Concerns About Side Effects of Antidepressants: A Patient's Dilemma

Q: Concerns About Side Effects of Antidepressants: A Patient's Dilemma

Hello, netizen： <br>1. <br>If taking Prozac causes emotional flatness or numbness, will it return to normal after stopping the medication? Is it possible that taking the medication changes me into a different person, and if I stop taking it, can I revert back? <br>A： Clinically,

Concern about the side effects of Prozac?

Dear Dr.
Wu,
I am the individual who previously consulted you (case number 174365).
As I mentioned last time, I have been suffering from obsessive-compulsive disorder (OCD) for seven years.
In the first couple of years, I regularly took 80 mg of Prozac (fluoxetine) and 5 mg of Ativan (lorazepam) daily.
As my symptoms improved significantly, I became very irregular with my medication (I have a strong aversion to taking medication).
Now, I usually take the medication only when I remember, but perhaps because of this, I occasionally experience some obsessive thoughts and worries.
I would like to ask you a few questions.
Recently, I read that Prozac may have potential side effects such as emotional blunting, possible violent behavior, and symptoms of hypomania or mania.
Upon reading this, I couldn't help but feel anxious and worried.
Will taking the medication make me emotionally numb, or lead to violent tendencies, or even cause me to develop bipolar disorder?
1.
If Prozac causes emotional flatness or numbness, will I return to normal after discontinuing the medication? Is there a possibility that I could change as a person due to the medication, and if I stop taking it, can I revert to my previous self?
2.
I have seen reports suggesting that Prozac can lead to violent tendencies, and some articles even listed several murderers who had taken Prozac or similar antidepressants before committing their crimes.
I understand that such articles may be somewhat biased or sensationalized, but I still can't help but worry that I might become like that.
Even though I have been taking Prozac for a long time, I have never harmed anyone, and I do not have violent inclinations.
I occasionally experience emotional fluctuations, but I believe that is normal, and my family does not think I am abnormal.
I hope this situation does not happen to me in the future; I just hope my obsessive thoughts are causing me to overthink.
3.
Regarding the occurrence of hypomanic or manic symptoms due to Prozac, how common is it? I am very concerned that I might be diagnosed with bipolar disorder after taking it.
I already have the "devil" of OCD in my mind, and I really do not want to add another mental illness to my struggles.
If it does occur, will I be able to return to normal after stopping the medication? If it is drug-induced, can it genuinely be diagnosed as bipolar disorder?
4.
Is it absolutely necessary to take medication for OCD? I have been on medication since I was 17, and now I am 25, which is a full eight years.
Is there really no other way besides medication? Am I destined to take medication for life? If my symptoms are manageable, can I choose not to take medication? Or is there another reason for taking medication besides preventing the worsening of OCD? Is it possible that not taking medication could lead to the development of other mental illnesses? I used to be very afraid that if I did not treat my OCD, I would eventually develop schizophrenia.
Taking medication makes me anxious about side effects, but not taking it also frightens me because I worry that OCD will return.
I feel very conflicted.
Although my dosage has decreased from the beginning to this year, my doctor still does not want me to stop taking the medication because, based on past experiences, stopping the medication leads to obsessive thoughts that affect me.
To be honest, I don't know what to do.
Additionally, my medication adherence has been sporadic, and I only take it when I feel uncomfortable.
Will this poor irregular medication behavior lead to long-term imbalances in neurotransmitters in my brain, potentially causing permanent damage or mental illness?
I sincerely apologize for the numerous questions.
I worry that you might find it bothersome, but these issues have been causing me significant distress and anxiety lately.
I kindly ask for your guidance.
Thank you for your patience in reading my questions, and I wish you peace and happiness.
Happy New Year!

Mr. Paul, 20~29 year old female. Ask Date: 2022/01/16

Dr. Wu Enliang reply Psychiatry

Hello, netizen:
1.
If taking Prozac causes emotional flatness or numbness, will it return to normal after stopping the medication? Is it possible that taking the medication changes me into a different person, and if I stop taking it, can I revert back?
A: Clinically, I have not encountered anyone with such issues, so you can rest assured.
Emotional stability can also be interpreted as emotional flatness or numbness.
In fact, the side effects that people complain about online are rarely experienced in reality, so please don't worry.
If such a problem does occur, it is reversible, and often switching to a different medication can help.
2.
I have seen reports that Prozac can cause violent tendencies, and some articles even list several murderers who had taken Prozac or similar antidepressants before committing their crimes.
I know these articles may be somewhat biased or sensationalized, but after reading them, I can't help but worry that I might become like that.
Even though I have been on Prozac for a long time and have never harmed anyone, I don't like violence.
I do experience emotional ups and downs occasionally, but I think normal people do too, and my family doesn't think I have any abnormalities.
I hope this situation won't happen to me in the future; I just hope my obsessive thoughts are making me overthink...

A: Yes, you will not develop violent tendencies.
3.
What is the incidence of mild mania or manic symptoms caused by Prozac? I am very worried that I might be diagnosed with bipolar disorder after taking it...
I already have the demon of OCD in my mind, and I really don't want to deal with another mental illness...
If it does occur, will I be able to return to normal after stopping the medication? If it is drug-induced, can it really be diagnosed as bipolar disorder?
A: Only individuals who already have bipolar disorder may experience mild mania or manic symptoms due to taking Prozac.
Since you have been taking it for so long without any issues, you don't need to worry.
4.
Is it absolutely necessary to take medication for OCD? I have been on medication since I was 17, and now I am 25, which is a full eight years.
Is there really no other way besides medication? Am I supposed to take medication for life...? If my symptoms are manageable, can I choose not to take medication? Or is there another reason for taking medication besides preventing the worsening of OCD? Is it possible that not taking medication could lead to the development of other mental illnesses? I used to be very afraid that if I didn't treat my OCD, I would eventually become schizophrenic...

A: It is not mandatory to take medication; you can also consider psychotherapy or behavioral therapy as alternatives, though they may require more time and money.
If OCD is not properly treated, it generally leads to depression rather than schizophrenia.
I understand your concerns about side effects from medication, but not taking it also raises fears of OCD returning...
It is indeed a contradiction...
Although my dosage has decreased over the past year, my doctor still does not want me to stop taking it because, based on past experiences, stopping the medication leads to intrusive thoughts that affect me...
So honestly, I don't know what to do.
Additionally, I have been inconsistent with my medication, only taking it when I feel unwell.
Will this irregular medication behavior cause long-term imbalances in neurotransmitters in my brain, leading to permanent damage or mental illness?
A: At most, it may worsen OCD symptoms, but it will not cause permanent damage or mental illness.
I still recommend discussing these issues further with your physician, as it will be more beneficial than seeking help online.

Dr.
Wu Enliang

Reply Date: 2022/01/16

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the side effects of your medication, particularly regarding your use of Prozac (Fluoxetine) for obsessive-compulsive disorder (OCD). It’s completely understandable to have worries about the potential side effects of any medication, especially when it comes to mental health treatments. Let’s address your concerns one by one.

1. Emotional Blunting and Discontinuation: It is possible for some individuals to experience emotional blunting or a sense of numbness while on antidepressants like Prozac. If you decide to discontinue the medication, many people find that their emotional range returns to normal over time. However, this can vary from person to person. It’s essential to work closely with your healthcare provider when considering stopping any medication, as they can guide you through a safe tapering process to minimize withdrawal symptoms and monitor your mental health.

2. Concerns About Violence: The fear of developing violent tendencies or becoming a different person due to medication is a common concern among patients. While there have been sensationalized reports linking antidepressants to violent behavior, it’s crucial to understand that these cases are rare and often involve complex factors beyond medication alone. If you have never exhibited violent behavior and your family does not perceive any concerning changes in your behavior, it is likely that your fears stem from anxiety rather than a genuine risk. Open communication with your doctor about these fears can help alleviate your anxiety.

3. Risk of Hypomania or Mania: The occurrence of hypomanic or manic symptoms while on Prozac is relatively low, especially if you do not have a history of bipolar disorder. However, if you notice any signs of increased energy, decreased need for sleep, or impulsive behavior, it’s essential to discuss these with your doctor immediately. If such symptoms arise and are attributed to the medication, your doctor may consider adjusting your treatment plan. Stopping the medication usually leads to a return to baseline mood, but this should be done under medical supervision.

4. Medication Necessity for OCD: It’s understandable to question the necessity of long-term medication for OCD. While many individuals benefit significantly from medication, therapy, particularly cognitive-behavioral therapy (CBT), is also an effective treatment for OCD. Some patients find that a combination of therapy and medication works best, while others may manage their symptoms effectively with therapy alone. If you feel that your symptoms are manageable without medication, discuss this with your healthcare provider. They can help you weigh the risks and benefits of continuing medication versus exploring therapy options.

5. Irregular Medication Use: Inconsistent medication adherence can lead to fluctuations in neurotransmitter levels, which may exacerbate symptoms. It’s crucial to establish a regular medication routine to maintain stability in your mental health. If you find it challenging to adhere to a schedule, consider discussing this with your doctor, who may suggest strategies or alternative treatments that can help.

In conclusion, your concerns are valid, and it’s essential to have open discussions with your healthcare provider about your fears and experiences. They can help tailor a treatment plan that addresses your OCD while considering your concerns about side effects. Remember, you are not alone in this journey, and there are various options available to help you manage your symptoms effectively.

Wishing you peace and clarity as you navigate your treatment.

Best regards.

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