Paroxetine

Paroxetine, commonly sold under the brand name Paxil, is a type of prescription antidepressant that belongs to a class of drugs called selective serotonin reuptake inhibitors (SSRIs). We use SSRIs to treat a number of mental health conditions to help balance the amount of serotonin in your brain.

Serotonin is a natural substance in the brain and an important “chemical messenger” (neurotransmitter) that delivers instructions to nerve cells through the brain. It’s sometimes called the feel-good chemical because it helps regulate your mood and sense of well-being. But serotonin also plays a role in memory, sleep, digestion, and sexual function.

Through no fault of their own, some people’s serotonin levels are too low. This can occur if your body doesn’t make enough of it or if your body doesn’t use serotonin the right way. Over time, low levels of serotonin may cause problems with mood, sleep, and other functions.

Paroxetine works by increasing the amount of serotonin in your brain. It’s thought that healthy amounts of serotonin improve communication between brain cells, which elevates your mood and improves other symptoms of depression—helping you feel like you again.

Many people take paroxetine, not only because it improves their symptoms, but also because it’s an effective treatment for many different conditions. But before we list those conditions, it’s helpful to understand the various forms of paroxetine available in the United States.

There are several different types of paroxetine, with different chemical formulations. Each type treats different symptoms or conditions. Medications containing paroxetine hydrochloride are available as immediate-release tablets and controlled-release (CR) tablets. In other medications, the main ingredient is paroxetine mesylate.

These different types of paroxetine are approved to treat the following conditions:

• Paroxetine hydrochloride—major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD)
• Paroxetine hydrochloride CR—MDD, panic disorder, social anxiety disorder, and premenstrual dysphoric disorder (PMDD) 
• Paroxetine mesylate—MDD, OCD, GAD, and panic disorder. A low-dose version of paroxtein mesylate is also approved to treat moderate to severe “vasomotor” symptoms of menopause, including hot flashes and night sweats.

Paroxetine is also used to treat other conditions, including:

• Diabetic nerve pain
• Irritable bowel syndrome
• Neurocardiogenic syncope (fainting spells)
• Premature ejaculation

At Brightside, our psychiatric providers specialize in personalizing treatment for each person. We give you personal attention and expert advice you can count on—we explain all your options and use our expertise to find the medication that’s right for you. We make sure you understand how medications work and what to expect so that your treatment is worry-free.

Paroxetine offers a wide range of benefits that vary by person. The benefits you may experience depend on several factors, including your diagnosis and the severity of your symptoms.

Because paroxetine is used to treat so many different conditions, it can help improve a diverse range of symptoms. These include: 

• Behaviors repeated over and over (compulsions)
• Changes in appetite (loss of appetite or overeating)
• Excessive, persistent, or uncontrollable worry
• Extreme, uncontrollable feelings of fear
• Fatigue
• Fear of social interactions
• Feeling restless or fidgety
• Feeling sluggish
• Feelings of worthlessness or guilt
• Hot flashes and night sweats caused by menopause
• Irritability
• Loss of interest in previously enjoyable activities
• Low sex drive
• Panic attacks
• Persistent low mood or sadness
• Recurring flashbacks, nightmares, and other symptoms following a traumatic experience
• Severe anxiety or depression, or suicidal thoughts, that coincide with menstruation
• Sleep problems (insomnia or excessive sleeping)
• Thoughts, images, or ideas (obsessions) that won’t go away
• Thoughts of suicide

Don’t worry if you don’t see some of your symptoms listed above. This isn’t a complete list, and if your provider recommends you take paroxetine, it’s because they think it’s a good fit for you. 

Brightside providers have an in-depth knowledge of the strengths and drawbacks of each medication. You’ll get all the information you need to make an informed choice about your treatment.

We understand that you may be feeling a bit uncertain about starting a new medication and whether it will help you feel better. This is a common question, and sometimes there isn’t a straightforward answer. That’s because many factors influence a person’s response to medication. Because we are all different, some medications work better for some people than others. These differences include our genetics, age, gender, underlying health conditions, and other medications we may take.

However, you can take comfort knowing that at Brightside, we’re here to help you find the most effective medication for your individual needs. Our team includes psychiatric providers who have years of experience prescribing paroxetine and other antidepressant medications. Together we’ll figure out which medication best suits your unique characteristics and needs.

Something to keep in mind is that it may take three or four weeks before you notice any improvements with paroxetine. If you’re not sure it’s working, don’t stop taking it; instead, tell your provider. Sometimes we simply need to adjust your dosage before you experience the maximum benefits.

Also, Brightside providers closely monitor your progress to make sure you’re on the best medication and dosage. And whenever you have questions or concerns, you can take advantage of our telehealth services and provider consultations that can be scheduled within 48 hours.

Before you start taking paroxetine, you may have some questions about how long you’ll need to take this medication. The amount of time you’ll need to take paroxetine or any antidepressant depends on your personal treatment plan—which is based on your diagnosis, symptoms, and how well you respond to the medication.

For example, some women who use paroxetine hydrochloride CR for PMDD may only need to take it several days a month, during the phase of their menstrual cycle when symptoms are at their worst. Others may find the medication works better if they take it daily.

Women who use paroxetine mesylate to treat hot flashes and night sweats may take it until their symptoms are more tolerable, or until they complete menopause.

If you use paroxetine to treat depression, OCD, GAD, panic disorder, social anxiety disorder, or PTSD, the amount of time you’ll need to take it is hard to predict. However, providers typically recommend patients take antidepressants for six months to a year after they feel better. People taking antidepressants for the first time may only need treatment for a year, while those with recurrent, persistent, or treatment-resistant conditions may take the medication longer. Fortunately, there are no known risks from long-term use of paroxetine.

Once you start taking paroxetine, you may notice improvements in the first couple of weeks. Most importantly, we recommend that you keep taking your medication until your provider says it’s time to stop—even after you start to feel better. That’s because stopping too early can cause your symptoms to return.

Your Brightside provider will work with you to determine what course of treatment is best for your specific needs.

Studies have shown that antidepressants relieve symptoms of depression about 40-60% of the time and additional treatments (such as therapy and lifestyle improvements) on top of medication often lead to the best outcomes.

To get the best results with medication, it’s important to consistently measure progress during treatment. This is known as Measurement Based Care, and it’s the approach we use at Brightside. It’s common to adjust the dose and/or medication when starting antidepressants until you find just the right fit.

Paroxetine is a safe and effective antidepressant. However, it’s important to keep in mind that its effectiveness varies from person to person.

If you’re interested in learning more about the scientific data the FDA used to approve paroxetine, we’ve summarized the research studies below:

First, clinical trials to test the safety and efficacy of paroxetine hydrochloride showed people with MDD, GAD, OCD, or panic disorder had a significantly lower relapse rate when taking the medication, compared to those on placebo. Other studies showed it was significantly superior for treating social anxiety disorder and PTSD symptoms compared to a placebo.

Additional clinical trials showed similar results when testing paroxetine hydrochloride CR as a treatment for MDD, panic disorder, PMDD, and social anxiety disorder. Paroxetine mesylate was also approved by the Food and Drug Administration (FDA) to treat MDD, GAD, OCD, and panic disorder based on various placebo-controlled studies.

Another type of paroxetine mesylate was approved by the FDA in 2013 as the first non-hormonal drug to treat hot flashes associated with menopause. Its efficacy was established in two phase III studies among more than 1,100 women.

Many people worry that antidepressants will alter their personality or change who they are. As long as you’re taking the right dosage, paroxetine will not change your personality or blunt your emotions. Actually, it will help you feel like yourself again by improving your mood, reducing your anxiety, and helping you let go of worries.

Just remember that your symptoms won’t improve overnight. Keep taking your medication as prescribed—even when you start to feel better—and talk to your Brightside provider if you have any questions or concerns.

At Brightside, our goal is to help you find the treatment that provides the most benefit with the fewest side effects.

Like any medication, paroxetine can cause side effects that range from mild to severe. It’s important to review the FDA’s warnings before starting this medication.

The most common side effects associated with paroxetine are nausea and sexual problems, such as low sex drive. That’s because the body produces serotonin in the gut and genitals, in addition to the brain. 

Other symptoms, which typically go away after a week or two after starting paroxetine, include:

• Headache
• Constipation
• Diarrhea 
• Dry mouth
• Increased sweating
• Dizziness
• Feeling restless
• Fatigue
• Insomnia 

Rare but serious side effects associated with paroxetine include:

• Abnormal bleeding
• Bone fractures
• Eye problems, including pain or vision changes
• Low blood sodium
• Mania
• Rapid heart rate

One of the most significant side effects associated with paroxetine is a condition called serotonin syndrome. It occurs when too much serotonin builds up in the body, leading to symptoms ranging from dizziness and nausea to hallucinations, seizures, or even death. 

You can significantly reduce the risk of serotonin syndrome by making sure you do not take any other medications that increase serotonin levels while taking paroxetine. In addition to SSRIs, medications that raise serotonin levels include certain migraine medications (such as sumatriptan); tricyclic antidepressants (such as amitriptyline); and over-the-counter cold and cough medications that contain the ingredient dextromethorphan.

At Brightside, your health and safety are our highest priorities. We make sure you get individual attention and guidance to make sure you feel your best.

Antidepressants are not physiologically or psychologically addictive, but they can cause a discontinuation syndrome if stopped abruptly.

Discontinuation syndrome is a consequence of abruptly stopping certain types of antidepressants—particularly SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs). It can include a range of symptoms that may occur in patients who suddenly stop their SSRIs or SNRIs.

These are the most common symptoms of discontinuation syndrome: 

• Feeling anxious
• Feelings of vertigo
• Odd sensory symptoms, such as tingling feelings in the skin or what some people describe as a “zapping” sensation in the brain
• Trouble sleeping

Your Brightside provider will prescribe paroxetine to help you feel better. After you start to feel these positive effects, you may be tempted to stop taking the medication. However, in most cases, paroxetine contributes to these good feelings, and abrupt withdrawal from an antidepressant can also cause your original symptoms to come back or get worse—and we don’t want you to experience that.

If you’re pregnant or planning to become pregnant, please let your provider know right away. Together we’ll discuss depression or anxiety treatment options that are effective for you and safe for your unborn baby.

Paroxetine is a pregnancy category D drug. Using this drug during pregnancy increases the risk of birth defects, especially heart defects. For this reason, you should only take paroxetine during pregnancy if your provider believes the benefits outweigh the potential risks.

You should also talk to your provider if you plan to breastfeed, as paroxetine passes into breast milk.

Paroxetine is not considered addictive, and it is not a controlled substance. However, it’s important to remember that you may still experience withdrawal symptoms if you stop taking it suddenly.

You can view the FDA black box warning for paroxetine here. If you have questions about whether the black box warning for paroxetine applies to you, please talk to your provider.