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Paxil is an antidepressant medication that entered the U.S. market in 1992. Paxil treats depression and anxiety disorders and is generally safe when used as prescribed. However, Paxil can interact with various drugs, and certain individuals may be more susceptible to its side effects.
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Although not addictive, long-term use of this antidepressant can lead to adverse symptoms upon discontinuation of drug use. While this can make the cessation of use difficult, a gradual reduction of drug dosage can help avoid these adverse symptoms.
Although generally well-tolerated, Paxil (paroxetine) use is associated with a higher risk of sexual side effects, like impotence and decreased libido than other antidepressants.
Paxil is the brand name for the antidepressant drug paroxetine. Other common brand names for paroxetine include:
Paxil belongs to the family of drugs called selective serotonin reuptake inhibitors (SSRIs). Neurotransmitters are chemicals in the brain that relay messages between different brain cells. Serotonin is one such neurotransmitter that plays a vital role in emotional and mental well-being.
Depression and anxiety disorders are associated with lower serotonin levels in the brain. SSRIs like Paxil help to alleviate the symptoms of depression by restoring balance to the brain’s serotonin system. Paxil and other SSRIs exert these effects by increasing the levels of serotonin.
Paxil is approved for the treatment of various anxiety and mood disorders. These include:
Although Paxil is a relatively safe medication when used as prescribed, Paxil may pose a substantial risk for certain subsets of individuals. For example, individuals below the age of 25 years are at risk of suicidal thoughts and actions after taking the medication.
Taking Paxil during pregnancy can increase the risk of birth defects, such as congenital heart defects. In addition, Paxil also passes through breast milk, and new mothers must seek medical advice before breastfeeding. Women with a family history of breast cancer must also avoid Paxil. Lastly, the drug may only be used as a last resort treatment for mood or anxiety disorders.
The use of Paxil alongside other medications may have adverse and potentially serious consequences. Since it works by increasing the levels of serotonin in the central nervous system, the use of other drugs that similarly increase serotonin levels can have life-threatening consequences. Serotonin syndrome or serotonin toxicity refers to these adverse symptoms that are due to excessive serotonin levels.
Presentation of serotonin syndrome may involve symptoms such as:
Hence, one should avoid using other antidepressants like monoamine oxidase inhibitors, tricyclic antidepressants, or SSRIs while using Paxil. Other drugs to avoid include non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.
Besides potentially causing serotonin toxicity when used with certain drugs, Paxil may also interfere with the action of other medications by blocking certain liver enzymes. Hence, the use of all other medications must be cleared by a doctor before initiating treatment with Paxil.
Using Paxil during the first trimester of pregnancy can increase the risk of birth defects, whereas the use of this medication in the third trimester can lead to withdrawal symptoms in the infant.
Like most antidepressant drugs, Paxil is also associated with some side effects after initiation of treatment. Many of these adverse effects subside within the first few weeks of treatment, but some may be serious enough to require switching medications.
Some of the most common side effects include:
Other less frequent disorders include:
Some relatively rare but serious adverse effects of Paxil include worsening of depression, suicidal thoughts, seizures, mania, and low blood sodium levels.
Whether the long-term use of Paxil results in addiction has been debated over the past 20 years. Much of this debate has revolved around the criteria used for identifying addiction. Furthermore, there is an absence of studies that have examined the addictive potential of Paxil.
However, it is clear that the discontinuation of Paxil after prolonged use can result in the development of severe withdrawal or discontinuation symptoms. These withdrawal symptoms are either mild or absent in most individuals but can be severe in some cases. The rate of appearance of such symptoms is higher with Paxil than other SSRIs, especially in younger individuals.
Commonly observed withdrawal symptoms may include:
These withdrawal or discontinuation symptoms tend to disappear upon reinstatement of drug use, leading some to categorize long-term Paxil use as addictive. However, unlike addiction to other substances, the long-term use of Paxil does not lead to drug-seeking behavior. Furthermore, the likelihood of developing a dependence on the medication is much lower than other medications like benzodiazepines (Xanax).
Although the long-term use of Paxil results in symptoms suggestive of physical dependence, these symptoms are not severe enough to be categorized as an addiction.
Since the sudden discontinuation of Paxil use leads to withdrawal symptoms, the dose must be gradually reduced or tapered during the cessation of treatment. However, in certain instances, tapering of the dose may still result in withdrawal symptoms. In such cases, treatment is resumed at the original dose, followed by an even slower rate of lowering the dosage.
Even when untreated, the withdrawal symptoms are manageable and resolve in a few days in the majority of patients. Thus, educating patients regarding withdrawal symptoms is essential to help them make the transition to stopping Paxil use.
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National Alliance on Mental Illness. “Paroxetine (Paxil).” NAMI, https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Paroxetine-(Paxil)
Shrestha, Prabina, and Abdijadid Sara. “Paroxetine.” NCBI Bookshelf, December 2019, https://www.ncbi.nlm.nih.gov/books/NBK526022/
Nevels, Robert M et al. “Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required.” Psychopharmacology bulletin vol. 46. Mar. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5044489/