Dr. Bob's Psychopharmacology Tips

Weekly fluoxetine

Date: Wed, 23 Aug 1995 22:47:49 -0700 (PDT)
From: Rafael Gray <rafael@itsa.ucsf.EDU>
Subject: Weekly fluoxetine

In the Aug 1995 Clin Psych News (p. 1) was a brief article from the New Clinical Drug Evaluation Unit meeting with no references.

Summary: "Research 10 years ago" found fluoxetine 80 mg weekly was as effective as fluoxetine 60 mg or amitriptyline 150 mg daily for acute depression. Although fluoxetine levels were "low" in weekly dosing, norfluoxetine levels were equivalent in those with good clinical response.

William Burke et al., Creighton/U Nebraska, Omaha, NE, now report a study with 32 pts who "responded favorably" to 20 mg fluoxetine for 8 wks with HAM-D falling to < 12. They were then randomly assigned to double-blind groups. The treatment arms were: placebo, fluoxetine 20/d, fluoxetine 60/wk. At 4 wks there was little group difference. At 11 wks those in the two fluoxetine groups had "nearly significant" advantage in depression score. Although depression scores rose in all groups [no speculation as to why in the article] the increase was greatest in placebo (9 points vs 2-3 points in fluoxetine). "Further research is required." Estimated cost savings: $400/yr with possible enhanced compliance.

Date: Sat, 26 Aug 1995 00:47:30 -0500 (CDT)
From: "Mtro. Alejandro Ibarra" <aibarra@leo.uacj.mx>
Subject: Weekly fluoxetine

I have used it twice a week for dysthimia, with good results, but I have never used it once or twice a week for acute major depresion or to begin a tx.

In spanish: Lo he usado para distimias 2 veces por semana con buenos resultados, nunca lo he usado en una depresion mayor severa o para iniciar un tratamiento una o dos veces por semana.

Subject: Weekly fluoxetine
From: eliot.gelwan@channel1.com (Eliot Gelwan)
Date: Mon, 11 Sep 1995 20:55:00 -0500

My "n" for the weekly dosing is small, so I can't say for sure, but my impression is that side effects are lessened considerably. This is certainly the aim -- to find a dose that is more tolerable but sufficiently efficacious. I have found that the fluoxetine-induced activation or agitation was still present -- I consider this to be a peak effect -- whereas the loss of libido or orgasmic capacity, which is a steady state effect, was absent.

Date: Wed, 17 Jan 1996 19:36:05 -0800
From: Ivan Goldberg <Psydoc@psycom.net>
Subject: Weekly fluoxetine

I have seen a few people who do very well on one to three 20 mg capsules of Prozac per week. On more they have too-severe side effects, on less they become depressed. Pharmacologic response or placebo response: who knows?

Date: Thu, 18 Jan 1996 00:33:00 -0500
From: "Paul Luisada, M.D." <pvl2@cornell.edu>
Subject: Weekly fluoxetine

I've a number of patients in my practice on Prozac twice a week, and some even on once a week dosing. Some have been on it for years without relapsing. Some have to nudge the dose upward once or twice a year. At this dose, many people appear to stop having so much trouble with that pesky sexual side effect.

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