Common and Rare Long-Term Effects of Prozac
SSRIs are typically prescribed long-term for months and years. The most commonly reported adverse effects of Prozac therapy come from short-term studies. Prozac has an activating effect that typically manifests within the first few weeks. These initial newly emerging effects can be more immediate. Some examples include suicidal thoughts and behavior, rashes, panic attacks, anxiety, agitation, insomnia, mood fluctuations, and some paradoxical reactions, which are quite prone to being misdiagnosed as a bipolar condition.8 However, the long-term effects of Prozac linger well beyond the first few days or weeks of treatment. A list below shows examples, followed by a more expanded description.
Long-term effects of Prozac can include:
- Lengthened half-life elimination due to liver toxicity
- Growth attenuation
- Sexual dysfunction
- Changes to weight
- Risks in pregnancy
- Impaired quality of life
- Tolerance, original symptoms re-emerge
Lengthened half-life elimination: Drug-induced liver damage can occur as soon as 2 to 12 weeks of treatment, or over a longer period. Liver toxicity lengthens the elimination window. Prozac already has the longest half-life of all SSRIs currently on the market. Hepatitis and acute liver failure are possible outcomes without intervention. While positively identified, the mechanism by which Prozac causes liver damage is unknown.9
Growth attenuation: While the exact mechanism has not been established, retardation of growth is associated with long-term Prozac use, as well as other SSRIs. It is thought that suppression of growth hormones during SSRI therapy has some connection, due to the fact that secretion of growth hormones may normalize after stopping drug therapy.10
Sexual dysfunction: Sexual dysfunction is the most prevalent reason people decide to stop SSRI therapy. Inability to reach orgasm, loss of interest in sex, and erectile dysfunction are all common manifestations. These symptoms typically normalize after the drug is stopped. In cases of priapism (painful sustained erection) taking short “drug holidays” has become the usual “treatment,” although sometimes surgery is necessary to avoid permanent damage, especially in children.11,15,17,18
Changes to weight: Weight gain or weight loss is commonly reported with long-term antidepressant use. Prozac is more commonly associated with weight loss. Increases and decreases in body temperature and energy expenditure while at rest, as well as changes to appetite, are the suggested causes of weight fluctuations, according to clinical research.12,13
Risks in pregnancy: Heart defects are associated with infants born to mothers taking Prozac past the 20th week of pregnancy. Prenatal exposure to SSRIs increases the likelihood of symptoms of autism. Preeclampsia (life-threatening multi-organ failure) in the near-term mother is associated with taking Prozac during pregnancy.8,14
Impaired quality of life: Whether from developing low-sodium, organ damage, cognitive decline, brain fog, apathy, mood dysregulation, loss of emotional responsiveness, altered gene expressions, or other lingering effects, the quality of one’s life can decline as a result of long-term antidepressant use.16
Tolerance: After any drug is used for a long time, the body/brain/CNS will develop tolerance. Tolerance happens after neuroadaptive changes, that cause the drug to become ineffective. Even after a decade of taking Prozac, the drug may suddenly stop working as it once did and the original symptoms are not able to be masked anymore. This is often called “relapse” and is typically a point where a prescriber will increase the dose or add additional medications to continue suppressing problematic symptoms. This practice, though common, ultimately leads to worsening health conditions.21,22