Fluoxetine (Prozac) versus Other
Fluoxetine (Prozac) appears to be the weakest of the SSRIs. Due to
it's very long half-life and relatively weak potency as a serotonin
inhibitor it has less prominent discotinuation symptoms than many other
Fluoxetine uniqe features led to that Prozac is the only SSRI approved
by the FDA for use in children 8 years of age and older.
Fluoxetine (Prozac) vs. Citalopram (Celexa)
- Major depressive disorder: Citalopram is as effective as fluoxetine
in the treatment of unipolar major depression. In the study citalopram
showed an earlier onset of recovery than fluoxetine 12.
- Bulimia nervosa: In the study patients treated with fluoxetine
displayed a greater reduction in introjected anger, whereas those
treated with citalopram displayed a greater reduction in depressive
feelings. Citalopram may be useful in depressed patients with bulimia,
whereas fluoxetine is more specific for those with introjected anger
and bulimia 13.
Fluoxetine (Prozac) vs. Paroxetine (Paxil)
Major depressive disorder: Paroxetine has comparable efficacy
to fluoxetine in the treatment of depression in elderly. However,
as indicated results of the clinical study, paroxetine has a significantly
higher response rate than fluoxetine. Paroxetine appears to produce
earlier antidepressant effect 22,
- Side effects: Constipation, dyspepsia, tremor, sweating
and abnormal ejaculation are more common with paroxetine, whereas
nausea and nervousness are more frequent with fluoxetine. Weight loss
is more common with fluoxetine 23.
- Withdrawal symptoms: Discontinuation of paroxetine
is more often associated with somatic and psychological symptoms than
discontinuation of fluoxetine. Patients treated with fluoxetine appear
to be protected by its longer half-life 1.
Fluoxetine (Prozac) vs. Sertraline (Zoloft)
- Major depression. Sertraline and fluoxetine have comparable
antidepressant efficacy in the treatment of Major depression. However,
sertraline has advantages over fluoxetine in those patients with severe
depression and low anxiety in the melancholia 17,
- Obsessive-compulsive disorder. Both medications have significant
efficacy in the treatment of moderate to severe OCD. However, patients
treated with sertraline have a greater likelihood of remission as
well as an earlier improvement 20.
- Tolerability: Sertraline is considered to be better
tolerated than fluoxetine 19.
- Side effects: Sertraline has advantages over fluoxetine
on parameters such as sleep and weight disturbance in severely depressed
patients, and sleep disturbance, weight, cognitive disturbance and
retardation in melancholic patients 18.
Fluoxetine treatment is associated with a higher incidence of agitation,
anxiety and insomnia than sertraline 19.
- Withdrawal syndrome: Fluoxetine has fewer discontinuation-emergent
events than sertraline 21.
Fluoxetine (Prozac) vs. Venlafaxine (Effexor)
Major depressive disorder: Venlafaxine appears to be superior
to fluoxetine and prodeces higher rate of remission in the treatment
for depression 24. Venlafaxine's
superior remission rates in the more severely anxious patients and
its ability to improve psychic anxiety compared with fluoxetine suggest
that venlafaxine's early efficacy on anxiety symptoms may be the basis
for its superior efficacy in depression 25.
Fluoxetine (Prozac) vs. Bupropion (Wellbutrin)
- Depression: Bupropion SR and fluoxetine are similarly effective
and well tolerated in the treatment of depression. There were no statistically
significant differences between both medications on any of the efficacy
variables 15, 16.
- Premenstrual dysphoric disorder: Fluoxetine is significantly
superior to bupropion in the treatment of premenstrual dysphoric disorder
- Side effects: Fluoxetine is more frequently associated
with sexual dysfunction compared with bupropion SR. Bupropion SR may
be an appropriate initial choice for the treatment of depression in
patients concerned about sexual functioning 15.
Fluoxetine (Prozac) vs. Amitriptyline (Elavil)
- Major depressive disorder: Both are effective in
relieving the symptoms of depression 5.
Recent memory can be improved significantly with the fluoxetine
- Anxious depression: Fluoxetine and amitriptyline have comparable
efficacy in the treatment of major depression with associated anxiety
- Fibromyalgia: Fluoxetine and amitriptyline are similarly
effective treatments for FM, and they work better in combination
than either medication alone 2.
- Musculo-skeletal pain: In the study moderate or good pain
relief was reported by 82% patients with amitriptyline, and by 77%
patients with fluoxetine. Fluoxetine relieved low back pain and
whiplash associated cervical pain with efficacy similar to that
of amitriptyline 4.
- Migraine headache: Amitriptyline appears to be more effective
than fluoxetine for migraine headache prophylaxis 9.
- Side effects: Adverse effects are more frequent and
more severe with the amitriptyline 3.
The most frequent side effects with fluoxetine are nausea, nervousness,
sleep disturbances, and headaches; and dry mouth, dizziness, and drowsiness
with amitriptyline 5, 6,
8. Weight gain is associated more with
Fluoxetine (Prozac) vs. Mirtazapine (Remeron)
Major depressive disorder: Mirtazapine is significantly more
effective than fluoxetine after 3 and 4 weeks of treatment
in moderate to severe major depressive disorder 10,
- Side effects: Tolerability profiles are comparable except for changes in body weight.
Mirtazapine is associated with significantly more pronounced body
weight gain compared to the fluoxetine. In the study mirtazapine
was associared with a mean weight gain of 0.8 +/- 2.7 kg, whereas
fluoxetine was associated with a mean decrease in weight of 0.4 +/-
2.1 kg 10, 11.
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Published: March 31, 2008
Last updated: May 29, 2011