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My 15 year old decided to quit Prozac (40mg) after 2 years

and 2 weeks later, is...
My 15 year old decided to quit Prozac (40mg) after 2 years and 2 weeks later, is losing energy and focus. Negative ideation isn't an issue but I'm concerned about some minor and short-lived mood shifts (including euphoria).Should we have tapered (I'm guessing yes)? He's appropriately interested in understanding whether his depression is a lifetime thing, as well as having the libido his age would dictate.How best to manage/correct/monitor safely and responsibly?
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Answered in 48 minutes by:
4/4/2013
Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Verified
Elliott, LPCC, NCC :

Seeking expert counseling is a sign of strength. A personal relationship with a caring professional is proven clinically effective.

Elliott, LPCC, NCC :

Dear friend,

Elliott, LPCC, NCC :

I believe that I can help.

Elliott, LPCC, NCC :

Discontinuing any of the SSRI antidepressants can give negative side effects. It takes longer for them to show up with Prozac because it has such a long half-life. It is less troublesome for many who withdraw, but there can be serious side effects.

Elliott, LPCC, NCC :

I am concerned about the issue of euphoria. This could be a sign of mania, which is one of the two poles of bipolar disorder (the other being depression). It could be triggered by his withdrawal.

Elliott, LPCC, NCC :

I also did not understand your reference to his libido. Most antidepressants can lower the libido.

Elliott, LPCC, NCC :

If he is losing energy and focus, this means that his depression is increasing. That is a sure sign.

Elliott, LPCC, NCC :

Most people experience one level or another of depression during their lifetime. Grief is a form of depression with all of the symptoms, but it is not diagnosable because it is normal to go through this period of depression called mourning or grieving.

Elliott, LPCC, NCC :

Some people are depressed because of their situation at the moment. Being a teenager is a big source of stress.

Elliott, LPCC, NCC :

If he seems to be suffering from highs and lows then he may very well have bipolar disorder and you should see a psychiatrist who would be much more adept at managing his medication than a GP. If he does show signs of euphoria then he should NOT take an antidepressant alone as that could make his moods more exaggerated and difficult to manage.

Elliott, LPCC, NCC :

Just for your enlightenment, here are the signs of mania. If you see they exist in him then talk to a physician or psychiatrist.

Elliott, LPCC, NCC :

Mania DSM-IV

A) A distinct period of abnormally and persistently elevated, expansive or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary)

B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1) inflated self-esteem or grandiosity

2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3) more talkative than usual or pressure to keep talking

4) flight of ideas or subjective experience that thoughts are racing

5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation

7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C) The symptoms do not meet criteria for a Mixed Episode

D) The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

E) The symptoms are not due to the direct physiological effects of a substance or a general medical condition.


Elliott, LPCC, NCC :

I hope that this has given you some guidance.

Elliott, LPCC, NCC :

I shall keep your family in my prayers.

Elliott, LPCC, NCC :

If you wish to get back to me on this question, I will be happy to accommodate you.

Elliott, LPCC, NCC :

Warm regards,

Elliott, LPCC, NCC :

Elliott, MAE, LPCC, NCC, CCMHC

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Customer reply replied 4 years ago
I am not sure what happened to our chat--I didn't realize I needed to be available at a particular time to continue our conversation.
So, I'd like to explain. Nobody wants to be on meds long-term, least of all teenaged boys who feel pretty good and function at a high level when on meds. I'm sure my son wants to understand if his depression is chronic (and whether he'll need meds to help manage for life) and would like to one day become sexually active (Prozac definitely gets in the way).
So how can he find out, safely, whether he needs to be maintained at his current dose and for how long? His euphoria is just sporadic bouts of laughter -- nothing like what you describe mania). 1-2 minutes in duration but sandwiched between moments of torpor or annoyance. He's been a bit uneven this last few days.
Dear friend,

There is no way that anyone could determine if your son's condition is chronic or not, or for how long he needs to be on meds. He probably will pull out of this and will not be on these meds for life.

Neither teenage boys nor anyone else will necessarily function at high level just because they are taking medications. They must be the appropriate ones at the correct dose.

At this point the safest thing to do is to take him back to the doctor who gave him the Prozac in the first place and get hims restarted on the dose the doctor thinks is appropriate, if he thinks that he still needs it.

The doctor must use his authority to convey to your son that he must not quit taking his medications if he feels like it, because quitting can be very harmful

Continue to do your best to encourage him as his mom and do not worry. He will grow out of this, I am sure.

May God watch over your family.

Warm regards,

Elliott
Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.
Verified
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Elliott, LPCC, NCC
Elliott, LPCC, NCC
Elliott, LPCC, NCC, Psychotherapist
Category: Mental Health
Satisfied Customers: 7,664
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Experience: 35 years of experience as a Licensed Professional Clinical Counselor, National Certified Counselor and a college professor.

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