Does Prozac cause mood swings? (+3 evidences)
By
Dr Maryam Shabbir (PhD)
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
Author bio
Dr Maryam Shabbir PhD is a pharmacist with expertise in drugs delivery, pharmacology, dosage form design, transdermal drug delivery system, microneedles, and solubility enhancement. She writes and reviews content on these topics.
Dr Maryam Shabbir’s Highlights:
Assistant Professor at The University of Lahore, Lahore, Pakistan.
PhD in Pharmaceutics with a focus on solubility enhancement of BCS class II and III drugs and their delivery through transdermal route using microneedles.
Doctor of Pharmacy at the University of Lahore with a two-year scholarship.
Professional Experience:
Dr Maryam Shabbir joined Faculty of Pharmacy, The University of Lahore as soon as she completed her Pharm-D in 2010. In 2017, she got promoted as an assistant professor.
Dr Maryam Shabbir has supervised twenty two M.Phil. students in pharmaceutics in areas such as transdermal drug delivery system, nanoparticles, microparticle, solid dispersion, and transdermal patches.
Dr Maryam Shabbir has also contributed to several business consultancies and research projects, including the development of lyophilized wafer of Acyclovir with Medisearch Pharmacal Pvt. Ltd., a major pharmaceutical industry in Pakistan.She has also worked as a team member in one of the Contract Research Organizations of Pakistan.
Dr Maryam Shabbir has organized two International conferences and three national conferences as conference secretary for the University of Lahore in collaboration with Punjab Higher Education Commission of Pakistan.
Dr Maryam Shabbir has submitted two patents to the Intellectual Property Organization of Pakistan (IPO), and three patents are in pipeline. She has also presented her work in different exhibitions organized by the Higher Education Commission of Pakistan. She works in close liaison with the Innovation Hub, University of Lahore, Pakistan.
Dr Maryam Shabbir participated as a member of the examination board for several Master’s exams and as an external examiner for Pharm-D in reputable universities of Pakistan. She is also a member of Punjab Pharmacy Council and Pakistan Pharmacist Association.
Education:
2010 Pharm D at the University of Lahore, Lahore, Pakistan
2013 Master of Philosophy (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
2022 PhD (Pharmaceutics) at the University of Lahore, Lahore, Pakistan
The main publications of Dr. Maryam Shabbir are:
Saeed S, Barkat K, Ashraf MU, Shabbir M, Anjum I, Badshah SF, et al. Flexible Topical Hydrogel Patch Loaded with Antimicrobial Drug for Accelerated Wound Healing. Gels. 2023;9(7):567.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, et al. Preparation and characterization of polymeric cross-linked hydrogel patch for topical delivery of gentamicin. e-Polymers. 2023;23(1):20230045.
Arshad J, Barkat K, Ashraf MU, Badshah SF, Ahmad Z, Anjum I, Shabbir M, Mehmood Y, Khalid I, Malik NS, Bin Jardan YAl. Fabrication of pH responsive hydrogel blends of chondroitin sulfate/pluronic F-127 for the controlled release of ketorolac: its characterization and acute oral toxicity study. Drug Development and Industrial Pharmacy. 2022;48(11):611-22.
Maher S, Shabbir M, Anam I, Khan N, Iqbal S, Saleem F. Anti-inflammatory and anti-oxidant activities of methanolic extract of medicinal plants from Balochistan. Int J Biol Biotechnol. 2020;15:691-7.
Shabbir M, Sajid A, Hamid I, Sharif A, Akhtar MF, Raza M, et al. Influence of different formulation variables on the performance of transdermal drug delivery system containing tizanidine hydrochloride: in vitro and ex vivo evaluations. Brazilian Journal of Pharmaceutical Sciences. 2019;54:e00130.
Nagra U, Adnan S, Shafqat S, Shabbir M, Ali S, Zafar A, et al. Effect of Sustained Release Polymers on Drug Release Profile of Aceclofenac Tablets Physicochemical Properties, Analysis of Kinetics and Fit Factor. Indian J Pharm Educ Res. 2019;53:58-65.
Fatima S, Akhtar MF, Ashraf KM, Sharif A, Saleem A, Akhtar B, Peerzada S, Shabbir M, Ali S, Ashraf W, Antioxidant and alpha amylase inhibitory activities of Fumaria officinalis and its antidiabetic potential against alloxan induced diabetes. Cellular and molecular biology (Noisy-le-Grand, France). 2019;65(2):50-7.
Saeed S, Raza M, Shabbir M, Akhtar MF, Sharif A, Zaman M, et al. Study of Multi-Drug Resistance Associated with Anti-Tuberculosis Treatment by DOT Implementation Strategy in Pakistan. Journal of Basic & Applied Sciences. 2018;14:107-12.
Arshad I, Ali S, Amin U, Shabbir M, Raza M, Sharif A, et al. Effect of hydrophilic and hydrophobic polymer on the release of ketoprofen and allopurinol from bilayer matrix transdermal patch. Advances in Polymer Technology. 2018;37(8):3076-83.
Sohail K, Javaid Z, Hamid I, Sharif A, Akhtar MF, Raza M, Ali S, Shabbir M, Peerzada S, Ahmad S. Formulation and evaluation of ranitidine floating tablets using different polymer combinations. Journal of Toxicological &Pharmaceutical Sciences. 2017;1(1):18-25.
Sharif A, Akhtar MF, Akhtar B, Saleem A, Manan M, Shabbir M, et al. Genotoxic and cytotoxic potential of whole plant extracts of Kalanchoe laciniata by Ames and MTT assay. EXCLI journal. 2017;16:593.
Shahid N, Adnan S, Farooq M, Ali S, Shabbir M, Masood Z, et al. Development of compressed coated polypill with mucoadhesive core comprising of atorvastatin/clopidogrel/aspirin using compression coating technique. Acta Poloniae Pharmaceutica. 2017;74(2):477-87.
Shabbir M, Fazli AR, Ali S, Raza M, Sharif A, Akhtar MF, et al. Effect of hydrophilic and hydrophobic polymer on in vitro dissolution and permeation of bisoprolol fumarate through transdermal patch. Acta Pol Pharm. 2017;74:187-97.
Saba Mazhar NS, Raza M, Akhtar B, Zahra A, Akhtar MF, Saleem A, Chishti SA, Shabbir M, Sharif A. A descriptive study of Measles outbreak in Lahore, Pakistan in 2013. J Toxicol Pharmaceut Sci. 2017;1(1):26-30.
Manzoor I, Raza M, Shabbir M, Ali S, Akhtar MF, Peerzada S, et al. Formulation and characterization of curcumin nanoparticles prepared from eudragit L-100 and poly vinyl alcohol as polymer. J Toxicol Pharmaceut Sci. 2017;1(1):7-12.
Akhtar MF, Sharif A, Saleem M, Saleem A, Akhtar B, Raza M, Ijaz H, Shabbir M, Ali S, Nasim MB, Peerzada S. Genotoxic and cytotoxic potential of Alternanthera Bettzickiana, an important ethno-medicinal plant. Cellular and Molecular Biology. 2017;63(8):109-14.
Ahmed S, Saeed-Ul-Hassan S, Islam M, Qureshi F, Waheed I, Munawar I, Ishtiaq S, Rasool S, Akhtar MF, Chishti SA, Shabbir M. Anti-oxidant activity of Pistachia khinjuk supported by phytochemical investigation. Acta Pol Pharm. 2017;74(1):173-8.
Shahid N, Ali S, Shabbir M, Waqar K. Compressed coated polypill with mucoadhesive core for cardiovascular disease-A review. The Pharma Innovation. 2016;4(3, Part B).
Shabbir M, Ali S, Farooq M, Adnan S, Yousaf M, Idrees A, et al. Formulation factors affecting in vitro and ex vivo permeation of bisoprolol fumarate from a matrix transdermal patch. Advances in Polymer Technology. 2016;35(3):237-47.
Mehmood A, Hamid I, Sharif A, Akhtar MF, Akhtar B, Saleem A, Shabbir M, et al. Evaluation of anti-inflammatory, analgesic and antipyretic activities of aqueous and ethanolic extracts of seeds of Buchanania lanzan Spreng. In animal models. Acta poloniae pharmaceutica. 2016;73(6):1601-8.
Ali S, Shabbir M, Shahid N, Amin U, Hamid I, Raza M. Effect of Polysorbate 80 Through Rabbit’s Skin Using Transdermal Patch Loaded with Bisoprolol Fumarate as Model Drug. Pakistan J Zool. 2016;48(1):227-34.
Akhtar MF, Saleem A, Sharif A, Akhtar B, Nasim MB, Peerzada S, Raza M, Ijaz H, Ahmed S, Shabbir M, Ali S. Genotoxic and cytotoxic action potential of Terminalia citrina, a medicinal plant of ethnopharmacological significance. EXCLI journal. 2016;15:589.
Ali S, Shabbir M, Shahid N. The Structure of Skin and Transdermal Drug Delivery System-A Review. Research Journal of Pharmacy and Technology. 2015;8(2):103-9.
Shabbir M, Ali S, Shahid N, Rehman K, Amin U, Raza M. Formulation considerations and factors affecting transdermal drug delivery system-A review. International Journal of Pharmacy and Integrated Life Sciences. 2014;2(9):20-35.
Ali S, Shabbir M, Farooq M, Adnan S, Shahid N. The enhancement effect of permeation enhancers on Bisoprolol fumarate across animal membrane using Franz diffusion cell. Research Journal of Pharmacy and Technology. 2014;7(12):1391-5.
Conference papers
Shabbir M (2022), Sustainable Development Goals (SDGs): A Policy Gap between Health and Pharmaceutical Industry. In International Social Science Conference 2022 (School of International Social Sciences, University of Lahore).
Shabbir M (2022), Controlling Permeation of Ketoprofen and Allopurinol through Bilayer Transdermal Patch using Multiple Pharmaceutical Ingredients. In Current Advancement in Pharmacy Practice (CAPP)- Theory to Practice (University of Lahore, Lahore)
Shabbir M (2018), Nanocarriers Mediated Photodynamic Therapy for the Treatment of Different Cancers. In the 4th Annual International Pharmacy Scientific Symposium and Poster Exhibition-2018 (University of Central Punjab, Lahore).
Shabbir M (2018), Lipid Enveloped Polymeric Nanoparticles for Targeted Photodynamic Chemotherapy. In the 3rd International Health Trigon Summit-2018 (University of Lahore).
You can view some of Dr Maryam’s work below and links to her professional profile.
Publon Profile: publons.com/researcher/1495244/maryam-shabbir
ORCID: 0000-0002-9308-5175
Researchgate: https://www.researchgate.net/profile/Maryam-Shabbir-4
Google Scholar: Maryam Shabbir – Google Scholar
Linkedin Profile: https://www.linkedin.com/in/maryam-shabbir-b409a270
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss if Prozac tends to alter your mood and cause mood swings. A mood swing is an abrupt or dramatic shift in a person’s emotional state. Mood swings in men and women can have a variety of causes, such as physical or mental health issues, and the use of certain antidepressants.
Does Prozac cause mood swings?
Yes, Prozac can cause mood swings. During the initial stages of Prozac administration, you might experience mood swings. These mood swings can be mild with no effect on your daily life, or they might be intense and interfere with your daily work. Once the body is adapted to the drug, these symptoms might go away. Clinical data also suggest that Prozac can be used to treat mood swings in certain disease conditions.
When starting the treatment, the patient should keep an eye out for new or worsening suicidal or depressive thoughts. This includes abrupt mood change, behaviour, or thought shift. These changes can occur at any moment but are more likely to happen at the start of treatment or following a dose modification.
Patients with bipolar disorder who use Prozac may experience manic episodes. Change in feelings or behaviour such as feeling worried, nervous, irritable, hostile, aggressive, agitated, and hyperactive episodes should be monitored.
How is Prozac linked with mood swings?
The destabilizing effect of Prozac on mood in Bipolar disorder (BD) has been attributed to the alteration in the Plns cycle. Prozac increases the integration of inositol generated by PIP2 (phosphotidylinositide, 4-5 biphosphate) hydrolysis into Plns resynthesis, which explains Prozac’s capacity to cancel off the effect of other stimulants used to stabilise mood swings (1).
It is also possible that Prozac’s effects on Plns turnover contribute to its antidepressant effect in unipolar depression, but more cruicially, to its mood destabilising effects in bipolar patients when taken without the balance of a mood stabilizer (1).
It has been reported that patients suffering from ‘subaffective syndrome’ (subsyndromal form of major mood disorder) respond well to Prozac treatment. Prozac has been found useful in patients who do not exhibit premorbid traits but whose depression is characterised by mood swings, irritability, and rumination (2).
What does the research suggest?
Prozac is prescribed to treat depression, panic attacks, bulimia, and premenstrual syndrome. Clinical data suggests that Prozac primarily aids in the improvement of mood swings, hunger, sleep, and energy levels, as well as the elimination of undesirable thoughts, fear or worry. It is a beneficial treatment to stay calm and relaxed (3).
In a three-blind clinical trial, it was established that Prozac decreased the symptoms associated with premenstrual syndrome including mood swings, depression, and abdominal bloating. It was also able to relieve breast and stomach discomfort (4).
In another case, a pregnant woman who presented with severe cases of nausea and vomiting during pregnancy was treated with Prozac due to her depression. She also admitted to being afraid of premature birth, and postpartum depression. After receiving Prozac for six days, she was able to accept an intake of antiemetic drugs. She reported feeling happier and experienced improvement in her mood swings and sleeping patterns. She added that she had given up on ending her pregnancy (5).
Prozac can also be used to improve mood swing associated with premenstrual disorders in which the patient might experience mental, behavioural, and physical symptoms that appears the day before and disappear immediately after menstruation (6).
What other factors might influence mood while on Prozac?
Various factors can cause mood swings while you are taking Prozac.
- Diet: A person may have mood swings due to blood sugar fluctuation and malnourishment if they are consuming an inadequate diet. Mood swings have also been linked to digestive problems like inflammatory bowel disease, and celiac disease that impair the body’s capacity to absorb nutrition.
- Prescription drugs: A person’s mood may change by taking or quitting a prescribed medicine. Although mood swings are a common side effect of antidepressants and mood stabilisers, mood swings can also be brought on by prescription drugs for other purposes (7).
- Sleep: The quantity of sleep that an individual receives can also have a significant impact on their mood. Intense mood swings and other psychiatric symptoms might be experienced by someone who lacks sleep, especially if the condition is chronic.
- Substance abuse: Extreme mood swings may also be more common in people with substance abuse disorder, particularly when they are unable to get or use a substance. Mood swings can also occur during the withdrawal period.
What is the prognosis of mood disorder?
The prognosis for mood disorders is dependent upon multiple factors such as:
- The nature of ailment and how bad it,
- How quickly it is identified, and
- If it receives the right care.
A poor prognosis is increasingly linked to recurrent episodes of mood disorders that can lead to underscoring the significance of prompt and efficient treatment.
How to manage mood swings when taking Prozac?
Mood swings can be difficult, particularly if they affect your relationships, job or school, and daily activities. Frequent and severe mood swings should be discussed with your doctor because treating them properly depends on determining the underlying medical reason.
The first step is figuring out what aspects of your life and surroundings, like stress, and restless nights, are contributing to or preceding your mood swings. Depending on the reason, you should modify your lifestyle and adopt more positive changes in your life.
Prozac is known to cause anxiety in the initial phases of the therapy. If Prozac is causing exacerbating mood swings, medications known as mood stabilisers, psychotherapy, counselling, and cognitive behavioural therapy (CBT) may be beneficial.
When to consult the doctor?
If the intensity of mood swings affects the quality of life then it is better to consult the doctor. The doctor will inquire about past medical history, any drugs co-administered with Prozac, and any diagnosis of mood disorders in the family. Although there is currently no known way to prevent mood disorders, medications may be able to decrease many of the associated problems.
The doctor might advise the patient to switch to a different antidepressant, increase the dosage of Prozac, or combine it with other mood stabilizers as part of your ongoing treatment.
Conclusion
In this article, we have discussed the impact of Prozac on mood swings. We have also discussed some non-pharmacological of managing mood swings while on Prozac.
Was this helpful?
References
1.-
Saiardi A, Mudge AW. Lithium and fluoxetine regulate the rate of phosphoinositide synthesis in neurons: a new view of their mechanisms of action in bipolar disorder. Translational psychiatry. 2018 Aug 31;8(1):175. https://www.nature.com/articles/s41398-018-0235-2
2.-
Bell DS, Shipman WM, Cleves MA, Siegelman J. Which drug for which patient? Is there a fluoxetine responding versus a bupropion responding personality profile?. Clinical Practice and Epidemiology in Mental Health: CP & EMH. 2013;9:142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735924/
3.-
Aswal N, Singh SK, Kamarapu P. Study on Antidepressant Drug to Cure Depression. J Formul Sci Bioavailab. 2018;2(121):2577-0543. https://www.researchgate.net/profile/Praneeth-Kamarapu/publication/328403845_Study_on_Antidepressant_Drug_to_Cure_Depression/links/5bcafb98458515f7d9cbf9c6/Study-on-Antidepressant-Drug-to-Cure-Depression.pdf
4.-
Nemat-Shahi M, Asadi A, Nemat-Shahi M, Soroosh D, Mozari S, Bahrami-Taghanaki H, Mehrpour M. Comparison of saffron versus fluoxetine in treatment of women with premenstrual syndrome: A randomized clinical trial study. Indian Journal of Forensic Medicine & Toxicology. 2020 Apr 1;14(2). https://web.s.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=09739122&AN=148369738&h=GzwBTwd7xtkOkAk15ndCGRT%2fPDf0bfNcDfpnHh%2fOmzjWxFbKFubCZXkaA%2fU8aa3B%2fBnrz0fLTv%2bhZU%2f0dE4Dxg%3d%3d&crl=c&resultNs=AdminWebAuth&resultLocal=ErrCrlNotAuth&crlhashurl=login.aspx%3fdirect%3dtrue%26profile%3dehost%26scope%3dsite%26authtype%3dcrawler%26jrnl%3d09739122%26AN%3d148369738
5.-
Sharma P, Johnathan Heller MS, Wakefield S. Treatment of Hyperemesis Gravidarum by Fluoxetine in a Depressed Pregnant Patient: A Psychosomatic Dimension. https://www.researchgate.net/profile/Pravesh-Sharma/publication/294090881_Treatment_of_Hyperemesis_Gravidarum_by_Fluoxetine_in_a_Depressed_Pregnant_Patient_A_Psychosomatic_Dimension/links/56be533308aee5caccf300df/Treatment-of-Hyperemesis-Gravidarum-by-Fluoxetine-in-a-Depressed-Pregnant-Patient-A-Psychosomatic-Dimension.pdf
6.-
Chin LN, Nambiar S. Management of premenstrual syndrome. Obstetrics, Gynaecology & Reproductive Medicine. 2017 Jan 1;27(1):1-6. https://link.springer.com/chapter/10.1007/978-3-319-40404-2_10
7.-
Cartwright C, Gibson K, Read J, Cowan O, Dehar T. Long-term antidepressant use: Patient perspectives of benefits and adverse effects. Patient Prefer Adherence. 2016; 10: 1401–7. https://www.dovepress.com/long-term-antidepressant-use-patient-perspectives-of-benefits-and-adve-peer-reviewed-fulltext-article-PPA
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