About the Antidepressant Paroxetine (Paxil, Seroxat)
Paroxetine is the generic name for a popular antidepressant medication, which is most commonly found under the brand names Paxil and Seroxat. The medication is most often used to treat all types of depression as well as social anxiety disorder and panic disorder. In some cases, paroxetine is prescribed to treat obsessive-compulsive disorder and post-traumatic stress disorder. Recently, the Food and Drug Administration (FDA) approved paroxetine to treat hot flashes in menopausal women; this is the first non-hormone medication used in this type of treatment.
As a selective serotonin reuptake inhibitor (SSRI), paroxetine is one of the many medications that treats mood disorders by preventing some serotonin, a neurotransmitter associated with happiness, from being absorbed by neurons. This enhances neuron-firing.
Who Makes Paroxetine Drugs, and How Are They Prescribed?
The most common brand names containing paroxetine are Paxil and Seroxat; however, other popular brands include Pexeva or Brisdelle. GlaxoSmithKline manufactures Paxil, which was approved by the FDA in 2001. Paroxetine as a generic drug was approved for prescription use in the US in 2003.
Paroxetine can be found as a tablet, controlled-release tablet, capsule, and suspension/liquid. The capsules are typically prescribed to be taken twice per day, or every 12 hours; the other formats are usually ingested once per day.
Paxil is typically found in tablet doses of 10, 20, 30, and 40 mg. The liquid suspension comes in a dose of 10 mg per 5 mL. Paxil CR is found in doses of 12.5, 25, and 37.5 mg. Pexeva comes in doses of 10, 20, 30, and 40 mg.
People who receive paroxetine to treat major depressive disorder typically receive a prescription for 20 mg once per day, and that dose can be increased over time as needed, although it should not exceed 50 mg. Those with obsessive-compulsive disorder also take this medication once per day, but their initial target dose is 40 mg and should not exceed 60 mg per day. People with panic disorder receive a similar dose, while social anxiety disorder is treated more like major depression.
Regardless of the mental health condition involved, no one should take paroxetine medications without a prescription. It is important not to make any dose adjustments without consulting a doctor, although some people with some conditions, such as major depression, may be able to temporarily lower their dose before seeing their physician if they find the side effects are too intense. In all cases, individuals should consult their doctor, at least via phone, prior to making any changes.
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Withdrawal from Paroxetine
People who take paroxetine antidepressants, whether as prescribed or for nonmedical reasons, may wish at some point to stop taking them. Even if the person takes paroxetine as prescribed, they may experience withdrawal symptoms because their body has developed a dependence on the medication to manage serotonin levels. Withdrawal symptoms include:
- Irritability or mood swings
With the help of a physician, a person can taper their dose of paroxetine until their body is no longer dependent on it. Attempting to stop taking the drug “cold turkey” is more likely to lead to withdrawal symptoms. About 7 percent of people who take paroxetine are likely to experience withdrawal symptoms, so it is important to work with a doctor.
Without a taper, withdrawal symptoms begin between 24 and 48 hours after the final dose and continue for about one week. The majority of symptoms resolve after two or three weeks, although in some rare cases, the person can develop a protracted withdrawal syndrome.
There are several side effects associated with paroxetine. These include both mental or emotional and physical side effects.
Physical side effects include:
- Weakness, especially in muscles
- Sleepiness, fatigue, or feeling “drugged”
- Nausea and vomiting
- Stomach pain
- Changes in how food tastes
- Dry mouth
- Excessive sweating
- Sensitivity to light
- Tightness in throat, or feeling a lump in the throat
- Pain in muscles, back, or bones
- Joint pain and swelling
- Sore teeth and gums
Mental side effects include:
- Trouble concentrating
- Nervousness or anxiety
- Difficulty sleeping
- Nightmares or strange dreams
Medications containing paroxetine have a black box warning in the United States due to the potential for increased suicidal thinking among those who take this prescription. While paroxetine and its brand names have consistently been effective in treating depression in adults, a study published in the British Medical Journal in 2015, which involved analyzing over a decade’s worth of medical data on the SSRI, found that paroxetine was not effective in treating depression in adolescents and children. Those under the age of 24, the study found, tended to experience an increase in suicidal thinking while not experiencing enough relief from their depression.
Some people do not experience relief from symptoms of depression; instead, they may develop deepening or worsening depression. This is a very serious side effect, and if a person experiences this, they should immediately speak with their doctor.
Overdose from Paroxetine
When a doctor monitors an individual’s prescription, it is unlikely that the person will overdose. However, it is possible to take too much paroxetine. Overdose symptoms include:
- Drowsiness or being unable to stay awake
- Uncontrollable shaking or tremors
- Changes in heart rate, either faster or slower
- Extreme confusion
- Nausea and vomiting
- Blurred vision
- Loss of appetite
- Unusual bruising or bleeding
- Trouble walking, as though one is drunk
- Abnormally excited mood
- Difficulty urinating
- Muscle twitching or jerking
- Aggressive or violent behaviors
- Yellowing of the skin or eyes (jaundice)
- Flu-like symptoms
Interactions with Other Drugs
Because paroxetine is a potent prescription medication, it can interact with other drugs. One of the most serious interactions is between paroxetine and other antidepressants, including other SSRIs, SNRIs, MAO inhibitors, and tricyclic antidepressants. Combining these medications, or taking more than the prescribed dose of paroxetine, can lead to serotonin syndrome. This condition involves too much serotonin in the brain, which can lead to agitation, anxiety, rapid and irregular heartbeat, high fever, seizures, and unconsciousness.
Other drugs that paroxetine can interact with include:
- Blood thinners, especially warfarin
- Medications that treat irregular heartbeat
- Anti-nausea medications
- Anti-seizure drugs
- Diuretic pills
- Drugs that treat gastrointestinal disorders
- Some antibiotics
- Atomoxetine, a medication to treat ADHD
- Some HIV drugs
- Anti-anxiety drugs
- Drugs used to treat other mental health issues, such as bipolar disorder or schizophrenia
- Antifungal medications
- Opioid pain medications
- Tamoxifen, which is used to treat breast cancer
Side effects from paroxetine can be more intense if a person drinks alcohol while taking this medication. Physicians and therapists will recommend limiting the amount of alcohol a person drinks while they take paroxetine.
Paroxetine’s Interactions with Physical Conditions
If a woman taking paroxetine is pregnant or breastfeeding, the antidepressant may affect her child. Taking paroxetine medications throughout pregnancy, especially in the last trimester, has been linked to some heart defects in newborns and to other health problems in infancy during breastfeeding. These issues are rare, but a woman who is pregnant or thinking of becoming pregnant while taking paroxetine should consult her doctor about the risks. Ultimately, it is up to the woman and her physician to decide whether it is psychologically safe for the woman to stop taking antidepressants or to switch her medication.
Other conditions that may interfere with paroxetine’s effectiveness or that can be made worse by taking paroxetine include:
- Bipolar disorder
- Seizure disorders, including epilepsy
- Kidney disease
- Liver disease
- People who are allergic to a variety of medications
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When a person struggles with depression, anxiety, or another mental health condition, it is important for them to get help. This help often comes in the form of prescription medications and talk therapy. Long-term therapy is the best treatment to manage mood disorders, but in the short-term, prescription medications like paroxetine can stabilize mood. Many people take antidepressants off and on for several years for a variety of conditions.
Receiving treatment for mental health problems helps to prevent substance abuse. People who suffer from a mental health condition are more likely to self-medicate with alcohol, tobacco, marijuana, cocaine, or other drugs. In order to manage co-occurring disorders, professional help is key.