Insomnia from fluoxetine

Nervousness and agitation in some patients early in treatment are characteristic side effects of the SSRIs. These too have been reported to be dose related. In the fluoxetine database, these side effects were more common with the 60-mg dose than with the 20-mg dose and were associated with some insomnia (G. L. Cooper 1988]. Although in general the various SSRIs differ little one from the other, there appear to be some differences in their propensity for producing nausea and nervousness. 

It is possible that these adverse effects of fluoxetine treatment may negatively affect patients with depression. Since depressed patients frequently suffer from insomnia, nervousness, anorexia, and weight loss, it is possible that fluoxetine treatment might, at least temporarily, make their illness worse. 

Fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) have been associated with increasing suicidal ideation in some populations of patients. Recent studies have led the British Department of Health to warn physicians against using paroxetine off label. Fluoxetine was specifically exempted from this recommendation. Long-term studies of patients with depression who were treated with fluoxetine have shown it to be fairly well tolerated. Primary adverse effects include nausea (23%), headache (21%), and insomnia (20%). 

Nicotine None in usual doses but more depression (2X), impotency, traffic accidents, and more days lost from work Irritability, depressed mood and heart rate, increased appetite, insomnia, anxiety Agonist at Ach receptors, activates dopaminergic pathway (positive reinforcer), speeds and intensifies flow of glutamate Nicotine patch, education, fluoxetine 1 trial success to quit = 9-10% 5-6X for success 24% of population are smokers. Increased use in women, blacks, teenagers and low SES... 

Fluoxetine is absorbed well from the GI tract, is bound to plasma proteins to the extent of 95%, is metabolized in the Uver to norfluoxetine, and is excreted in the urine. Tryptophan is used as an antidepressant. However, the combined use of tryptophan, which increases the level of serotonin, and fluoxetine, which inhibits the neuronal uptake of serotonin, enhances the side effects of fluoxetine such as GI disturbances, anxiety, and insomnia (see Figure 86). 

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