Anxiety disorders and depression affect millions of people in the United States, leading to the widespread use of medications like Prozac (fluoxetine) and Xanax (alprazolam). While these medications are effective in treating mental health conditions, they also come with potential side effects, including changes in weight. Understanding the weight loss and weight gain effects of Prozac and Xanax is important for individuals considering or currently taking these medications. Treatment for anxiety disorders usually consists of a combination of medication and/or psychotherapy.
What are Prozac and Xanax?
Prozac and Xanax are prescription medications used to treat mental health conditions, but they work in different ways. Both medicines are approved by the United States Food and Drug Administration (FDA).
Prozac (Fluoxetine)
Prozac, also known by its generic name, fluoxetine, is an SSRI or selective serotonin reuptake inhibitor. Prozac is part of a group of drugs called selective serotonin reuptake inhibitors (SSRIs). SSRI medications work by increasing levels of the neurotransmitter serotonin in the brain. Prozac is available in both brand and generic formulations, in tablet and capsule form, as well as an oral solution. Although the dosage varies, a typical dose is 20 mg once a day. Prozac is indicated to treat major depression and obsessive-compulsive disorder (OCD) in children, adolescents, and adults. Prozac can also be used to treat bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Note: Symbyax is a combination drug containing the ingredient in Prozac, fluoxetine, along with another medication called olanzapine. Prozac treats depression, obsessive-compulsive disorder, bulimia nervosa, premenstrual dysphoric disorder, and panic disorder. Prozac is commonly used to treat depression and panic disorder, which is a type of anxiety disorder. However, some people who take Prozac do experience anxiety as a side effect. Because of the risk of suicidal thoughts or behavior, your healthcare provider will monitor you closely while on Prozac. When taking Prozac, it may take up to 4 to 6 weeks for your symptoms to fully improve. Some people may start to feel better in 1 to 2 weeks, while others may need 8 weeks or longer to feel the effects. In a clinical research study, over 50% of people who responded to treatment with Prozac had a positive effect by the second week. Studies have shown fluoxetine (Prozac, Reconcile), when prescribed by your veterinarian, is usually a safe and effective medicine for dogs for the treatment of behavioral disorders like separation anxiety. It is most effective when used in conjunction with a behavior modification plan for your pet. As an antidepressant, Prozac is thought to work by increasing serotonin in the brain. Serotonin is a neurotransmitter that affects mood. It’s often prescribed for long-term treatment of chronic conditions like depression and OCD.
Xanax (Alprazolam)
Xanax, also known by its generic name, alprazolam, is a benzodiazepine drug that treats anxiety and panic disorder. Xanax (alprazolam) is in the benzodiazepine class of drugs and works in the CNS (central nervous system). Benzodiazepines work by increasing activity at receptors for a neurotransmitter called gamma-aminobutyric acid (GABA), resulting in a relaxing and calming effect. Xanax is available in both brand and generic form. Xanax is indicated for the short-term relief of anxiety symptoms and the short-term relief of anxiety associated with depressive symptoms. Xanax is also indicated for the treatment of panic disorder, with or without agoraphobia. Xanax works by enhancing the effects of gamma-aminobutyric acid (GABA), a natural chemical in the body. This neurotransmitter causes you to feel more calm and relaxed. Xanax is prescribed for adults to treat: generalized anxiety disorder, panic disorder. Xanax works by potentiating the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that dampens neural activity. By binding to GABA receptors, Xanax amplifies its inhibitory effects, thereby reducing nervous system excitability. Xanax offers quick relief, often within the first hour of ingestion, due to its direct effect on the central nervous system. Typically, Xanax is used for short-term management of severe anxiety and panic disorders due to its potential for dependency and tolerance.
Key Differences Between Prozac and Xanax
One of the most common misconceptions involves the drug classifications of Prozac and Xanax. Prozac is not a benzodiazepine - it belongs to a class called selective serotonin reuptake inhibitors (SSRIs). Prozac and Xanax work in very different ways. Prozac comes as immediate-release capsules, tablets, and an oral solution. Xanax comes as immediate-release tablets, orally disintegrating tablets, and an oral solution. The immediate-release formulations of Prozac are usually taken by mouth once a day. However, the dose can vary depending on your age and the reason you are taking it. Xanax is usually taken by mouth three times a day, except for the extended-release tablet that is taken by mouth once a day. It is difficult to compare the two drugs. Studies do not compare the two drugs directly. Prozac is commonly used for depression and is used for a longer time, while Xanax is intended to be a short-term treatment for anxiety (although many people take Xanax long-term under their doctor’s supervision). Some patients take both an SSRI and a benzodiazepine to help with anxiety and depression.
Read also: The Impact of Metformin and Fluoxetine on Weight
Weight Changes and Antidepressants
Antidepressants are one of the most commonly prescribed drugs in the US, and a common side effect of the drug class is a gain in mass. However, the degree of gain varies among different users and different antidepressants. Just as antidepressants have a profound effect on the body, such as the relationship between Prozac and weight gain, so does the mental health disorder itself. Major depressive disorder is a highly complex mental health disorder due to the brain’s complexity and the factors affecting its function. Some individuals who suffer from depression notice an increase in body size, while others notice losing pounds. The most apparent way depression affects body weight is through changes in appetite and eating patterns. Some depressed individuals eat more while others start eating less. Another important factor is the effect of specific mental health conditions on physical activity. The last factor is the poorly understood effects of depression on the body’s metabolism and overall health. Depression has a profound and varying impact on brain chemistry, which affects the body’s health and metabolism in various ways, leading to changes in body mass.
Prozac and Weight Loss
Prozac can affect weight, but usually causes a decrease in appetite and weight loss rather than a weight gain. Patients taking Prozac lost approximately 13 pounds, twice as much as those on alternative medications like Xenical. Fluoxetine initially promotes weight loss by preventing serotonin reabsorption, which acts as an appetite suppressant. Prozac (Fluoxetine) is sometimes prescribed as a treatment for obesity. Studies have shown that the use of the antidepressant Prozac can cause an acute loss in weight among those taking the drug to treat major depressive disorders. This may be due to the effect of the drug on serotonin, an appetite suppressant. It may lead to restoration of normal feeding patterns, which are often distorted in depression, making it a good option for overweight or obese individuals who also have depression. A study showed patients on Fluoxetine lost 13 pounds, more than twice as much as those on Xenical (6 pounds) in the same time frame. Likewise, patients taking Fluoxetine for 27 weeks on average lost 11 pounds, compared with less than 10 by patients using Meridia in the same period. Experts have not established the relationship between the medication Prozac and weight loss. Researchers conclude that Fluoxetine is a safe and effective drug for short-term obesity treatment. However, drinking on Prozac can impede the size reduction process because spirit drinks are usually high in calories. Besides it, this practice is also dangerous. Short-term Prozac treatment for up to 3 months usually leads to little weight change, but most patients need medication for longer periods. Weight loss during early treatment with Prozac may also be due to stomach (gastrointestinal) side effects.
Prozac and Weight Gain
The relationship between Prozac and body mass changes remains complex, with initial weight loss often followed by weight gain during long-term treatment. It is not fully clear if longer-term weight gain with selective serotonin reuptake inhibitors (SSRIs) is due to a drug side effect, the recovery of appetite after symptom recovery, or a mix of both. Weight gain during long-term treatment with Prozac may be due to a recovery of your appetite after your symptoms subside. In a one-year randomized study, patients whose depressive symptoms had subsided after 12 weeks of treatment with fluoxetine 20 mg/day received either fluoxetine or a placebo (an inactive treatment) for 38 weeks. During the initial 4 weeks of treatment, an average weight decrease of 0.4 kg (0.9 lb) was observed for all patients. After 50 weeks, weight increases were similar between the Prozac and placebo-treated groups. Weight gain was associated with a poor appetite at the beginning of treatment and an improved appetite after depressive symptoms cleared. In another study in 284 patients with major depressive disorder, long-term weight changes with Prozac were assessed when compared to paroxetine (Paxil) or sertraline (Zoloft), other commonly used SSRIs. Patients treated with paroxetine (Paxil) had a significant increase in weight, and those with a 7% or greater weight increase were highest in this group. Prozac is associated with a low amount of weight gain over the long-term compared to many SSRIs.
Xanax and Weight Changes
Anxiety medications are not known for causing weight loss. Anxiety medications often tend to make patients gain weight.
Other Medications for Anxiety Disorders
Treatment for anxiety disorders usually consists of a combination of medication and/or psychotherapy. Besides Prozac and Xanax, other medications used to treat anxiety disorders include:
Read also: Comparing Effexor and Prozac
- Selective serotonin reuptake inhibitors (SSRIs): paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluvoxamine (Luvox), and citalopram (Celexa).
- Serotonin and norepinephrine reuptake inhibitors (SNRIs): venlafaxine (Effexor and Effexor XR) and duloxetine (Cymbalta)
- Atypical antidepressants: nefazodone (Serzone), mirtazapine (Remeron), and trazodone (Desyrel).
- Tricyclic antidepressants: imipramine (Tofranil) and clomipramine (Anafranil)
- Monoamine oxidase inhibitors (MAOIs): phenelzine (Nardil), selegiline (Emsam), tranylcypromine (Parnate), and isocarboxazid (Marplan).
- Benzodiazepines: lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax).
- Anti-anxiety drugs: buspirone (BuSpar).
- Anticonvulsants: pregabalin (Lyrica), divalproex (Depakote), and gabapentin (Neurontin).
- Antihypertensive drugs: clonidine (Catapres), propranolol (Inderal, Betachron E-R, InnoPran XL), nadolol (Corgard), and atenolol (Tenormin).
Side Effects of Prozac and Xanax
Prozac and Xanax have unique side effects. Everyone responds to medications differently.
Prozac Side Effects
Common side effects may include:
- Nausea
- Tremor (shaking)
- Nervousness
- Problems sleeping
- Sexual problems
- Sweating
- Agitation
- Feeling tired
- Dry mouth
- Sedation
- Orthostatic hypotension (low blood pressure, dizziness when standing)
Serious side effects may include:
- Suicidality
- Serotonin syndrome
- Hyponatremia (low sodium)
- Rash and allergic reactions/systemic anaphylaxis reactions
- QT prolongation and ventricular arrhythmia
Xanax Side Effects
Common side effects of Xanax side effects usually increase with higher doses. The most common side effects of Xanax are sedation, dizziness, and weakness. Side effects may include:
- Drowsiness
- Lightheadedness
- Confusion
- Balance problems
- Dizziness
- Slurred speech
- Muscle weakness
- Memory problems
- Constipation
- Nausea
- Dry mouth
- Blurred vision
Serious side effects may include:
Read also: Benefits of Wellbutrin and Prozac
- Extreme sedation
- Severe respiratory depression
- Coma
- Dependence
- Withdrawal symptoms
- Risk of suicide
Drug Interactions
Prozac Drug Interactions
Do not use an MAO inhibitor (MAOI, or monoamine oxidase inhibitor) within 14 days of Prozac. The combination may increase the risk of serotonin syndrome, a life-threatening medical emergency due to excess serotonin. Triptans-migraine medications, such as Imitrex (sumatriptan), and other antidepressants, such as Elavil or Cymbalta, should not be used in combination with Prozac due to the risk of serotonin syndrome. Taking other drugs that increase serotonin levels (triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, dextromethorphan, amphetamines, St.
Xanax Drug Interactions
Xanax should not be taken in combination with opioid painkillers due to increased risk of sedation, respiratory depression, and overdose, possibly leading to death. If no other combination is possible, the patient should receive each medication at the lowest possible dose and for the shortest duration and be closely monitored. Xanax can interact with opioids, which are prescription drugs typically used short term to relieve severe pain. Taking Xanax with opioids can raise your risk of CNS depression. In most cases, your doctor will not prescribe opioids with Xanax unless other medications haven’t worked for your condition. If your doctor prescribes Xanax with an opioid, they’ll monitor you closely for signs of CNS depression during treatment. They’ll also prescribe Xanax at the lowest effective dosage and for the shortest length of time needed. If you do take Xanax with an opioid, let your family or close friends know. If you experience symptoms of CNS depression, you or another person should call 911 or your local emergency number right away. If you take an opioid with Xanax, your doctor may also recommend keeping naloxone (Narcan) nasal spray on hand. Interaction with trazodone: Trazodone can interact with Xanax. Taking trazodone and Xanax together can increase your risk of excessive sleepiness. If your doctor prescribes Xanax with trazodone, they’ll likely monitor you for signs of excessive sleepiness. Let your doctor know if you have trouble staying awake or waking up while you’re taking these drugs together. They’ll likely adjust the dosage of one or both medications to help relieve your side effects. Consuming grapefruit or grapefruit juice while taking Xanax can increase the level of Xanax in your body. This could raise your risk of side effects from Xanax. Due to this risk, your doctor will likely recommend avoiding grapefruit or grapefruit juice during your Xanax treatment. Taking Xanax with cannabis can increase your risk of side effects from Xanax. Because of this, doctors typically recommend you avoid taking Xanax with cannabis.
Precautions and Warnings
SSRIs, including Prozac, have a black box warning of suicidality. A black box warning is the strongest warning required by the FDA. Children, adolescents, and young adults (up to 24 years old) taking antidepressants are at an increased risk of suicidal thoughts and behavior.
Xanax also has a boxed warning. Xanax should not be taken with opioid pain relievers because of an increased risk of extreme sedation, severe respiratory depression, coma, or death. If the combination of a benzodiazepine and opioid cannot be avoided, the patient should be prescribed the lowest dose for the shortest period of time and must be closely monitored. Xanax may cause dependence-the risk increases with higher doses, longer duration of use, and/or a history of drug or alcohol abuse. Keep Xanax out of the reach of children and others. Xanax is for short-term treatment.
Discontinuation
When discontinuing Prozac, withdrawal symptoms such as agitation may occur. Your healthcare provider can advise you on the best way to discontinue Prozac, with a slow taper schedule. When discontinuing Xanax, taper slowly to avoid withdrawal symptoms. Patients with seizure disorders are at higher risk for withdrawal symptoms.
Pregnancy and Breastfeeding
Prozac should only be used in pregnancy if the benefit to the mother is greater than the risk to the baby. Stopping the medication may cause a relapse of depression or anxiety. However, neonates exposed to SSRIs in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding. Xanax should not be used in pregnancy because of the risk to the fetus. Xanax passes into breast milk and may cause harm to a child who is breastfed, including: excessive sleepiness, problems feeding, low body weight, withdrawal symptoms, such as irritability, crying, and problems sleeping.
Other Considerations
Prozac and Xanax are on the Beers’ List (drugs that may be inappropriate in older adults). Certain health conditions or other health factors may raise the risk of interactions with Xanax. Before taking Xanax, talk with your doctor about your health history. They’ll determine whether Xanax is right for you. If you’re age 65 years or older, your risk of side effects with Xanax may be higher. If you have kidney problems, your body may not be able to remove Xanax properly. If you have liver problems, your body may not be able to break down Xanax properly. Xanax can cause slowed breathing. If you already have breathing problems, Xanax may worsen your condition. Benzodiazepines, including Xanax, may worsen depression. Xanax may also cause episodes of mania in people with bipolar disorder.
Can Prozac and Xanax Be Taken Together?
Yes, Prozac and Xanax can be prescribed together under proper medical supervision. This combination is sometimes used when patients need both long-term mood stabilization (Prozac) and short-term anxiety management (Xanax). Taking Prozac with Xanax can cause Xanax to build up in your body. This could raise your risk of side effects from Xanax.
Alternatives to Prozac and Xanax
If you are concerned about weight gain or loss with any antidepressant treatment, speak with your healthcare provider. There are many options to treat depression, some that have fewer side effects like weight gain.