Q: I am 30 years old and have been taking fluoxetine. I was prescribed this last year because I attempted to take my own life.
I have noticed that my behavior, though no longer suicidal, is increasingly irrational. I get explosively angry at the smallest of things and struggle daily to control my temper toward my husband.
Until now I would have said that the drug was working for me, but recently I have begun to question whether it is in fact putting my husband at risk. My explosive reactions are right on the edge of violence. Is it possible that the drug is having a negative effect on me?
A: When antidepressants like fluoxetine (Prozac), paroxetine (Paxil) and sertraline (Zoloft) were linked to suicidal thoughts in some patients, most health professionals were skeptical. After all, these drugs are prescribed to lift depression and prevent suicide, as fluoxetine did for you. The Food and Drug Administration now requires such medications to carry a black-box warning about suicidal thoughts or behaviors, however.
A new study from Sweden (PLOS Medicine, Sept 15, 2015) suggests that people between 15 and 24 are more likely to commit violent crimes if they are taking SSRI-type antidepressants or venlafaxine (Effexor). These individuals were convicted of assault, robbery, arson, sexual offense or homicide.
Although you are over the age range the study found to be at risk, it is not inconceivable that fluoxetine might be contributing to your bursts of rage. Please discuss this with your doctor and show him the PLOS Medicine article.
Our Guide to Dealing With Depression offers a number of alternatives to fluoxetine and other antidepressant drugs. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. E-7, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.
Q: Jublia has worked well for me. In three years, I tried two different oral medications and some topical treatments that helped a little, but did not knock out the toenail fungus on my big toe.
I was resigned to the fact I would have to live with an ugly nail and never have a pedicure again. But I started taking Jublia last fall, and my toe is now nearly normal. There is no sign of fungus on my new nail growth, and I can wear sandals again!
It took six bottles to work this magic, and insurance covered it until the last refill. Now I need to pay a $40 copay for each refill.
A: Jublia (efinaconazole) was approved to treat nail fungus in 2014. This prescription medicine is applied to the toenail daily. In the clinical trials, 15 to 18 percent of people who used Jublia for 48 weeks had a complete cure of their nail fungus. It sounds like you might be in that group.
Q: I cannot tolerate daily aspirin to prevent a heart attack. I take Tylenol instead. Is that as effective as aspirin for helping the heart?
A: There is no evidence that acetaminophen (Tylenol) helps the heart. On the contrary, scientists have asked whether this drug might increase the likelihood of heart attacks or strokes as other nonaspirin pain relievers such as ibuprofen and naproxen do. A 10-year study from the U.K. found no link between acetaminophen and cardiovascular complications (Hypertension, May 2015).
In their column, Joe and Teresa Graedon answer letters from readers. Email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”
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