Fluoxetine (Prozac) is an approved anti-depressant drug. It is manufactured by Dista Products, a subsidiary of Eli Lilly and Co. Ltd.

Fluoxetine works by prolonging the action of a chemical called 5-hydroxytryptamine (serotonin), which acts as a messenger between nerve cells in the brain. 5-hydroxytryptamine levels are thought to affect mood. People who have been taking fluoxetine for a period of time often reported relief from the symptoms of depression, such as withdrawal from social contact, feelings of sadness, tiredness and helplessness, preoccupation with problems and loss of appetite.

Fluoxetine has been shown to be more effective in relieving symptoms of depression in HIV-positive patients diagnosed with depression, regardless of their CD4 cell count^[1].

Common side-effects can include nausea, diarrhoea, loss of appetite, insomnia, nervousness, drowsiness and increased sweating. A range of other, rare side-effects has also been reported. Although clinical trials have not shown fluoxetine to be any more effective in alleviating depression than other types of anti-depressant, its side-effects tend to be much better tolerated. This improves the chance that a patient will stay on the course of treatment long enough to benefit from it.

Patients who have already been treated with an anti-depressant of the monoamine oxidase inhibitor type such as phenelzine (Nardil), moclobemide (Manerix), tranylcypromine (Parnate / Parstelin) or isocarboxazid, it is dangerous to begin treatment with fluoxetine for at least five weeks after ceasing the previous course of treatment.

As with other anti-depressants, it may take two to five weeks before relief from depressive symptoms is experienced. It is usually recommended that treatment for depression continue for at least three to six months, especially in the case of recurrent depression.

Fluoxetine should not be used by people with diabetes or a history of heart problems.

Fluoxetine levels may be increased in patients taking antiretroviral drugs, particularly protease inhibitors, due to similar routes of clearance from the body. This may raise the risk of side-effects^[2]. There is no significant interaction with nelfinavir (Viracept) or the non-nucleoside reverse transcriptase inhibitors (NNRTIs) efavirenz (Sustiva) and nevirapine (Viramune).