Fluoxetine, often known as Prozac, may not be the right choice for everyone. In such cases, patients can discuss Prozac alternatives with their medical providers. These alternatives may be other drugs within the same class as Prozac (selective serotonin reuptake inhibitors, or SSRIs) or they may belong to a different drug class altogether.
Alternatives to Prozac
When it comes to alternatives to Prozac, what are your options?
Prozac is a common go-to drug for treating anxiety since many people tolerate it well. That said, not everyone tolerates this medication well. In such cases, medical providers may suggest another SSRI like Zoloft (sertraline), an adjunct treatment like Wellbutrin (bupropion), or even a medication from another drug class, such as Effexor XR (venlafaxine), a serotonin-norepinephrine reuptake inhibitor (SNRI).
For more information, please visit our page on Prozac for anxiety.
Treatment for OCD usually combines both medication and specific forms of therapy, such as cognitive behavioral therapy (CBT). When Prozac is not effective for OCD, other medications may help. Other SSRIs that may help treat this condition include Zoloft (sertraline) and Lexapro (escitalopram). SSRIs primarily affect the neurotransmitter serotonin, which may not be effective for some patients.
In these cases, SNRIs may be considered; this drug class affects both serotonin and norepinephrine (noradrenaline). Venlafaxine (Effexor XR) and duloxetine (Cymbalta) are two SNRIs that evidence suggests can be effective in the treatment of OCD. Like SNRIs, tricyclic antidepressants (TCAs) can also affect levels of serotonin and/or norepinephrine in the brain. One TCA, clomipramine (Anafranil), has shown efficacy in OCD treatment.
For Weight Loss
Modest weight loss is reported for some patients taking Prozac. Although, experts believe this fact is an indirect side effect of improvement in depression and other conditions that may have led to weight gain, rather than a direct effect of fluoxetine itself.
Other people gain weight with Prozac. Anyone experiencing drastic changes to their weight—either gaining or losing weight—should talk to their healthcare provider about alternative treatments. These treatments could include other SSRIs like Zoloft or a drug from another class, such as Effexor XR.
For more information, please visit our page on Prozac weight gain.
The FDA does not have data evaluating the effectiveness and safety of Prozac use in treating OCD in patients under 7 and depression in patients under 8. Guardians of patients under these ages should talk to their medical provider for alternatives.
If a child does not tolerate fluoxetine well, sertraline (Zoloft) or fluvoxamine (Luvox) may work instead when treating OCD. Guardians should note that medications are only half of the treatment equation; therapy is the other. Children with OCD benefit especially from CBT, which helps children learn new coping strategies for dealing with this condition.
Research shows that TCAs are not effective in treating depression in children and adolescents. Instead, therapy and a medication like citalopram (Celexa) may help.
For Bipolar Disorder
Prozac alone is not indicated for the treatment of bipolar I disorder. Instead, it is used in combination with Zyprexa (olanzapine). That said, Prozac is not typically used in the treatment of bipolar I disorder; rather, mood stabilizers and atypical antipsychotics are often the first line of treatment. Mood stabilizers include lithium (Lithobid) while second-generation antipsychotics include aripiprazole (Abilify). These treatments are often paired with talk therapy, otherwise known as psychotherapy.
For Sleep Problems and Insomnia
When treating insomnia or other sleep-related problems, medical providers may opt for a class of medications known as sedative-hypnotics. Two popular drugs in this class include Lunesta (eszopiclone) and Ambien (zolpidem).
Some research suggests that fluoxetine and other SSRIs may be an alternative treatment for chronic pain, although more studies are needed to confirm its efficacy. Further, evidence so far does not suggest that SSRIs are effective in treating nerve pain.
Common treatments for pain include the following:
- For Back Pain – prescription-only non-steroidal anti-inflammatory drugs (NSAIDs) like celecoxib (Celebrex)
- For Neck Pain – over-the-counter (OTC) NSAIDs like acetaminophen (Tylenol) or finding a better pillow to sleep with at night
- For Neuropathic Pain (Peripheral Neuropathy) – an opioid like tramadol (ConZip, Ultram) or an SNRI like duloxetine (Cymbalta)
Which treatment works best depends on the individual patients, the type of pain they experience, and what causes their pain.
Adolescent treatment of OCD can include antidepressants like fluoxetine (Prozac) and sertraline (Zoloft) as well as a special kind of CBT known as exposure and response prevention (ERP). Depression treatment for this group also typically includes both SSRIs and some form of therapy. It’s important for guardians of children and adolescents to know that there is an increased risk of suicidal thoughts and behavior for these groups when taking SSRIs. As such, guardians need to be especially vigilant when their children and adolescents are taking this class of medications.
For patients who find that their depression is resistant to Prozac, there is good news: there are plenty of alternative treatments for this condition. Other medications that may help include other SSRIs like Zoloft (sertraline), SNRIs like Effexor XR (venlafaxine), antipsychotics like quetiapine (Seroquel XR), and anxiolytics like alprazolam (Xanax).
Beyond medications, patients can also explore therapies like CBT, psychotherapy, and behavior therapy. In some cases, medical procedures like electroconvulsive therapy may help.
For Bulimia Nervosa
Bulimia nervosa is the clinical term for bulimia, a condition where someone binges food. This binge period can be followed by a purging period, where someone attempts to avoid weight gain through methods like induced vomiting, although purging is not necessary for a bulimia diagnosis.
Treatment for bulimia and other eating disorders typically involves a multi-pronged approach; in other words, it typically involves more than just medication. Treatment for eating disorders can include nutrition education, physical exercise, and counseling. When medications are involved, they are typically SSRIs, specifically fluoxetine, the only currently FDA-approved SSRI for treating bulimia nervosa. That said, medical providers still sometimes prescribe SSRIs for binge-eating disorders, including paroxetine (Paxil) and sertraline (Zoloft).
For Dogs and Cats
The FDA has approved the use of fluoxetine in dogs for separation anxiety. That said, sometimes veterinarians prescribe fluoxetine and other SSRIs, such as sertraline, to both dogs and cats for other off-label uses.
For more information, please visit our page on Prozac for dogs and cats.