Fluoxetine

Fluoxetine, sold under the brand name Prozac, among others, is an antidepressant medication of the selective serotonin reuptake inhibitor (SSRI) class used for the treatment of major depressive disorder, anxiety, obsessive–compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorder, and bulimia nervosa. It is also approved for treatment of major depressive disorder in adolescents and children 8 years of age and over. It has also been used to treat premature ejaculation. Fluoxetine is taken by mouth.

Common side effects include loss of appetite, nausea, diarrhea, headache, trouble sleeping, dry mouth, and sexual dysfunction. Serious side effects include serotonin syndrome, mania, seizures, an increased risk of suicidal behavior, and an increased risk of bleeding. Antidepressant discontinuation syndrome is less likely to occur with fluoxetine than with other antidepressants. Fluoxetine taken during pregnancy is associated with a significant increase in congenital heart defects in newborns. It has been suggested that fluoxetine therapy may be continued during breastfeeding if it was used during pregnancy or if other antidepressants were ineffective.

Fluoxetine was invented by Eli Lilly and Company in 1972 and entered medical use in 1986. It is on the World Health Organization's List of Essential Medicines and is available as a generic medication. In 2023, it was the eighteenth most commonly prescribed medication in the United States and the fourth most common antidepressant, with more than 27 million prescriptions.

Eli Lilly also markets fluoxetine in a fixed-dose combination with olanzapine as olanzapine/fluoxetine (Symbyax), which was approved by the US Food and Drug Administration (FDA) for the treatment of depressive episodes of bipolar I disorder in 2003 and for treatment-resistant depression in 2009.

Fluoxetine is frequently used to treat major depressive disorder, obsessive–compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bulimia nervosa, panic disorder, premenstrual dysphoric disorder, and trichotillomania. It has also been used for cataplexy, obesity, alcohol dependence, social anxiety disorder, as well as binge eating disorder. Studies do not support a benefit in children with autism, though there is tentative evidence for its benefit in adult autism. Fluoxetine together with fluvoxamine has shown some initial promise as a potential treatment for reducing COVID-19 severity if given early.

Fluoxetine is approved for the treatment of major depression in children and adults. A meta-analysis of trials in adults concluded that fluoxetine modestly outperforms placebo. Fluoxetine may be less effective than other antidepressants, but has high acceptability.

For children and adolescents with moderate-to-severe depressive disorder, fluoxetine seems to be the best treatment (either with or without cognitive behavioural therapy, although fluoxetine alone does not appear to be superior to CBT alone) but more research is needed to be certain, as effect sizes are small and the existing evidence is of dubious quality. A 2022 systematic review and trial restoration of the two original blinded-control trials used to approve the use of fluoxetine in children and adolescents with depression found that both of the trials were severely flawed, and therefore did not demonstrate the safety or efficacy of the medication. In 2025, a trial restoration of the influential TADS study found that fluoxetine had not been superior to placebo in the treatment of depressed adolescents, contradicting previously reported results used in meta-analyses and guidelines.

Fluoxetine is effective in the treatment of obsessive–compulsive disorder (OCD) for adults. It is also effective for treating OCD in children and adolescents. The American Academy of Child and Adolescent Psychiatry state that SSRIs, including fluoxetine, should be used as first-line therapy in children, along with cognitive behavioral therapy (CBT), for the treatment of moderate to severe OCD.