Fluoxetine Side Effects

Question:

«Good morning, my question is the following:

This is a person who has a mixed adjustment disorder for that he has been given Fluoxetine in the morning (in addition to Bromazepam
2-1-2 and Lormetazepam at night). Until now it seemed that the Fluoxetine had no effect on him, but just today (in week 4) he has managed to sleep better, he is calmer, but dizzy and with motor coordination problems and mental slowness. Is it normal or is it worrying? It is also advisable to lower the dose of the benzodiazepines (takes a little over a month)».

Answer:

First of all, thank you so much for your detailed description of the situation and I’m so sorry your friend feels this way. My advice around here should not be a substitute for following up with your regular psychiatrist, because I don’t know enough about you and your circumstances to give you personalized recommendations.

It is important to know, that antidepressants, such as Fluoxetina, usually take four to six weeks to have an effect. We don’t exactly know why that is the case, but it has to do with the genetic expression of the serotonin transporter and receptor. It takes a while before the suppression of the gene influences the serotonin in the brain.

People suffering from depression are short on that chemical messenger called serotonin. The most popular type of antidepressant (the SSRI) blocks serotonin from reabsorbing into brain cells, leaving more of it flowing around. Its job is to boost your mood.

In patients with severe anxiety, we sometimes cover this transition period (before the antidepressant works at its full effect) with benzodiazepines, such as the Bromazepam. The advantage is that it acts fast and reduces anxiety in the short term. This generally allows the patients to adhere better to the treatment and to cope better with the anxiety. Since Benzodiazepines cause dependence, it is only used as a short-term solution and monitored strictly by the physician.

In your case, it would be important to know the dosage of the Bromazepam that you are taking. But you are right, I would recommend that you slowly decrease the Bromazepam. It could be the source of the nausea and incoordination. Depending on when your anxiety is highest, but since you say that the person is starting to sleep better, the decreasing plan could start by only taking one tablet of Bromazepam at night, meaning 2-1-1. This step should last at least ten days before considering decreasing the medication further. Then I would recommend only taking one in the morning, 1-1-1. The rest should be discussed and adapted with your physician according to your well-being and health status.

Here is a short explanation of the Bromazepam:

• It belongs to a group that is called Benzodiazepines and is an intermediate-acting benzodiazepine. This means that the peak plasma levels of Bromazepam are reached between 0.5 – 4 hours and may be maintained for up to 12 hours.
  Bromazepam, administered at low doses, relieves psychic tension, anxiety and nervousness. At higher doses it has a sedative and muscle relaxant effect.
• In most cases only a short-term treatment with Bromazepam is necessary (in general it should not exceed four weeks).
• Restlessness, anxiety, insomnia, lack of concentration, headache and hot flushes may occur after cessation of administration, especially if you have been taking it for a long time. In general, it is not recommended to stop the medication abruptly, but to reduce the dose gradually, according to the doctor’s instructions.
• Drowsiness, dizziness, headache, ataxia are among its most frequent side effects.
• Prolonged use of bromazepam can cause tolerance and may lead to both physical and psychological dependence. That is the reason we are very careful with the prescription and monitor the dosage carefully.
• It is important to know that you should not consume alcohol since doing so can reduce the effectiveness of this medication and increase the risk of side effects.

I hope that this information is helpful to you and that your friend will feel better soon.

Sources:

* https://cima.aemps.es/cima/dochtml/p/79661/Prospecto_79661.html
* Baudry A, Mouillet-Richard S, Schneider B, Launay JM, & Kellermann O (2010). miR-16 targets the serotonin transporter: a new facet for adaptive responses to antidepressants. Science (New York, N.Y.), 329 (5998), 1537-41 PMID: 20847275
* https://www.medbroadcast.com/drug/getdrug/bromazepam