HOW IS PROZAC USUALLY GIVEN?

Most psychopharmacologists start patients on small doses of Prozac, anywhere from 10 to 20 mg per day. If a patient has not responded after two to four weeks, dosage may be increased to 40 mg and eventually even as much as 80 mg a day. Patients must be closely monitored on a weekly basis by a depression expert or psychopharmacologist who knows when to increase the drug and when to decrease or discontinue it if side effects become too disturbing.

Although a number of studies have shown that the depressed mood may begin to lift in a week, it generally takes at least two to three weeks for the patient and family to notice a real difference. The low mood may continue to lift for five to eight weeks before leveling off. In 65% to 70% of cases, the depression recedes within four to eight weeks. A patient should take a full dose of Prozac, under the supervision of an expert physician, for at least six weeks before concluding that the drug has failed to act on the depressive illness.

Occasionally people may claim to experience immediate relief. Although psychiatrists generally say this is the placebo effect, no psychopharmacologist can rule out the possibility that a given patient’s metabolism may in rare instances react to the drug immediately, causing rapid changes in mood and behavior within one or two days.

Is it justified to give Prozac to patients who are not suffering from an identifiable psychiatric illness but who have one or two symptoms? Symptoms such as low self-esteem, sadness, sluggishness, or chronic discouragement may not add up to full-blown depression or dysthymia but can be considered symptoms of subclinical or subsyndromal depression, which is about to become a new diagnostic entity. In previous years, subclinical depression hadn’t been identified as a formal DSM disorder. Instead, psychiatrists and analysts diagnosed a personality or character disorder and concentrated in therapy on self-defeating personality traits and defense mechanisms rather than mood. (Cognitive therapy is the only exception.) Today, subclinical depression is recognized as a disorder that can be responsive to medication. Therefore, many psychiatrists treating these patients now use Prozac along with psychotherapy or instead of it if the therapy alone has not worked.

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