[mel020377]

My sister in law has depression among other things. She is on 100 to 120mg of Prozac a day. One of her counselors said that this was a dangerous dose. I dont know much about this drug, what do you guys think/know?

[wi_fighter]

My drug book that I use for work says max 80 mg a day.

[mel020377]

WOW!!!! So I guess it could be dangerous then huh? The only good thing is that she isnt feeling like hurting herself right now

[CamW]

me - 100mg to 120mg of Prozac (fluoxetine) is a very high dose. I do not understand the rationale behind taking a daily dose of this size. Usually doses beyond 60mg daily are not necessary, as at this level (in most people) the serotonin reuptake receptors are fully blocked and giving any more of the drug will have no therapeutic effect.

In other words, the dose response curve flattens because there is nothing more that extra Prozac can do. The doctor may have some rationale for giving a dose this high: your sister may not absorb Prozac very well and she needs doses this high just to obtain sufficient concentrations at the receptors, similar to the concentrations achieved other people at much lower doses. The rest of her Prozac dose is not absorbed and travels straight through her intestines and is excreted unchanged in her feces.

Your sister should not lower the dose on her own. She must be weaned slowly from doses this high to avoid withdrawl syndrome. She should perhaps ask her doctor (a psychiatrist, I am hoping) why she is taking double the normally highest dose. Her pharmacist should also have asked the doctor why her Prozac dose is so high; he/she may know the reason. Lastly, your sister could consult another psychiatrist, just to be certain that this dose is warranted.

There really is not much to worry about at doses this high, except that some side effects (ie. due to secondary receptor binding effects) may be much more pronounced. The specific side effects that she would experience (if any) would be related to the rationale behind the reason for giving a daily dose this high.

In any case, your sister should talk to her doctor as to why her dose is this high. I hope that this helps. - Cam

[mel020377]

Thanks for the info. She says that the guy she is going to a psychiatrist, just asks how she is doing, gives her a prescription and sends her out the door. I have told her she needs to find another one and she is looking. She is talking to a counselor as well. THe meds keep her from hurting herself which is good as she has two young kids

[darkeyes]

She may need a different med or a combo to really help, if this med is not working.
She needs to confront her doc about this, it is not uncommon for some meds to have a "poop out" point, and with some meds increasing the dosage will not target the problem, fortunately there are various types and/or combos that can be tried under doctor supervision.
I wish you lots of luck with this, I understand how frustrating it all can be.

Take care,
DE

[T_MD]

Usually if I see doses that high a psychiatrist is trying to treat obsessive-compulsive disorder (OCD), though you didn't mention that your sister had it. Unnecessarily high doses expose patients to higher cost, more frequent side effects, withdrawal from missed doses, potential interactions etc. Prozac is pretty potent stuff and I've never had a reason to push it past 60mg a day expect in one or two cases of OCD. However at 100mg Prozac starts to generate more anxiety than most people can stand. In general I very, very rarely have to exceed the published dose ranges with antidepressants. If you take a careful history on people's previous medicines and intolerable side effects you can usually pick one they'll tolerate right off the bat.

[mel020377]

I dont think that she has OCD. I know that she is depressed, and has a tendency to hurt herself by either hitting or cutting or burning. Her last episode included burning herself with hot water and beating her legs with toothbrush. The bruises were horrible. That is when he upped her does to 100mg of Prozac. He didnt even want to talk to her about her problems, he just gave her the prescription and she left.

[mel020377]

Just talked to her and she said that he also has her on Valium and he told her that she would start with one and that eventually she would have to up the dose to get the same effect. He told her that she would get addicted to it.

i'm starting to have real concerns about that doctor.....p

[mel020377]

My thoughts exactly!!!!!