Prozac vs Xanax: How do they compare?
Key Points
- Prozac (fluoxetine) is a selective serotonin reuptake inhibitor (SSRI), and Xanax (alprazolam) is a benzodiazepine.
- Both Prozac and Xanax may be prescribed to treat certain mental health conditions. Xanax is only FDA approved for use in adults, while Prozac can be used in children for some indications.
- Drowsiness is more common from taking Xanax, while Prozac tends to cause insomnia and nausea as side effects.
Prozac (fluoxetine) and Xanax (alprazolam) are both prescription medications used to treat mental health conditions, but they work in different ways. Below, we will review several differences between these two medications.
What are Prozac and Xanax used for?
Prozac (fluoxetine) and Xanax (alprazolam) are both used to treat some of the same and some different mental health conditions. Both medications require a prescription from a healthcare provider.
Prozac is FDA approved to treat:
- Major depressive disorder
- Obsessive-compulsive disorder
- Panic disorder
- Bulimia nervosa
- Depressive episodes associated with Bipolar I disorder
- Treatment-resistant depression
Xanax is FDA approved for adults to treat:
- Generalized anxiety disorder
- Panic disorder
It is important to note that certain forms of each medication treat specific conditions. In addition, Prozac is approved for children only for specific indications. Follow up with your healthcare provider to learn more.
Is Prozac a benzodiazepine?
One of the most common misconceptions involves the drug classifications of Prozac and Xanax. Prozac is not a benzodiazepine – it belongs to a class called selective serotonin reuptake inhibitors (SSRIs). Similarly, Xanax is not an SSRI – it's classified as a benzodiazepine.
How do Prozac and Xanax work?
Prozac and Xanax work in very different ways. Prozac belongs to a group of medications called selective serotonin reuptake inhibitors, or SSRIs. Xanax is a benzodiazepine.
Prozac is thought to work by increasing serotonin in the brain. Serotonin is a neurotransmitter that affects mood. It works gradually over 4-6 weeks to achieve its full therapeutic effect.
Xanax works by enhancing the effects of a chemical in the brain called gamma-aminobutyric acid (GABA). This neurotransmitter causes you to feel more calm and relaxed. It works rapidly, within 30-60 minutes for most.
| Prozac | Xanax | |
| Primary target | Serotonin system | GABA system |
| Mechanism | Blocks serotonin reuptake | Enhances GABA activity |
| Onset of action | 4-6 weeks | 30-60 minutes |
| Effect duration | Long-term mood stabilization | Short-term anxiety relief |
What dosage forms do Prozac and Xanax come in?
Both Prozac and Xanax are available in immediate-release and extended-release formulations.
Prozac comes as immediate-release capsules, tablets, and an oral solution. It also comes as a delayed-release capsule that is approved to treat major depressive disorder.
Xanax comes as immediate-release tablets, orally disintegrating tablets, and an oral solution. It also comes as an extended-release tablet that is approved for panic disorder.
How are Prozac and Xanax taken?
Prozac Dosing
The immediate-release formulations of Prozac are usually taken by mouth once a day. However, the dose can vary depending on your age and the reason you are taking it. The typical dose of the delayed-release capsule is 90 mg taken by mouth once a week.
Xanax Dosing
Xanax is usually taken by mouth three times a day, except for the extended-release tablet that is taken by mouth once a day. The typical starting dosages of Xanax are listed below.
Immediate-release formulations:
- Generalized anxiety disorder: 0.25 mg to 0.5 mg by mouth 3 times a day.
- Panic disorder: 0.5 mg by mouth 3 times a day.
Extended-release tablets:
- Panic disorder: 0.5 mg to 1 mg by mouth once a day.
Your healthcare provider may increase your dose based on how you respond to the medication.
Related questions
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Can you take Prozac and Xanax together?
Yes, Prozac and Xanax can be prescribed together under proper medical supervision. This combination is sometimes used when patients need both long-term mood stabilization (Prozac) and short-term anxiety management (Xanax). However, this requires careful monitoring due to potential interactions.
What are the side effects of Prozac and Xanax?
Prozac and Xanax have unique side effects. For example, common side effects of Prozac include sleeping problems, nausea and headache while Xanax more commonly causes drowsiness and memory problems.
The most common side effects reported by people taking Prozac in clinical trials include:
- Insomnia (up to 33%)
- Nausea (up to 29%)
- Headache (21%)
- Asthenia (weakness) (up to 21%)
- Diarrhea (up to 18%)
- Poor appetite (up to 17%)
- Drowsiness (up to 17%)
- Anxiety (up to 15%)
Everyone responds to medications differently. Side effects can vary depending on your age, dose, and medical conditions.
The most common side effects reported by people taking Xanax extended-release tablets in clinical trials include:
- Sedation (45% vs. 23% placebo)
- Drowsiness (23% vs. 6% placebo)
- Memory problems (15% vs. 7% placebo)
- Fatigue (14% vs. 9% placebo)
- Depression (12% vs. 9% placebo)
- Slurred speech (11% vs. 3% placebo)
The most common side effects reported by people taking immediate-release alprazolam in clinical trials include:
- Drowsiness (up to 77%)
- Tiredness (up to 49%)
- Difficulty with coordination (up to 40%)
- Irritability (up to 33%)
- Larger appetite (up to 33%)
- Memory problems (up to 33%)
- Trouble thinking (up to 29%)
- Smaller appetite (up to 28%)
- Weight gain (up to 27%)
- Constipation (up to 26%)
- Slurred speech (up to 23%)
- Weight loss (up to 23%)
- Light-headedness (up to 21%)
Prozac and Xanax should not be stopped abruptly to avoid withdrawal symptoms. If you need to stop taking one of these medications, speak to your healthcare provider about a safe way to do so.
What’s better for anxiety, Prozac or Xanax?
Both Prozac and Xanax may be prescribed to treat anxiety. However, SSRIs like Prozac are considered first-choice treatment for anxiety. Prozac is currently not FDA approved for treating anxiety, but other medications in the same class are approved for this use.
Benzodiazepines, like Xanax, are typically used for short-term treatment of anxiety. They may work faster to control anxiety symptoms compared to other treatment options. Your healthcare provider will regularly assess whether you need to continue to take Xanax for your anxiety symptoms, and will likely recommend a different long-term treatment option.
Studies have shown that benzodiazepines do not work better than antidepressants for treating anxiety. For panic disorder, benzodiazepines and SSRIs are comparable in how well they work. The choice of treatment is based on side effects, cost, drug interactions, and medical history.
This is not all the information you need to know about Prozac (fluoxetine) and Xanax (alprazolam) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.
References
Alprazolam tablet [package insert]. Updated January 2023. Actavis Pharma, Inc. Accessed on August 28, 2024 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a23063c0-099a-4256-b95f-3a857bbf704b
American Psychiatric Association. Updated January 2009. Practice Guideline for the Treatment of Patients with Panic Disorder, Second Edition. Accessed August 28, 2024 at https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/panicdisorder.pdf
Degeorge, K., et. al. 2022. Generalized Anxiety Disorder and Panic Disorder in Adults. In: American Family Physician. Accessed on August 28, 2024 at https://www.aafp.org/pubs/afp/issues/2022/0800/generalized-anxiety-disorder-panic-disorder.html
George, T. T., et. al. Updated April 2023. Alprazolam. In: StatPearls [Internet]. Accessed on August 28, 2024 at https://www.ncbi.nlm.nih.gov/books/NBK538165/
National Institute for Health and Care Excellence. Updated June 2020. Generalised anxiety disorder and panic disorder in adults: management. Accessed August 28, 2024 at https://www.nice.org.uk/guidance/cg113/resources/generalised-anxiety-disorder-and-panic-disorder-in-adults-management-pdf-35109387756997
Prozac [package insert]. Updated August 2023. Dista Products Company. Accessed on August 28, 2024 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c88f33ed-6dfb-4c5e-bc01-d8e36dd97299
Sohel, A. J., et. al. Updated February 2024. Fluoxetine. In: StatPearls [Internet]. Accessed on August 28, 2024 at https://www.ncbi.nlm.nih.gov/books/NBK459223/
Xanax XR [package insert]. Updated January 2023. PHARMACIA & UPJOHN COMPANY LLC. Accessed August 28, 2024 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=aa58fff3-c297-49be-838b-599c32ad9835
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