The Link Between Prozac and Tics

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Biology 202, Spring 2005
Third Web Papers
On Serendip

The Link Between Prozac and Tics

Camilla Culler


Recently it has been widely publicized in the news media that Prozac, an antidepressant and SSRI also know as fluoxetine hydrochloride, is linked to disturbing incidents of suicide and violence. However, there is another side effect, which is harder to detect that has not gotten quite so much media attention. Involuntary tics or muscle twitches affecting the face and specifically the eye area can occur as a side effect of taking an SSRI, a drug that directly interferes with serotonin levels in the brain. Tics are defined as, "... a problem in which a part of the body moves repeatedly, quickly, suddenly and uncontrollably"(1). A tic is a reminder that by taking drugs such as Prozac we are altering our natural neurological state.


My personal experience of witnessing friends and family members, adolescents and adults alike develop eye twitches and excessive blinking seemingly overnight, has prompted me to investigate the link between Prozac and facial tics. What causes them? What methods are used to treat them? And most importantly, how can our society address the problem of "transient tics" that is seemingly ignored?


On a neurological level, Prozac works by increasing "serotonin messages" (2). Serotonin is a chemical in the brain and dispersed throughout the nervous system that impacts mood. Depressed people often have unusually low serotonin levels. Fundamentally, brain cells are engaged in the activities of sending and receiving information in the form of chemical messages. In Prozac Backlash, Dr. Glenmullen explains this process of sending and receiving, and explains that the way the drug works to increase serotonin is through a process of disallowing "reuptake" of serotonin. He defines "reuptake" as a mechanism through which excess serotonin that is not utilized, is taken in by the same cell, which sent the chemical message in the first place (2). To understand Glennmullen's example it helps to picture a college student cleaning up a messy dorm room with clothes strewn everywhere. Some of the clothes on the floor will be worn and others will be put back in the closet. Ultimately, this process of disallowing "reuptake" or re-absorption of the chemical allows for the proliferation of the chemical serotonin in the body. The end result will hopefully be a happier mood. Trouble arises when neurological consequences occur such as facial tics. Or as Glennmullen explains, "Whenever the drugs step on the chemical gas pedal, the brain tries to slam on the brakes. The result is jerking, stop-and-go oscillations in brain activity that can go out of control" (2). It makes sense that the brain would be resistant to unnatural activity, and thus when a person develops facial tics from Prozac, these are really a neurological coping mechanism.


Dr. James Robert Brasic and Brian Bronson cite dopamine in their recent article, "Tardive Dyskinesia" (3) as a chemical related to motor functioning, and the main culprit responsible for the transient tics. In this article the doctors attribute the problem to a lack of the presence of dopamine, as it is being continuously barricaded or obstructed while the patient is taking Prozac (3). The question I was left with was how long does it take for dopamine amounts to stabilize after the person has stopped the SSRI? Could finding out this information help us to know how long a Prozac induced tic will persist, or if it will persist even after Prozac dosage has been either significantly lowered or discontinued altogether? Might the fact that the barricades for dopamine that the medicated patient has formed take a long time to dissipate? Could this lengthier period be the reason tics persist when the Prozac is no longer being ingested?


Besides simply waiting or hoping that the facial tic will go away, cognitive behaviorists and school psychologists can work together to help children and adults who suffer from this side effect to deal with them. An article entitled "Habit Reversal. A Treatment Approach for Tics, Tourettes's Disorder and Other Repetitive Behavior Disorders" written by Dr. Michelle Pearlman, details important techniques that can help to counteract the tic. Primarily, she emphasizes that developing a sense of awareness that the tic is occurring and developing a "counter-behavior" to replace the tic can help the student (4). Interestingly, in my experience it seems that people who have the tics are not even aware of them.


My friend approached me one day visibly distressed, that the night before his mother had pointed out to him that he had developed an eye tic on the left side, which looked like squinting. The problem is that because stress can make tics worse, it would seem that alerting someone of the fact that they have a tic when it might not be treatable, might increase stress levels resulting in a worse, more pronounced tic. However, a person living with an obvious facial tic does have the right to know about it so that they can do everything possible to get off the medication or to find some other way of treating it.


The treatments listed for tics brought on by taking Prozac seem to have both a rudimentary and trial and error theme. The Internet resource emedicine.com cites anti-Parkinson medication in order to keep people who decide to stay on the Prozac tic free (3). However, taking other medications can result in even more side effects. Another Internet site prozactruth.com discusses the implications of using Lecithin and Vitamin E. The web site compares the occurrence of the tic to a short circuiting in the brain. The site explains that, "many parts of our bodies are composed of positive and negative terminals, the same as an electrical switch. If you reverse the polarity, changing the negative to positive or changing the positive to negative, the switch will not work or will short out. The same is true within our body" (5). However, it seems that there is really no scientifically definitive solution in how these tics can be treated or prevented, except not to take Prozac in the first place, and also to learn from previous experiences with the drug.


In my first web paper on epilepsy, through my research I learned that once a person has a seizure they are more likely to have another one (6). Certain neurological pathways have been forged. It appears that this chance of recurrence being dependent upon previous behavioral episodes might also be the case with tics caused by taking SSRIs. Once the patient has exhibited the involuntary muscle twitch chances are it will happen again. It becomes a neurological habit. It is a prime example of brain change literally equaling behavior. Similarly, if the patient is taken off the drug and then put back on, chances are if they exhibit the tic the first time they will exhibit it the second time around as well as Glenmullen's case studies exhibit (2).


Though taking Prozac can sometimes be unavoidable, if a patient knows of the risks involved before beginning a trial of the medication and knows the red flags to watch for, it seems that this might mitigate the risk of the possibility of a lifelong, debilitating tic occurring. However, Eli Lilly the company behind Prozac does not make this information readily accessible. On their website prozac.com, running a search for "tics" yields no results. The probable reason behind the company's avoidance of the word "tic" is that society has attached a certain stigma to it, that people who exhibit involuntary muscle twitches are different or not normal. The stigma surrounding tics is similar to the one attached to epilepsy, the origination being that in ancient times epileptics or people who exhibited loss of motor control were thought to be evil or possessed (6). The idea of losing control of motor functioning is frightening. The possibility that a pill that is supposed to make you feel better could potentially ruin your life, your self- esteem, or your ability to socialize and enjoy life, is shocking and definitely would not help Eli Lilly's Prozac sales.


The emotional impact of having a transient tic obviously varies. The people I know who have tics from Prozac and Zoloft live their lives normally without any obvious disturbances. However, the fact that our society either ignores these "transient tics" or treats tics brought on by medications as though they are not serious, is a dangerous problem in itself.


Society dictates that it is rude to either point out a tic or to stare at someone who has one, but the other extreme of completely ignoring a tic is equally destructive. Are these tics brought on by Prozac ignored and overlooked because they are easier to conceal than other side effects? Are people more reluctant to acknowledge and discuss them because of the idea that they might be evidence of neurological brain damage as suggested in Prozac Backlash (2)? It seems that people are either so desperate to be helped by the drug Prozac that they are willing to endure the side effect, or that our culture has simply decided to turn it's back on virtually undetectable facial tics, because they are not deemed to be a "serious side effect". Often they do not incapacitate the patient, and are therefore might be viewed by Eli Lilly as not being worthy of being listed (7).


However, there are certain approaches that might combat this ideology and allow patients to be better informed, as well as to draw attention to how undeniably prevalent facial tics are as a result of Prozac usage. A documentary with consent from participants would be an interesting way to go about examining the scope of facial tics. Being confronted with an image of someone ticing is much more powerful than reading about it as a side effect on a pill bottle label anyway. Besides drawing attention to the prevalence of facial tics, it might as also be informative to conduct an informal, anonymous survey of how many people in Manhattan who are using Prozac either have been told that they have facial tics or have noticed them themselves.


Books like Prozac Nation by Elizabeth Wurtzel (8) and Prozac Backlash, detail the dangers of taking the medications and the frightening array of side effects that can occur. Though these books are definitely an invaluable resource, and describe in-depth accounts of patients who have suffered from facial tics, they seem to scare people as a tactic to have them not take the medications in the first place. The problem with this approach is that people can justify the fact that this type of side effect has happened to others, who probably didn't really need the medication in the first place. Readers can rationalize that they are taking Prozac in a controlled way and need to take it in order to function. By engaging in this type of thought process readers can distance themselves from the case studies Glenmullen writes about and Elizabeth Wurtzel's experiences on the drug. Therefore it is imperative that our society takes transient facial tics seriously, as they are a sign that something is wrong in the brain, or more specifically that misfiring is occuring. Ultimately, the field of tics related to Prozac usage needs to be studied a lot more in depth before we understand fully why people get these tics and how they can be controlled or eradicated once and for all.

References

1)Definiton of "tic" on psychnet-uk, a website that defines what a tic is.

2)Glenmullen, Joseph. Prozac Backlash. New York: Simon and Schuster, 2000.

3)"Tardive Dyskinesia" , an article by James Robert Brasic and Brian Bronson.

4)"Habit Reversal. A Treatment Aproach for Tics, Tourette's Diorder and Other Repetitive Behavior Disorders", an article by Dr. Michelle Pearlman.

5)prozactruth.com, a website that describes supplements and vitamins that could combat tics as well as personal stories.

6)Serendip Home Page, the first Web Paper assignment.

7)Eli Lilly's Website, a website run by Eli Lilly.

8) Wurtzel, Elizabeth. Prozac Nation. New York: Riverhead Books, 1994.

 

 

Comments made prior to 2007

I took Zoloft for about 7 or 8 years & I have developed a very bad case of facial & eye tics. I feel that they are a direct result from taking the Zoloft. Is there anything that I can do to get rid of them? I am getting desperate! ... Janice, 3 October 2006

 

 

Just wondering if you've come across anyone who's child (not on an SSRI) has a facial tic, and they happened to have taken an SSRI while pregnant ... Christine, 14 November 2006

Comments

karen temple's picture

tics

I have been taking Paxil for 14 years...low dose...20mg..i have had the under eye tic for about 2 months now,,,it comes and goes...will it get worse?

Jose Vasquez's picture

Tics

I took prozac for my anxiety and never knew this was one of the side effects till this month. I have been researching a bad twitch i have in my neck and shoulders that has become very painfull and irritating. I am currently unable to work and socialize. most people look at me because it looks as if i am dancing a bit. I hate this i was always healthy exept for the anxiety and panic attacks i get. I am only 27 and this sucks.

Carol Booth's picture

prozac - tics

i too took prozac for 20 years approx and my tic sounds exactly like yours- i work in a school so its embarrassing as well as exhausting x glad to know someone else the same

JOANNA's picture

YOU ARE DEFINATELY NOT ALONE :)

I AM 20 YEARS OLD, AND I HAVE SEVERE PTSD. I WAS PRESCRIBED PROZAC (60 MG DAILY) ABOUT THREE YEARS AGO. I HAVE MUSCLE TWITCHES ON A HOURLY BASIS, IN MY ARMS, LEGS, AND EYES, ESPECIALLY AT NIGHT. THEY HURT, AND ARE SOMEWHAT EMBARRASSING TO ME. I JUST WANTED TO REPLY TO YOUR COMMENT TO LET YOU KNOW THAT YOU ARE DEFINITELY NOT ALONE. :) STAY STRONG AND KEEP TRUCKING.

Lolita  Stalkfleet 's picture

twitchy eye's / prozac

In 2009 I was in my local jail serving time. While in there I started to take prozac. I asked to Be taken off prozac after a few weeks because my eyes started to do this weird twitching thing. (Not my eyelids ) my eyeballs. While they twitch my brain feels like it ticks. Its now 2012and my eyes are still doing this. Is it ever going to go away??? It bothers me alot. Can anyone help me out with some information on this please. And is this caused by prozac? Thank-you.

Dr. Sonal Hattangdi-Haridas's picture

Homeopathy Clears Facial Tics While On Zoloft

This case study maybe of interest in situations where the facial tics need to be dealt with - without the withdrawal of the antidepressant.

http://sonalh.com/2012/02/02/a-case-of-facial-tics-chronic-sinusitis-and-depression/

You will note the facial tics came undercontrol with homeopathy much before the antidepressant was withdrawn.

Maira's picture

tics and prozac

I have been taking 20 mg of prozac for five weeks now. This week my right eye started to twitch. It would come and go since two days ago. Today again my eye twitched for a couple of min and then it went away. Over all I like the prozac but the tics are making me worried. I want them to go away and hope they do. I will see my doctor next week for a follow up. Will see??

Serendip Visitor's picture

Thanks-Zoloft/Sertraline/Prozac MyLifeIsSerewed

WOW thanks to you people (Newley trained Doctors) That know it all (with a guess of BOOK-TEXT).
I now have a permenant (TIC) Chattering of my teeth/clicking/clentching and NO-it is not Buxisem.
Similar to Tourettes uncontrolled chattering of teeth.

Gee more drugs. Only took Sertraline 2 weeks NOW for a LIFE of un-controlled twitching and funny looks, Good thing I paid my Bill at the office.

I am pissed ! and I should be ! the blame game of Neurologists and drug sales !

Serendip Visitor's picture

Facial Tics

It's interesting that you took Sertraline for two weeks and developed a permanent facial tic. I was on Paxil for only a week and developed jaw clenching and teeth grinding that causes horrible pain that prevent me from turning my head. Imagine the worst earache you've ever had... that's what I feel after a bout of jaw clenching. I took the Paxil in 2009. It's now 2012 and the clenching/grinding as bad as ever. In all fairness, I never had this problem after taking Zoloft or Celexa. I tried Paxil only after those didn't work.

Serendip Visitor's picture

I was advised by an Autism

I was advised by an Autism clinic after 18 months of therapy for Aspergers to start a small dose of Prozac (10 mg) for him to help him become more out-going. Within the first week I noticed the eye tic. I didn't know exactly what it was at first but three weeks in, it was progressively worse. I called the dr. and went in and was told it was highly unlikely it had anything to do with the medication as it has NEVER been documented that Prozac has this side effect. I decided to do some research online and found this article and forum and was terrified. I immediately stopped the Prozac but now it has started in his mouth as well. This company needs to add this to the side effects. The drug may be worth the possibility enduring tics for some that the benefits out-weigh the side effects. But it was NOT the decision I would have made for my son and I deserved to know the full facts before making a decision that could now effect the rest of his life! I am furious that this is not being disclosed when it is obvious that so many are experiencing the same thing.

Anonymous's picture

Prozac and eye twitch

I was on Prozac for two months and had a very atypical experience where taking the drug immediately launched me into a prolonged manic episode (I had never experienced mania before). The eye twitch started about a month into my treatment, and I didn't connect the twitch to Prozac until now. I've been off Prozac for two months now and the eye twitch has gotten worse and worse over that time. I'm afraid it will never stop...

Anonymous's picture

Tics are a warning of worse thing to come Parkinsonism

I have been on many different antidepressants and have a long story I will make short. I started prozac for chronis pain after an accident. I wanted to kill myself shortly after taking prozac emerg helped. I quit prozac however had horrid withdrawal including body pain fatigue and given amitriptyline for that I couldn't see on it so went to zoloft thought I was well and could finally quit ssri guess what a few months later had serever depression for the first time ever. The list grows I would go on a drug try to get off never could on to another one. I know now the reason I could not get off was chemical induced brain changes cause horrid withdrawal withing 3 months of quitting. I gave up decided the only way to have life was to stay drugged. Changing the ssri occassionally as they stop working after a time. The ticks ans twitches I had over the years were alwasy ignored and never was I told the drugs could cause them and other bizzaro symptoms.

Move ahead a few years I am ok bumping along lifes path and out of the blue I start having severe symptoms head drops,blood pressure very high (200) and fluctuating one side of my body has seized up foot drags can't think digestive symptoms can't process food ect. Docs think MS testing shows a change in my brain but it isn't ms. I am given another hand ful of pill by a neurologist some for parkisons some for epilepsy he takes me off the snri I was on gives me a new one. I now have the internet and do my own research. I try his approach it does not work. I can't see well enough to read. I quit all meds yep including lipitor and bp meds ALL meds. Go thru hell for a good solid year...but I am getting better slowly I am getting back my health. Just my story but it happens every day I know that now from all the people I talk to online. These drugs had a profound affect on my life and I am trying to warn others not to take them. Once you start you can't get off well not without taking about 4years out of your life to lay around to heal and believe me it can take that long even longer for some. There is a lot more I could say but you have google look it up. Link to one site below. I think the ticks are just a warning of way worse things to come. Oh and btw I went cold turkey and lived to tell about it a lot of stories out there say don't do that I think if I had of waited I may be dead. Thank God for Glenmullens book without as I was getting no real information from my doctor he didn't know the truth so he couldn't tell me.

PDF] Drug-Induced Parkinsonism
File Format: PDF/Adobe Acrobat
Parkinson's. Some reports have linked SSRI antidepressant drugs such as fluoxetine. (Prozac) to drug-induced Parkinsonism but ...
www.housingcare.org/downloads/kbase/2597.pdf

Nina's picture

I had Tourette's to begin with

I'm 19 and was diagnosed with Tourette's when I was about 7 or 8. The doctors never put me on medication 1) because my mom wanted me to be "normal", and 2) because the doctors said it might actually make the tics worse. [Kinda pointless to have medication then, hm?]
Anyway, I just started 40mg Prozac a couple of months ago, and recently, I've noticed that my tics have gotten worse. Mainly twitching of my head though. I didn't think about that when I started taking Prozac.
But already living with Tourette's, I think the twitching is a small price to pay for having less anxiety attacks and being in a better mood.
The bad part about it though is that my tics have always been more pronounced when I'm tired. And driving at night when I'm tired happens a lot. It's scary when you're driving on a curvy road at night and your head starts twitching...

T's picture

Same as me!

Hi, Nina. I'm 18 (female) and was also diagnosed with Tourette's by around 7 or 8 years old. I started taking Prozac this April (for severe depression) while I was in a psychiatric hospital because of suicidality. I recently have been noticing blatantly worse facial tics which have been wearing me down to the point where my anxiety is worse, causing further depression and thoughts of self-harm. Honestly, I'm not going to get off of Prozac because even if it is (not sure) making my tics worse, I'm already living with Tourette's and this medication helps my anxiety and depression tremendously. I also fear that the constant eye twitches and squinting will affect my ability to drive. I've considered Valium, but again, it would affect my ability to drive as well... Don't give up! I know I'm not. Just keep trying, no matter how difficult.

dan's picture

tics

i am 23 n was diag. with disthymia at age 16 i was on MMA inhibertors till recentally when my ins. was cut off, i found som prozac n have been taking prozac for a few days now (10mg and 20mg) and i have nticed my eye twiching so i typed it in google and this page is a result. im not sure if im going to cintinue taking it or not because it does work and makes me feel better. any other seritonine reuptake meds out there that dont cause twitches?????????

Anonymous's picture

tics

Ive been on prozac 20 mg. since Nov. 1991. Ive had a few tics and twitches but dang everyone does. It could be MSG reaction in the foods u eat or caffeine or something like that. Everyone blames Prozac for everything. Its a shame. It saved my life. I havent had to up my meds ever. I havent had any problems with it and I dont want to find out what would happen if I go off it. Im peri-menopausal and Prozac helps me even though Ive been on it a long time.

Sometimes these anti-prozac people want to find something wrong with it. They have nothing better to do than take away something that may be HELPING others live.

Plus, PROZAC has been studied more than any other anti-depressants ever known or made. Eli Lily made sure of the side effects and they are aware of all the studies and whatnot.

If you dont want to be on any SSRI go off it with the help of your doctors. Dont do it alone.

I dont work for Eli Lily or am affiliated with them. So dont use that as an excuse. Im just an ordinary woman in my late 40's that tried to kill herself due to abuse as a child/teenager.... and Prozac saved my life. thats all.

Paige's picture

Muscle Twitches/Tics

I've only been on Prozac 20mg for 1 month and already have experienced under-the-eye twitches, twitches on the top side of my thigh and twitches (right now, in fact) on the back side of my upper arm. The eye twitches are worse when I'm anxious or stressed. I'm contemplating stopping this medication but fear my deep depression with come back. I, too, am wondering if these twitches go away after discontinuation of the med.

Frankie's picture

Avaza withdrawal symptoms twitching?

I have been taking Avanza "mirtazapine" for 18 mths, every time i reduce the dose my nervous system reacts badly causing facial spasms the most noticable being complet hemifacial spasms. I also get twitches all over my body in my calves thighs neck and numbness in my fingers which i attribute to the adrenaline dump that comes with the anxiety. When i dropped from 45mg to 30mg within a week i was rushed to hospital with complete facial palsy, nothing turned out to be neurological in that it wasnt a stroke or TIA. I havent been so scared in my whole life!! Ar these symptoms normal while dropping doses of such D's?

Anonymous's picture

facial tics

About 7 months age I started to have facial tics. I just started to search for an answer on the internet and came across your website. I have been taking Prozac and more recently Cymbalta which is also an anti-depressant utilizing SSRI.
I am 74 years of age. Is it likely there is a cause-effect relationship between the antidepressants and the facial tics.

karen 's picture

Celexa and tics

I have been taking Celexa 20 mg for 5 years. The last 6 months I have developed facial tics. They are worse at times that others. Does anyone else have the same? The DR. says Celexa does not cause this, .....stop drinking caffine.

Anonymous's picture

your posting re Celexa

Did you stop taking Celexa? If yes did the facial tics stop?
Joe

Alicia M. Estep's picture

Extreme Facial Tics

I have been on 60 mg Prozac fo some time, and thought I had finally found something that has worked for me. I really loved it. I never had any problems until I had three infected teeth pulled, and got a severe infection in that area, to where my immune system was compromised. I also, am a child of fetal alcohol syndome, so I feel that is why the prozac worked so well. Is there anyone out there, that can relate to any of this?
My whole face wrinkles up, and my eyes sockets feel like sand. The Dr's say there is nother on the EEG, that shows it is neuroloogical.

Cody Kennedy's picture

Do the tics stop????

I have been taking Prozac and Lamictal for a few months now and i have an increasing problem with facial and neck tics...they are horrible and are driving me nuts. I had no idea that these medications could cause this. Do the tics stop when the medication is stopped?? Thank you.

Anonymous's picture

Prozac and Adderall

My 9 year old son has ADHD and although I was against putting him on medication I finally had to because his grades and his behavior were getting out of hand. He was started on Adderall XR 10 mg and that has made such a huge difference in him. He went from being a straight C student to making mostly A's! Then he became really depressed and anxious and was crying all the time. I had him seeing a counselor and despite months of seeing his counselor he was still crying a lot, etc. so I decided to put him on a low dose of Prozac 10 mg. He has been on it for about 2 months now and the first thing was it made him sleepy. He actually fell asleep in class! I started giving it to him at night but then he started having eye tics. Now they are terrible! It has gotten so bad that the kids and other people are noticing and telling him about it which is making him feel bad. For some reason the a couple of days ago it dawned on me (duh) that maybe it was not the ADHD medication (as his doctor had thought) but the Prozac so I started researching it. Thank God I found this page because in addition to other things I have read this has clarified so much for me. I am no longer going to give him the Prozac and see what that does. I feel so terrible because sometimes the tics are so bad he keeps his eyes closed for a few seconds. I feel like such a horrible parent. Thanks to this website!!

Serendip Visitor's picture

I am right there with you.

I am right there with you. It has been a couple years since you posted. Can you tell me if the tics went away or got better. I feel just aweful about this and something needs to be done about this company not disclosing it when its obvious its been known for so long!~T

Anonymous's picture

Zoloft and Tics

I saw your post and was wondering if the your son's tics went away after discontinuing the prozac? I have a 9 year old son who has ADHD, he is on ritalin short acting, 3 times a day and his doctor put him 50mg zoloft. He has been on the zoloft for almost 3 months for aniexty, 2 months ago he started nose sniffing, now he is smacking his lips. We went to the doctor today and we are going to stop the zoloft. Any info would be helpful.

me's picture

tics

I was both on Zoloft n Prozac n many others. I think my tics first started with my eye then started happening with my head and neck. I was wondering if anyone else ever felt a wierd sensation that i can only compare to a numb tingling feeling in the back lower part of my head.Sometimes i can even hear an off sound when i feel that sensation. I always blamed it on the meds i was wondering if anyone else had a similiar feeling in the back of their heads.

Serendip Visitor's picture

Tingling beck of neck and,numb

Also lip twitch
While on ssri sertrauline zoloft

Tara's picture

i feel it too.

i am only 19 years old and had my first baby about two weeks ago. i have always had problems with depression but didnt decide to take medication untill after i had my baby because it seemed so much worse. i have been taking 20mg of prozac for 5 days now and i started developing eye twitches and the feeling in the back of my neck that you described... i really think that im going to dicontinue the use of it because ide rather feel a little down than have uncontrolled movements that annoy the heck out of me. i dont want these tics to become permanent its a scary thing to think about and the other things that the use of prozac can lead to really scares me... counciling would just be better.

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