Paroxetine

Paroxetine is an SSRI antidepressant that was introduced by GlaxoSmithKline in 1992. Since then, millions of people all over the world have taken paroxetine to treat a depression, anxiety and a number of other conditions.

The Bottom Line: What You Really Need to Know

Uses of paroxetine: Paroxetine is mostly used to treat depression, Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder (SAD), anxiety (Generalized Anxiety Disorder or GAD), panic disorder, Post Traumatic Stress Disorder (PTSD) and Premenstrual Dysphoric Disorder (PMDD).

Dosage and Instructions: Most people take between 20 and 40 mg of paroxetine once a day. You will probably start with a prescription for 10 or 20 mg once a day; your doctor may increase your dose after a couple of weeks. Elderly people and those with kidney or liver problems take smaller doses. The maximum dose is 60 mg a day. Here are some things you need to know about taking paroxetine:

Actions (how paroxetine works): One of the causes of depression is an imbalance of serotonin and other chemicals in your brain. Paroxetine and other SSRI's correct the imbalance by allowing the chemicals to accumulate between the brain cells.

Paroxetine is different from other SSRI antidepressants because it works almost exclusively on serotonin (it is "serotonin selective").

Side Effects: Paroxetine can cause many side effects, and you will probably experience a few of them. Most of the side effects are mild and go away after you've taken paroxetine for a few weeks. The side effects you are likely to notice are:

More serious side effects are rare, but do watch for them. Notify your doctor immediately if you notice any of the following:

In rare cases, paroxetine can cause Serotonin Syndrome, especially if you are also taking other medications that increase serotonin levels (check the section on drug interactions for a list). Serotonin Syndrome is very serious and can be fatal. Signs of Serotonin Syndrome include:

Drug interactions:

MAOI Antidepressants Nardil (phenelzine), Parnate (trancyclopromine), Marplan (isocarboxazid) and Emsam (Selegiline): MAOI's and SSRI's can have a very serious interaction characterized by muscle spasm and rigidity, rapid pulse, very high fever, agitation, delirium, coma or death.

Pimozide (Orap) and thioridazine (Mellaril): These medications are used mostly to treat schizophrenia. When taken with paroxetine, they can cause abnormal heart rhythms and sudden death.

Warfarin (Coumadin), Non-sterioidal Anti-inflammatory medications (NSAIDs) (ibuprofen, Advil, Alleve, etc) and Aspirin: When these medications are taken at the same time as paroxetine, your blood may not clot properly or you could have bleeding in your stomach.

"Serotogenic" medications: If paroxetine is taken with other medications that effect serotonin, it could cause Serotonin Syndrome. Those medications include other antidepressants, lithium, triptans (medications used for migraine headaches), tryptophan, St.John's Wort, linezolid (Zyvox, an antibiotic), tramadol (a pain medication) and 5-HTP.

Other medications: When you are taking paroxetine, you may need to decrease the amount of other medications you take.

Contraindications, warnings and precautions:

Children, adolescents and young adults: Paroxetine is not approved for use by children and adolescents. The FDA has issued a "black box" warning (their strongest warning) for the use of paroxetine in children, adolescents and young adults because it may increase the risk of suicide, especially in the few weeks of taking it.

No matter how old you are, it's wise to monitor your condition for the first few weeks you take paroxetine. A friend or family member should check on you every day for the first few weeks and ask if you are having thoughts of suicide. Your doctor may want to see you weekly for the first month. Contact your doctor immediately if you have worsening depression or suicidal thoughts.

Once in a while someone who has just started taking paroxetine becomes anxious, irritable, agitated, aggressive or hostile. He or she may have bizarre thoughts or feel paranoid and be extremely restless. These symptoms have occurred before suicide attempts and violent behavior. Although this is a rare occurrence, you should report any unusual symptoms to your doctor.

Pregnancy and nursing: Women who are pregnant, planning to get pregnant or nursing should not take paroxetine. Babies born to mothers who are taking paroxetine early in pregnancy can have congenital heart defects. Babies born to mothers who take paroxetine later in pregnancy may need prolonged hospitalization, machines to help them breathe or tube feedings. Paroxetine is excreted in breast milk.

Controversy: Both GlaxoSmithKline and the FDA have been accused of withholding information from the public about paroxetine, especially about the increased incidence of suicide in people who begin taking it.

It's important for you to learn as much as you can about your medications and to ask your doctor or pharmacist to explain anything you don't understand so that you can make informed choices about managing your depression.

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