# Prozac as needed - Is this normal?



## Freckles (Jan 10, 2010)

I've been trying to get a referal to a therapist however, I am expecting and since I am under the care of my OB mostly they seem hesitant to send me to someone. Mostly I think this may be because my insurance doesn't cover this kind of treatment. (I am trying to find someone on my own and see what I can do to get in for treatment. I have severe anxiety and find myself obsessing about my spouse and questioning him relentlessly.)

So in the meantime, they keep trying me on different anxiety medications. I tried Celexa which made me have some odd thoughts like rage and I really felt just restless. Like I might possibly hurt someone I loved. Don't know why that happened but that ONLY happened on the medication. I just told the OB that it made me feel loopy. I didn't tell them the entire extent of it - guess I should have but they treat you like you are a nut of sorts when you're at the ob and you're talking about this kind of stuff. 

Long story short, sorry for the longwinded-ness of the above . . . she gave me something generic for prozac. It's 10 mg and she said that I could take it "as needed". In other words, it's a pill I don't have to take everyday. But I read up online and most sites say you should take it everyday at the same time.

So my question is, can you take prozac as needed? After the scary response to the first medication I'm a bit anxious about trying this in the first place and I really don't want to start out on the wrong foot when I DO start taking it.

:thankyou2:


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## Retired (Jan 10, 2010)

Just for clarification, by OB do you mean your obstetrician?

And to be sure I understood correctly, was it your obstetrician who prescribed _fluoxetine, prn_, in other words a generic version of Prozac to be taken as needed.  Does the prescription actually say, fluoxetine, PRN?

Your doctor may have her reasons for doing so, and I would consult with the pharmacist who mightcall the doctor to verify that this is indeed what was meant.

I am not familiar with SSRI's being prescribed "as needed" because my understanding of their mechanism of action requires a build up in the bloodstream, n order to affect the levels of neurotransmitters in the brain.

We are more accustomed to seeing short acting minor tranquilizers such as lorazepam to be prescribed PRN or as needed.

For your own satisfaction, you might want to get clarification from your doctor and or pharmacist.

Others may have more information on this question that I am not aware of.


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## Freckles (Jan 10, 2010)

Thank you for your response and for taking the time to answer so in depth.

Yes. This was prescribed by my obstetrician. And the bottle reads "fluoxetine 10 mg". I don't see a "prn" on there though.

Thanks again!


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## David Baxter PhD (Jan 10, 2010)

"PRN" simply means "take as required".


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## forgetmenot (Jan 10, 2010)

I too think it is important to get back to you obstetrician to clarify the dosage that is to be taken. Again you said you are expecting so it is so necessary to be careful when taking any medication.  Your obstetrician will be the one that knows what medication is safe and the amount to take get a clear answer on how much of this to take and when okay


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## Freckles (Jan 10, 2010)

Thanks, Violet. I'll be sure to check with my OB before I start taking the medication. I think this may be one reason they have treaded so lightly on the subject of therapy. I will be breastfeeding once the baby arrives, which is only a few weeks away, and I'm sure that they are thinking of what medication may affect the little one.

Hopefully, however, I will be able to find a good therapist on my own. If I can't take certain medications at least I will be able to have someone that can coach me through this. I've actually seldom told anyone about the problems that I have and I think it would be very healing and helpful to talk with someone who knows all about these things. I am a Christian writer and am in the public eye so I often keep this to myself as there tends to be some stigmata that comes with it. I'm confident though that someday I'll be able to look back on this and write about it when I am able to gain a hold on this situation and begin to learn to cope better.

Thanks again everyone!


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## forgetmenot (Jan 10, 2010)

I think you are correct in getting some form of therapy for you as it will  help you immensly especially now with a little one on the way.  The stigma today is not as it once was with mental illness as many people suffer from it and need help.  Talk with your GP and get him or her to get you a good psychologist okay as it does help take care.


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## Retired (Jan 10, 2010)

Some of the most credible resources I found discussing depression and pregnancy, with emphasis on antidepressants in pregnancy can be found among the folowing:

Antidepressants: Safe during pregnancy? - MayoClinic.com  where specific medications are listed including fluoxetine.

Are antidepressants safe during pregnancy? - Harvard Health Publications

ACOG Issues Opinion on SSRI Antidepressant Use During Pregnancy

Excerpt from the ACOG statement:

The potential risk of SSRIs during pregnancy must be weighed against the risk of depression relapse if the medication is discontinued. Untreated depression has its own risks, including low weight gain, alcohol and substance abuse, and sexually transmitted diseases, all of which have negative maternal and fetal health implications. Fetal echocardiography should be considered for women who were exposed to Paxil? in early pregnancy. 



> ACOG's Committee on Obstetric Practice emphasizes that decisions about depression treatment should involve the obstetrician and the mental health clinician, along with the patient, ideally prior to pregnancy. However, because approximately 50% of pregnancies are unplanned, preconception planning for women with depression will not always be feasible, and treatment decisions about SSRIs will undoubtedly occur during pregnancy.



Safety of Newer Antidepressants in Pregnancy  Medscape Article, Posted: 05/09/2007

The Medscape is technical, providing an overview of studies examining SSRI's in pregnancy.  Although the mechanism of action is similar, the chemical structures of each of the compounds is different.  Fluoxetine has the most evidence, suggesting its use might be of benefit when used in pregnancy, but should be a decision made in consultation with the mother, the obstetrician and the mental health specialist to evaluate the benefits and risks in each case.


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