy are currently in great need of further study.6,8
There have also been pregnancy-related complications tied to taking fluoxetine throughout the third trimester. There has been some evidence to suggest a higher chance for preterm delivery (delivery prior to 37 weeks of pregnancy) and a higher likelihood of the infant having a low birth weight, especially at higher doses of fluoxetine.
Once the child is born, they may also experience some symptoms of withdrawal, including tight muscles, difficulty breathing, tremors, unusual sleep patterns, being irritable, and/ or trouble eating. These symptoms appear to be more likely when fluoxetine is used throughout the third trimester or combined with other psychiatric medications during the pregnancy.
Some patients breastfeeding an infant while taking fluoxetine have reported vomiting, irritability, diarrhea, and reduced sleep in their babies. These instances are more likely to occur when the infant is less than two months of age. The product labels for fluoxetine recommend that those who breastfeed should not use the medication.7
Ultimately, while fluoxetine is considered one of the safest antidepressant prescriptions to take during pregnancy and breastfeeding, there are many complications that can arise. It is important to note, however, that untreated mental health symptoms can also pose potential pregnancy issues. It is critical to have a discussion with your doctor and your child’s pediatrician regarding alternative ways to address mental health symptoms so your pregnancy remains as medically sound as possible.
Is Fluoxetine Addictive?
It is important to note that addiction and dependency are not considered the same thing in the medical community, even if they may feel similar to those affected. There are certain criteria that define substance use disorder, characterized by continuing to take a substance despite any negative consequences. Defining criteria include:
A desire to cut back or quit but being unable to do so.
Spending an excessive amount of time and effort to acquire the substance.
Urges or cravings to use the substance.
For a person to be addicted to fluoxetine, they would need to experience negative consequences while taking fluoxetine instead of when they stopped taking it, as well as cravings. Those consequences must have a significant impact on day-to-day life. This lack of addictive properties is the reason why fluoxetine and other SSRIs are not controlled substances and are not considered addictive in the traditional sense.
However, this does not mean that people cannot develop a dependency on fluoxetine. This dependency occurs when the body and brain become accustomed to functioning in the presence of the drug and cannot return to normal function without it. Withdrawal effects are the main driver in drug dependency. This dependency is more likely to arise when fluoxetine has been taken long-term, but can also occur in the short term.
Common fluoxetine withdrawal symptoms include:
Electric shock sensations
Emotional lability, crying spells, irritation, rage, and agitation
Because fluoxetine has a long half-life, withdrawal symptoms may not arise until days or even potentially weeks after the medication is stopped. If fluoxetine was combined with other medications, the half-life could be extended even further. It is not generally recommended to stop taking fluoxetine abruptly, as it can exacerbate the severity of withdrawal symptoms, as compared to gradually tapering off the dose.
Unfortunately, the risks of fluoxetine addiction and dependency were not studied before its approval. In fact, it has yet to be a priority, even as the number of prescriptions rises. 30-plus years later, the label states no studies have been done on fluoxetine dependency as a potential outcome of using the medication.
Because fluoxetine may cause dependency, the best way to avoid these negative side effects is to find alternatives to long-term antidepressant therapy when possible. There are safe and holistic methods that can provide relief as effectively, if not more so, than fluoxetine. Some of these methods include:
Meditation and mindfulness
Test for nutritional deficiencies
Correct the diet
Supplements to restore a healthy gut microbiome
Though these methods can be effective, they are best approached with professional guidance and competent oversight. GPs are generally untrained in nutrition. If you plan to treat your symptoms with methods other than fluoxetine, you should speak with a doctor that specializes in complementary, integrative, holistic, or alternative medicine.
Long-Term Recovery With ATMC
Whether your goal is tapering off an existing fluoxetine prescription or looking for a solution before attempting an SSRI, Alternative To Meds Center can help you on your journey. With a skilled medical team in place and decades of experience supporting patients as they titrate off medications, we can help you avoid complications throughout the process.
Our alternative mental health and addiction treatment in Arizona is combined with a welcoming, therapeutic environment in order to support a transition to a symptom-free and healthier life. We will formulate a unique plan that focuses on whole-body wellness, as being successful in your path requires more than simply detoxing from fluoxetine.
1. Edinoff, A. N., Akuly, H. A., Hanna, T. A., Ochoa, C. O., Patti, S. J., Ghaffar, Y. A., Kaye, A. D., et al. (2021). Selective Serotonin Reuptake Inhibitors and Adverse Effects: A Narrative Review. Neurology International, 13(3), 387–401. MDPI AG. Retrieved from http://dx.doi.org/10.3390/neurolint13030038
2. Khan, A., & Brown, W. A. (2015). Antidepressants versus placebo in major depression: an overview. World psychiatry : official journal of the World Psychiatric Association (WPA), 14(3), 294–300. https://doi.org/10.1002/wps.20241
3. Maslej, M. M., Bolker, B. M., Russell, M. J., Eaton, K., Durisko, Z., Hollon, S. D., Swanson, G. M., Thomson, J. A., Jr, Mulsant, B. H., & Andrews, P. W. (2017). The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis. Psychotherapy and psychosomatics, 86(5), 268–282. https://doi.org/10.1159/000477940
6. Gao, S. Y., Wu, Q. J., Zhang, T. N., Shen, Z. Q., Liu, C. X., Xu, X., Ji, C., & Zhao, Y. H. (2017). Fluoxetine and congenital malformations: a systematic review and meta-analysis of cohort studies. British journal of clinical pharmacology, 83(10), 2134–2147. https://doi.org/10.1111/bcp.13321
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.
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