Bipolar Disorder Treatment Medications How Prozac (Fluoxetine) Is Used to Treat Bipolar Disorder By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on March 21, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Jonathan Nourok Collection / The Image Bank / Getty Images Table of Contents View All Table of Contents Use in Treating Anxiety Disorder Recommended Dosages Common Side Effects Drug Hypersensitivity Black Box Warning Withdrawal Symptoms Prozac (fluoxetine) is a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI), which is often used for the treatment of depression, bipolar disorder, and other mental illnesses. As useful as Prozac can be in treating these conditions, the drug may cause side effects ranging in severity from mild to life-threatening. Moreover, people who take Prozac may experience withdrawal symptoms if the treatment is not tapered off appropriately. Use in Treating Anxiety Disorder Prozac is commonly used to treat anxiety disorders, many of which can co-exist with bipolar disorder. These include generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and post-traumatic stress disorder (PTSD) In fact, a 2015 review of studies published in EBioMedicine concluded that the lifetime risk of an anxiety disorder co-occurring with bipolar disorder was 42.7%. Within the context of bipolar disorder, Prozac is considered the only antidepressant with a formal indication in treating bipolar depression but only when used in combination with the antipsychotic drug Zyprexa (olanzapine). Antidepressants need to be used with caution in bipolar disorder, as there is some evidence that they can trigger mania and worsen cycling of the disorder. On the downside, the concomitant use of Prozac and Zyprexa also increases the risk of side effects. Recommended Dosages There is a fixed-dose combination drug called Symbyax which combines Prozac and Zyprexa in a convenient capsule formulation. Approved for adults in 2009 and children in 2013, Symbyax is usually prescribed at a lower dose and gradually increased until the depression symptoms resolve. Ultimately, the aim of bipolar depression treatment is to alleviate symptoms at the lowest possible dose to reduce the risk of side effects. Common Side Effects Side effects are not uncommon when taking Prozac. Some are mild and transient and will often resolve as your body gradually adapts to the medication. Side effects of Prozac may include: Abdominal cramps and bloatingAbnormal dreamsAnxietyConstipationDiarrheaDizziness or lightheadednessDrowsinessDry mouthSexual side effectsHeadachesIncreased sweatingInsomniaLoss of appetiteLow libidoNausea and vomitingTremorsWeakness Call your doctor if any of these side effects persist or worsen. Drug Hypersensitivity Some adverse reactions to Prozac may be serious and require emergency medical treatment. This is especially true if there are signs of a potentially life-threatening allergic response known as anaphylaxis. Call 911 or seek immediate emergency care if you experience some or all of the following symptoms: Rash or hivesFeverFacial swellingSwelling of the tongue and/or throatTrouble breathingDifficulty swallowingDisorientation and confusionNausea and vomitingRapid heart rateFaintingA feeling of impending doom If left untreated, anaphylaxis can lead to shock, coma, respiratory or heart failure, and death. Black Box Warning Prozac and other antidepressants have been found to potentially increase suicidal thoughts or actions in some children, teenagers, or young adults. This usually occurs within the first few months of starting treatment or when the dose is changed. Call your doctor immediately if you notice any sudden or severe changes in mood, behavior, thoughts, or feelings. If your child is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Withdrawal Symptoms It is important to never stop taking Prozac without first speaking with your doctor and working out a dosage reduction plan. Stopping treatment abruptly can lead to a form of drug withdrawal known as SSRI discontinuation syndrome. While withdrawal is more common with shorter half-life antidepressants like Paxil (paroxetine) or Zoloft (sertraline), it can occasionally happen with the longer half-life Prozac, especially if you have been on treatment for a long time. SSRI withdrawal is rarely dangerous, but it can be extremely uncomfortable and distressing. Symptoms typically include: DizzinessExtreme anxietyFatigueHeadachesMalaiseNausea and vomitingProfuse sweatingVertigoHeadachesWeakness If the decision is made to stop Prozac, you would need to taper down slowly. Your doctor can provide specific instructions as well as the appropriate dosage pills. 6 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Nabavi B, Mitchell AJ, Nutt D. A Lifetime Prevalence of Comorbidity Between Bipolar Affective Disorder and Anxiety Disorders: A Meta-analysis of 52 Interview-based Studies of Psychiatric Population. EBioMedicine. 2015;2(10):1405-19. doi:10.1016/j.ebiom.2015.09.006 US Food & Drug Administration. Highlights of prescribing information: Symbax. US Food & Drug Administration. Medication Guide: Prozac. US National Library of Medicine. Fluoxetine. US Food & Drug Administration. Highlights of prescribing information: Prozac. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom. 2015;84(2):72-81. doi:10.1159/000370338 Additional Reading Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016;352:i65. doi:10.1136/bmj.i65 Silva MT, Zimmermann IR, Galvao TF, Pereira MG. Olanzapine plus fluoxetine for bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2013;146(3):310-8. doi:10.1016/j.jad.2012.11.001 By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! 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