Fluoxetine, commonly known as Prozac, is a selective serotonin reuptake inhibitor (SSRI) widely prescribed for depression, anxiety, OCD, and bulimia. While effective for many, it carries significant risks that patients must weigh carefully.

One major concern is suicidal ideation and behavior, especially in young adults under 25. FDA black-box warnings highlight increased suicide risk during initial treatment or dose changes, with clinical trials showing a 2-4% higher incidence in adolescents versus placebo. Symptoms like worsening depression or agitation demand immediate medical attention.

Sexual dysfunction affects up to 70% of users, including reduced libido, erectile dysfunction, delayed orgasm, or anorgasmia. These persistent effects can strain relationships and often linger post-discontinuation (post-SSRI sexual dysfunction, or PSSD).

Withdrawal syndrome upon abrupt stopping includes dizziness, nausea, irritability, "brain zaps," and flu-like symptoms, lasting weeks to months. Tapering is essential, yet some experience protracted withdrawal.

Other side effects encompass weight gain (average 1-5 kg long-term), emotional blunting (feeling numb, impacting 20-50% of users), akathisia (restless agitation linked to violence), and rare but severe risks like serotonin syndrome (fever, seizures from drug interactions) or bleeding disorders due to platelet interference.

Fluoxetine's long half-life (1-4 days, active metabolite up to 16 days) prolongs side effects compared to shorter-acting SSRIs. It interacts with MAOIs, NSAIDs, and alcohol, heightening dangers.

Critics argue overprescription ignores root causes, with placebo responses in trials (30-40%) questioning true efficacy for mild cases. Long-term use may alter brain chemistry permanently.

Always consult a doctor; benefits may outweigh risks for severe conditions, but informed consent is crucial. Monitor closely and report issues promptly.