Question:
Dear Dr. Heller,
After reading and enjoying your book 'Biological
Unhappiness', I was left a little confused about the
use of BuSpar and Prozac to treat GAD and Dysthymia
(aka 'Fractured Enjoyment'), respectively. Can you
please let me know from your medical experience if
you have had patient complaints of side-effects from
the use of BuSpar and Prozac in combination?
If so, were these side-effects severe? The below link
to the Access Med Net website has made the following
statement about the combined use of Prozac and
BuSpar:
http://www.AccessMedNet.com/prescription-drug-information/buspar-side-effects.html
"Selective serotonin
reuptake inhibitors (SSRIs) like Celexa (citalopram),
Paxil (paroxetine), Prozac (fluoxetine), Luvox
(fluvoxamine), or Zoloft (sertraline) may increase
serious side effects, possibly even serotonin
syndrome, when used with BuSpar. The combination may
need to be avoided, or your doctor may need to
carefully regulate your dosages."
The above statement greatly concerns me, as I am
considering treating my Dysthymia using Prozac while
maintaining my use of BuSpar at 15mg, taken 2 times
daily. The BuSpar has been working very well and I do
not want to stop using it. Your professional opinion
would be greatly appreciated.
Regards,
Sydney, Australia.
Dr. Heller's Answer:
I've never had a significant problem with the
combination. In fact, I had a patient take an overdose
of 250 15mg BuSpar pills and 350 20mg Prozac pills.
Nothing bad happened to her. I probably have 500
patients on the combination.
If the patient needs BuSpar and takes Prozac first
there is usually a significant increase in anxiety.
Most patients who have trouble taking BuSpar do
extraordinarily well with the temporary addition of
Remeron (mirtazapine).
Rare side effects can happen from any medication.
Serotonin syndrome is extraordinarily uncommon and
usually requires the mixing of an SSRI antidepressant
with a tricyclic antidepressant.
I have no problem with loved ones or friends taking
the combination. In fact, a number of them do.
Being chronically depressed increases the odds of a
heart attack by 600%. Anxiety and depression increase
the risk of cancer and infections. As with every area
of life, one has to balance the extraordinarily tiny
risk of a significant side effect with the potential
benefits.
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