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Prozac: Long Term Use of SSRIs

Daniel Becker

Daniel Becker, M.D.

Mills-Peninsula Medical Group

Mills-Peninsula Physician HMO Network

Question:

What are your thoughts on the long-term use of SSRIs like Prozac? I have OCD and think I'll probably need it for the rest of my life.

Answer:

Obsessive-compulsive disorder (OCD) is an anxiety disorder that typically begins early in life - and which, for most afflicted individuals, has a chronic fluctuating course. Exacerbations of this disorder are often related to stress. The syndrome is characterized by persistent and unwanted intrusive thoughts (obsessions) and/or repetitive behaviors (compulsions), that cause distress to the individual and interfere with normal social and occupational functioning. Because of this distress and dysfunction, those affected by OCD are encouraged to seek psychiatric evaluation and appropriate treatment. Selective serotonin reuptake inhibitor (SSRI) medications, such as Prozac, are among the most effective treatment approaches. Although some individuals may find that - under their physician's guidance - they can reduce or discontinue medication over time, the chronic nature of OCD often requires that patients continue to take medication for prolonged periods.

All medications have the potential to cause side effects or adverse effects. Although the therapeutic effects of SSRI medication often take several weeks to manifest themselves, side effects (such as sleep difficulties or gastrointestinal symptoms) typically occur early and improve during the first several weeks of treatment. The majority of patients who take SSRI medication do not experience significant side effects. Nonetheless, some patients who take this medication for prolonged periods will experience adverse effects (such as weight gain, sleep disturbance, fatigue, or sexual dysfunction). When one medication in the SSRI class is ineffective or results in intolerable side effects, another SSRI medication may prove more effective or more tolerable.

The decision to use, or to continue to use, any medication rests on a risk-benefit analysis. If you and your physician are convinced that your medication is reducing or preventing your symptoms, and if you are experiencing no or few side effects, then it is likely that your physician will recommend your continuing this medication. This may be especially so in the case of OCD, where - as noted above - considerable distress or dysfunction may result from the untreated illness. That being said, you and your physician should periodically reevaluate this risk-benefit ratio.

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