Fluoxotine (Prozac generic) issues

[Rixram]

What is the name of your state (only U.S. law)? Rhode Island

I am a married (for the moment) 35 yo consultant, living in Rhode Island. I moved here with my family in late 2005, and stated work with a firm locally in early 2006.

In mid-2006, my local physician prescribed Prozac for what he'd referred to as dysthymia. The medication did improve my attitude, but I suspect there were a certain kind of unexpected side effect.

I have been in charge of the family budgeting for ages. Shortly after I'd been prescribed the Prozac, I made an unwise choice to dip into savings to purchase family items. These were unnecessary items, but we'd opted (based on my controlling the budget) to purchase them for family enjoyment.

This began a trend of my lying about the budget. I'd gotten in trouble once before with it (prior to 2006) , but had paid everything off. This time, however, I repeatedly, and often dipped into the family savings to supplement our lifestyle. The curious part was that I felt no alarm about doing this.

This past summer, July (?) 2008, I reviewed finances, and knew I should be shocked and dismayed at what I was seeing, but was curious that I felt little of this. Shortly thereafter, my perscripton ran out. I refilled it, but did not resume taking the Prozac.

Shortly after I stopped with the Prozac, I began to feel the feelings that I SHOULD have been feeling all along: concern, fear, terror, and shame of my lies about the budget and having deceived my wife.

I recently informed my wife of my lies and the resulting financial damage. She, understandably, wants a divorce. We are not destitute, but have had to refinance the house to payoff the $50,000 in credit card debt and to payof the vehicles (another $40K) I said we could afford that we certainly could not.

I believe that a side effect of the Prozac may have lowered my mental concern and subdued my feelings of personal responsibility, permitting this to happen. I do not forego my personal responsibility to my family in this, nor my lies, but I'd like to know if the effects of the Prozac (generic version) could have altered my perception/mental state, permitting this to occur. Could the prescribed Prozac (generic) had "lowered my defenses" on this?

It was almost like gambling, or something. I cannot put it well into words. But the personal concern and attention to a financial matter went absent until I ceased using the prescribed Prozac (generic), and then what I should have felt, I then felt.

[ecmst12]

Could the Prozac have contributed to your financial irresponsibility? Yes. It is known that in some people, Prozac counters depression TOO well and brings on a manic state such as you described. However this is a known side effect of the drug and so not anything that could make the drug company liable to you in ANY way. You could have sought further treatment at any time and chose not to.

And while I think it is medically IRRESPONSIBLE for your family doctor to prescribe a psychiatric drug without ALSO referring you to a psychiatrist and/or therapist to get a better evaluation of your psychological condition and monitor the drug's effect on you, I do not believe that the standard of care requires it. So there was no malpractice on the part of the doctor either.

Of course, maybe your family doctor DID refer you for further psychological diagnosis or treatment, and you chose not to follow through. This of course puts your problems entirely on you.

[Rixram]

Originally Posted by ecmst12

Could the Prozac have contributed to your financial irresponsibility? Yes. It is known that in some people, Prozac counters depression TOO well and brings on a manic state such as you described. However this is a known side effect of the drug and so not anything that could make the drug company liable to you in ANY way. You could have sought further treatment at any time and chose not to.

And while I think it is medically IRRESPONSIBLE for your family doctor to prescribe a psychiatric drug without ALSO referring you to a psychiatrist and/or therapist to get a better evaluation of your psychological condition and monitor the drug's effect on you, I do not believe that the standard of care requires it. So there was no malpractice on the part of the doctor either.

Of course, maybe your family doctor DID refer you for further psychological diagnosis or treatment, and you chose not to follow through. This of course puts your problems entirely on you.

Thank you for your response.

I've looked over the side effects, and cannot see financial irresponsibility listed in there, or (more correctly) anything that is close to it. Can you please elaborate? Some of the side-efects are in "Medical-ese", and therefore unintelligble to the common man.

As for the prescribing doctor, no, there was not a recommendation to see a psychiatrist, nor a reference. I will double-check, to be sure on that.

[ecmst12]

The side effects you are looking for, as I've seen them listed on various sites, are:
Increased impulsivity
Mood or behavior changes

The package insert that comes with the medication instructs you to contact your doctor right away if you experience the above symptoms, as well as a bunch of others. You did not do this.

You should see a psychiatrist for a complete workup. People who experience feelings of mania while on SSRIs are frequently those whose diagnosis should have been some form of bipolar disorder rather then pure depression. The latest studies are finding that bipolar conditions are more common then previously thought, and they are frequently mistaken for depression when the problem is milder. Some patients who cycle through periods of mild depression and periods of normalcy will experience periods of mania when SSRIs are prescribed to treat a depressive cycle. It is definitely known that giving prozac to someone with established bipolar disorder will bring on a manic cycle. So it's definitely possible that you have an undiagnosed bipolar condition. This is why it makes me angry when family docs just write scripts for SSRIs like it's nothing when these drugs really shouldn't be prescribed without evaluation and monitoring by a mental health professional!

However, you did still have the responsibility to read the package insert and report your mood and behavioral changes to your doctor as soon as you noticed it.

[Rixram]

Originally Posted by ecmst12

The side effects you are looking for, as I've seen them listed on various sites, are:
Increased impulsivity
Mood or behavior changes

The package insert that comes with the medication instructs you to contact your doctor right away if you experience the above symptoms, as well as a bunch of others. You did not do this.

You should see a psychiatrist for a complete workup. People who experience feelings of mania while on SSRIs are frequently those whose diagnosis should have been some form of bipolar disorder rather then pure depression. The latest studies are finding that bipolar conditions are more common then previously thought, and they are frequently mistaken for depression when the problem is milder. Some patients who cycle through periods of mild depression and periods of normalcy will experience periods of mania when SSRIs are prescribed to treat a depressive cycle. It is definitely known that giving prozac to someone with established bipolar disorder will bring on a manic cycle. So it's definitely possible that you have an undiagnosed bipolar condition. This is why it makes me angry when family docs just write scripts for SSRIs like it's nothing when these drugs really shouldn't be prescribed without evaluation and monitoring by a mental health professional!

However, you did still have the responsibility to read the package insert and report your mood and behavioral changes to your doctor as soon as you noticed it.

I'd attributed the behavorial changes as an intended effect of the prescription (feeling not as depressed), but I understand what you are saying. But honestly, when the meds are prescribed to counter depression, and then you feel less depressed when using them, that'd be expected. Isn't that the intent, and not a side effect?

With your explanation, I understand how "Increased Impulsivity" could be used to describe my response to financial matters. Unfortunately, it is sad that these were not readily identifiable at the time for me as a side effect.

These "side effects" have helped cost me my family. I never imagined that an antidepressant could have helped dig a hole for me like this.

[lya]

I must point out that the behaviors being attributed solely to Prozac are behaviors that occurred in the past, without Prozac. Perhaps the difference is that during the previous episode(s), feelings of guilt and remorse accompanied the behavior; with Prozac, the feelings of guilt were inhibited.

While psychiatric evaluation is not required for those receiving Prozac, it is recommended for those with impulse disorders. My advice is to seek counseling and a support groups similar to AA or NA. This behavior will occur again, regardless of Prozac or no Prozac.
It does not make one a bad person to have an impulse disorder. It does make one accountable to oneself and to others to be involved in a support group.

Editing note: There may be an underlying addictive personality problem. Compulsive spenders are addicts as much as are those who are addicted to "drugs" or alcohol. The OP describes addictive personality behaviors, ie. spending money, making purchases in order to feel good, lying to cover his behavior, etc.

Bottom line: I see no evidence of any kind of professional negligence or product liability described in this scenario.

[ecmst12]

There is definitely a difference between feeling less depressed, and the mania that you experienced. I do understand that you did not recognize it at the time, but it is what it is. So long as the standard of care does not REQUIRE special monitoring for patients taking these meds for the first time, there is no legal recourse for you in this situation. But I do hope that you follow up for further diagnosis and treatment - even if you don't need or want medication, there are other treatments available that can help you. Although the meds may have brought on the manic symptoms this time, it's possible they could recur again at some time in the future even without any meds.