One of the most common medications I see in clinical practice on a daily basis is fluoxetine or Prozac. Consequently, I hear many complaints concerning the side effects of this medication and am frequently asked by patients to help manage these side effects with acupuncture and Chinese medicine. The two most common side effects I see in clinical practice with patients taking Prozac are: loss of libido and fatigue. I want to share an interesting new study and two important statements of fact in Traditional Chinese Medicine to explore treatment protocols for low libido and fatigue in patients taking Prozac.
Treating side effects from allopathic medications can be an overwhelming challenge for clinicians, however for practitioners of Traditional Chinese Medicine we can always use the "scope" of the statements of fact of Chinese Medicine to guide our clinical vision. I always view new research through these "lens" or "scope" of Chinese Medicine and was very interested in a new article published in New Scientist (study referenced via the journal Nature Medicine) entitled "Antidepressant makes bones weaker by slowing down bone growth." This study quickly reminded me of the TCM statement of fact: The Kidneys control the Bones. In this study, the drug fluoxetine was slowing down bone growth. Using the scope of TCM, I was reminded of how the common symptom of low libido is a common symptom of Kidney Vacuity. One of the most common TCM patterns I see in patients with long term use of Prozac in Kidney Vacuity, mainly Kidney Yin Vacuity. It is most common to see a scarlet, dry tongue with fissures in these patients as well, another sign of Kidney Vacuity. The following are the key formulas I use for managing and ameliorating the symptom of low libido due to Kidney Vacuity in these unique cases.
Liu Wei Di Huang Wan/Zhi Bai Di Huang Wan: These two foundational formulas are very important gentle formulas for targeting low libido in Kidney Yin Vacuity. I typically use these in concentrated tablet form as opposed to standard patent medicine due to the large dosage of patent pills necessary to resolve the pattern. Therapy is one to three months and in most cases, I recommend the use of B-complex vitamins and the use of 500 mg of Pantothenic Acid daily in order to help with the stress of the condition. Practitioners and students can easily reference standard TCM texts for more information on these foundational formulas.
Zuo Gui Wan: This is a Ming dynasty formula for nourishing Kidney Yin and Jing and tends to be a bit more heavy and cloying than the aforementioned Liu Wei Di Huang Wan/Zhi Bai Di Huang Wan. I use when patients show deeper signs of Kidney Vacuity along with low libido such as lower back pain, knee pain, insomnia, dizziness or basic overall fatigue. This formula can also be combined with Liu Wei/Zhi Bai Di Huang Wan.
When the presenting complaint is low libido combined with overall fatigue, I am reminded of the TCM statement of fact: The Liver and Kidneys share a common source. In these cases, I rarely see standard Spleen Qi Vacuity signs such as pale tongue with teeth marks and slippery/wiry pulses. Usually I see red, dry tongues with fissures and the pulse is wiry, thready and or fast. In other words, I more commonly see Liver Blood Vacuity/Liver Yin Vacuity as opposed to a generic Spleen Qi Vacuity. However, since Qi and Blood share an intimate relationship, I often still use formulas which address the issue of Qi Vacuity along with the Blood/Yin Vacuity. It's important to remember that Qi nourishes Blood and Blood nourishes Yin. And consequently since Liver and Kidneys share a common source, I almost always use some type of Kidney formula along with a formula for Liver Blood or Qi Vacuity in cases of side effects due to Prozac. The following formulas are the most common ones I use for fatigue in patients using Prozac who present with standard Liver/Kidney Yin Vacuity signs. I almost always combine the following formulas with Liu Wei / Zhi Bai Di Huang Wan.
Ren Shen Yang Rong Wan: This is an excellent formula for systemic vacuities of Qi, Blood, Yin and Yang. It can easily be combined with other formulas as needed based upon the TCM pattern differentiation.
Shi Quan Da Bu Wan: This is another excellent formula for use with basic Yin tonics, and contains Rou Gui to stimulate Yang which can be helpful when using Yin tonics long term.
Bu Nao Wan: This is one of the most underutilized formulas for mental and physical fatigue in patients presenting with Liver Blood/Kidney Yin vacuity combined with Qi Vacuity. I frequently combine this formula with Shi Quan Da Bu Wan in cases of long-standing physical fatigue and mental malaise from long term use of Prozac. It is extremely effective and works quickly.
I hope this short article on the use of some common TCM formulas for low libido and fatigue due to the use of Prozac inspires clinicians to use the "scope" or "lens" of Chinese Medicine to think logically and creatively instead of blinding handing out the usual Liver Qi stagnation formulas in cases of "depression." Traditional Chinese Medicine offers an exquisite array of formulas to help resolve the complex pattern presentations which the use of long-term allopathic medications can create. Take your time and see beyond the surface with patients suffering from side effects from allopathic medications and use the vision of Traditional Chinese Medicine to guide your way.
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