Does Prozac damage brain cells? (+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 whether the use of Prozac can cause brain cell damage. Prozac is a selective serotonin reuptake inhibitor (SSRI). In addition to its effect on serotonin levels, Prozac can promote neurogenesis and alter pathways involved in neural plasticity and neuronal survival.
Does Prozac damage brain cells?
Yes, Prozac is known to cause damage to brain cells. The long-term use of Prozac can lead to brain damage and neurological agitations. However, no sign of brain injury or loss of intellectual capacity is observed in patients taking Prozac for a shorter time.
Chronic Prozac exposure alters the expression of genes involved in myelination, a process that regulates brain connectivity. The long-term use of Prozac can also cause a shift in fatty acid metabolism. Lipids help in the formation of cell membranes and are required for normal brain function. Deficiencies and abnormalities in fatty acid metabolism can lead to brain damage.
On the flip side, an International joint study revealed that persistent depression causes brain damage rather than Prozac being a risk factor for it. Some clinical and animal studies have suggested that Prozac can protect against cerebral ischaemia.
What is the potential effect of Prozac on the brain cells?
Several gene expression experiments in rodents have revealed that, in addition to the serotogenic systems, SSRIs like Prozac can alter a wide range of pathways. Adult SSRI drugs can change gene expression levels of hypothalamic hormones, neurotrophic factors, components of non-serotogenic neurotransmitters, and inflammatory factors.
Downregulation of proinflammatory cytokines can limit HPA axis function (facilitating stress reduction), enhance serotonin (5-HT) and dopamine production, and inhibit 5-HT and dopamine absorption (1, 2).
Critically, 5-HT functions as a neurotransmitter throughout development. In particular, 5-HT regulates neurodevelopmental processes such as neuron migration and brain formation during the early stages of development (2).
What does the animal experimental data suggest?
Exposure to SSRIs during brain development has been shown to disrupt the formation of the myelin sheath in rats. Additionally, there is evidence that Prozac can alter the microstructure of white matter during adulthood, which is primarily made up of myelinated axons (3).
In one of the studies, when Prozac was administered in adult and neonatal rats, the regulation of Cntf, a neurotrophic factor involved in myelination, revealed an opposing pattern in the adults. There was a negative correlation between the expression of genes related to myelination and anxiety-like behaviour. The authors concluded that long-term exposure to Prozac results in alterations in the expression of genes related to myelination, a process that modifies brain connectivity (4).
In another study, 10mg/kg of Prozac provided after global cerebral ischemia reduced neuronal damage. Although long-term neuroprotection requires more research, the authors’ findings imply that Prozac may have therapeutic potential and neuroprotective effects when given after cerebral ischaemia, cardiac arrest, and cardiopulmonary resuscitation (5).
In a study conducted on mice, Prozac inhibited apoptotic cell death in hippocampus neurons as well as vascular endothelial cell death while improving learning and memory. The author’s finding suggested that Prozac’s neuroprotective effect is likely mediated by blocking matrix metalloproteases (MMP) activation following blood-brain barrier (BBB) disruption after transient global ischemia. Thus, Prozac may be a potential therapeutic agent for preserving BBB integrity following ischemic brain injury (6).
How does Prozac alter the brain structure in humans?
In a case report, a patient with OCD was treated with Prozac after a brain injury. The investigators observed a reduced quantity of serotonin neurons emerging from the raphe nuclei and lesions in the orbital-frontal circuits, which are implicated in OCD following traumatic brain injury (7).
In a preliminary pilot study, patients who were administered 40 mg/day of Prozac showed a decrease in choline was assessed in grey matter tissue after the first and second weeks of administration. The apparent diffusion coefficient was raised in white matter lesions at week one and N-acetyl aspartate was increased in the second week.
The observed partial normalization of the structure-related Magnetic Resonance Spectroscopy (MRS) parameter in white matter lesions provided evidence of Prozac’s neuroprotective effect in multiple sclerosis (8).
What are the long-term effects of Prozac on the brain?
Prozac is generally administered for months or years at a time. It has an energizing effect that usually becomes apparent during the first few weeks. These new effects can be felt almost immediately. Long-term use of Prozac can cause brain damage and the patient might experience symptoms like neurological agitation, suicidal thoughts, panic attacks, anxiety, and mood changes.
Prozac’s long-term effects last much beyond the initial few days or weeks of medication. In one of the case reports, prolonged use of Prozac led to tic (tongue darting in and out of the mouth) in a female patient. The condition persisted even when the drug was discontinued. The involuntary and disfiguring symptoms included:
- Lip puckering,
- lip-smacking,
- fish-like kissing motions, and
- pelvic thrusting.
What are the mitigation plans for Prozac-induced brain damage?
Caring for a person who has suffered brain damage due to Prozac can impose greater difficulties on the patient and their family members. It will be beneficial if family members:
- Have enough knowledge of the impacts of acquired brain damage,
- recognise the obstacles that may arise in the life of the patient,
- accept that rehabilitation is a slow process.
Depending upon the severity of brain damage, the patient might be referred to a neurologist or a physiotherapist.
Considering the benefits vs. risks of Prozac
Despite the black box warning for increased suicidal thoughts, Prozac is the only SSRI that is not prohibited for children. This signifies that the advantages of using Prozac exceed its risks and side effects.
Long-term Prozac use can cause damage to brain cells or decrease memory and psychomotor function. However, short-term use reduces the occurrence of such changes. Therefore, it is important to comply with the dosage regimen and slowly taper off the medication when needed.
Conclusion
It is important to consult your healthcare provider if you are on long-term treatment of Prozac and happen to experience any abnormal behaviour. Never take any side effects casually and always comply with the follow-up plan with your healthcare provider.
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References
1.-
Kroeze Y, Zhou H, Homberg JR. The genetics of selective serotonin reuptake inhibitors. Pharmacology & therapeutics. 2012 Dec 1;136(3):375-400. https://www.sciencedirect.com/science/article/abs/pii/S0163725812001878
2.-
Alme MN, Wibrand K, Dagestad G, Bramham CR. Chronic fluoxetine treatment induces brain region-specific upregulation of genes associated with BDNF-induced long-term potentiation. Neural plasticity. 2007 Oct;2007. https://www.hindawi.com/journals/np/2007/026496/
3.-
Fan Q, Yan X, Wang J, Chen Y, Wang X, Li C, Tan L, You C, Zhang T, Zuo S, Xu D. Abnormalities of white matter microstructure in unmedicated obsessive-compulsive disorder and changes after medication. PloS one. 2012 Apr 27;7(4):e35889. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0035889
4.-
Kroeze Y, Peeters D, Boulle F, Van Den Hove DL, Van Bokhoven H, Zhou H, Homberg JR. Long-term consequences of chronic fluoxetine exposure on the expression of myelination-related genes in the rat hippocampus. Translational psychiatry. 2015 Sep;5(9):e642-. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5068807/#:~:text=In%20conclusion%2C%20our%20data%20reveal,to%20symptoms%20of%20psychiatric%20disorders.
5.-
Taguchi N, Nakayama S, Tanaka M. Fluoxetine has neuroprotective effects after cardiac arrest and cardiopulmonary resuscitation in mouse. Resuscitation. 2012 May 1;83(5):652-6. https://www.sciencedirect.com/science/article/abs/pii/S0300957211006344
6.-
Lee JY, Lee HE, Kang SR, Choi HY, Ryu JH, Yune TY. Fluoxetine inhibits transient global ischemia-induced hippocampal neuronal death and memory impairment by preventing blood–brain barrier disruption. Neuropharmacology. 2014 Apr 1;79:161-71. http://www.sciresearch.co.kr/htm/pdf/2014%20neuropharmacology.pdf
7.-
Stengler-Wenzke K, Müller U. Fluoxetine for OCD after brain injury. American Journal of Psychiatry. 2002 May 1;159(5):872-. https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.159.5.872
8.-
Sijens PE, Mostert JP, Irwan R, Potze JH, Oudkerk M, De Keyser J. Impact of fluoxetine on the human brain in multiple sclerosis as quantified by proton magnetic resonance spectroscopy and diffusion tensor imaging. Psychiatry Research: Neuroimaging. 2008 Dec 30;164(3):274-82. https://www.sciencedirect.com/science/article/abs/pii/S0925492707002612
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