US Brand Name: Paxil / Paxil CR
Other Brand Names: Aropax (Argentina, Australia, Belgium, Mexico, New Zealand, South Africa)
Deroxat (France, Switzerland)
Paxan (Colombia) Paxetin (Iceland)
Paxxet / פקסט (Israel)
Seroxat (Belgium, Denmark, Finland, Greece, Italy, Netherlands, Norway, Spain, Sweden, United Kingdom)
Paroxat (Austria, Czech Republic, Germany)
パキシル錠 / Paxil (Japan)
Generic Name: paroxetine hydrochloride
Other Forms: oral suspension
What is Paxil and Paxil CR. Paxil and Paxil CR are Antidepressants, specifically SSRI.
Read up on these sections if you haven’t done so already, because they cover a lot of information about multiple medications that I’m not going to repeat on many pages. I’m just autistic that way about not repeating myself.
What are Paxil and Paxil CR Approved For.
The immediate release form (vanilla Paxil) has FDA approval for:
Major Depressive Disorder
Social Anxiety Disorder
General Anxiety Disorder
Post Traumatic Stress Disorder (whether or not it’s combat PTSD is not specifically defined).
The Controlled Release form of Paxil (Paxil CR) is approved for:
Major Depression and Panic Disorder
Premenstrual Syndrome & Premenstrual Dysphoric Disorder (but watch out for sexual side effects)
What Else are Paxil and Paxil CR used for: Paxil and Paxil CR are prescribed off-label for:
Multiple Chemical Sensitivities (at least when they think it’s all in your head)
Bipolar Depression (this one study has it less apt to cause mania than Effexor (venlafaxine), although I can find plenty of case histories where mania was induced)
Irritable Bowel Syndrome (IBS) (effective and cost effective)
Paxil’s pros and cons:
Pros: The data on the PI sheet for the immediate release version show it to be moderately effective for just about everything under the sun, hence its official approval for so many disorders instead of just off-label usage. The data for the CR version are much more vague, and you’ll note it isn’t approved for as many disorders.
Cons: Paxil and Paxil CR (paroxetine hydrochloride) are the worst true SSRI to stop taking. SSRI discontinuation syndrome for Paxil and Paxil CR (paroxetine hydrochloride) are worse by far than any of the others. No, Effexor (venlafaxine) doesn’t count, because it isn’t an SSRI. Paxil and Paxil CR also have the worst sexual side effects, although the CR version tends to make the sexual side effects less harsh, the CR version is also less effective for a lot of disorders, hence its lack of approvals.
Paxil and Paxil CR’s Typical Side Effects: The usual for SSRIs – headache, nausea, dry mouth, sweating, sleepiness or insomnia, and diarrhea or constipation, weight gain, loss of libido. Everyone I’ve read on the subject of how long side effects last (Dr. Stephen Stahl’s Essential Psychopharmacology: The Prescriber’s Guide, Dr. Diamond’s Instant Psychopharmacology, Dr. Drummond’s The Complete Guide to Psychiatric Drugs , Preston et al.’s Consumer’s Guide To Psychiatric Drugs) agrees that everything but the weight gain and loss of libido usually goes away within a couple of weeks. Paxil is notorious for having the worst impact on your libido of all SSRIs.
Paxil’s Not So Common Side Effects: Motion sickness/vertigo, food tasting weird, making the symptoms worse.
These may or may not happen to you don’t, so don’t be surprised one way or the other.
Paxil’s Freaky Rare Side Effects: Complete loss of taste (like Gabitril (tiagabine) did to me), enlargement of skin, reflexes increased (some people are just never happy), tongue discoloration.
You aren’t going to get these. I promise.
Interesting Stuff Your Doctor Probably Won’t Tell You: Paxil and Paxil CR (paroxetine hydrochloride) happen to be those types of meds that if you stop taking it and start up again, they won’t work as well as it used to. Even if you stop for just a couple of days. You have to be totally med compliant with Paxil and/or Paxil CR (paroxetine hydrochloride) or it’s pointless. Symptoms may even worsen, which may have something to do with the rash of suicidal acts and ideation amongst adolescents on Paxil / Seroxat, as teenagers are as bad as the bipolar when it comes to being med compliant. Obviously mileage varies, and I’ve even read a few accounts of people switching from one form to the other to get over the problem of Paxil no longer working. However, I’ve read far more accounts of people where any form of Paxil not working after they were non-compliant or had to switched to another med or ran out or whatever and then tried to start again.
On the subject of discontinuing antidepressants, it turns out that their withdrawal can trigger mania. So you always have to be careful when using them if you’re bipolar.
Paxil’s Dosage, How and When to Take Paxil and Paxil CR: Immediate release – the initial dose of Paxil (paroxetine hydrochloride) is 10mg for Panic Disorder and 20mg for all other disorders, taken in the morning in any event. The dose is increased 10 mg a week, as required, until it reaches a maximum of 20mg for General Anxiety, 40mg for PTSD, 50mg for Depression, and 60 mg for everything else.
Controlled Release – start at 25mg in the morning and work up by 12.5mg a week, as required, until a maximum of 62.5mg a day is reached.
As with all SSRIs I suggest staying at a fairly low dosage for the first four weeks. It sucks, but honestly, it will suck less that way. For the immediate release just start at 10mg for everything, go up to 20mg after a week if you need to. For depression you can go up to 30mg before your month is out, otherwise just hold where you are for a month, otherwise the discontinuation will suck for nothing. You’ll know after a month if Paxil (paroxetine hydrochloride) will do anything for you or not, even at a lower dosage.
For the controlled release, start at 12.5mg, move up to 25mg after a week if need be. For depression you can move up to 37.5mg a week after that if you think it will do you any good, otherwise just hold out for a month to see if it works.
Dr. Stephen Stahl in Essential Psychopharmacology: The Prescriber’s Guide writes that it is best to first try taking either Paxil or Paxil CR at bedtime, as often either form is sedating and it’s easier to keep taking it daily when you take it at night. He also agrees that you should stick with the lowest dosage possible, 10mg for Paxil and 12.5mg for Paxil CR and waiting two weeks before increasing the dosage.
When will Paxil, Paxil CR start working: Like all SSRIs, Paxil or Paxil CR will take anywhere from a couple days to over a month to work. The generally accepted wisdom with all SSRIs is that if you don’t feel any positive benefit after four to six weeks, then you should talk to your doctor about either another SSRI or trying a med that hits another neurotransmitter.
Dr. Stephen Stahl in Essential Psychopharmacology: The Prescriber’s Guide and Essential Psychopharmacology of Depression and Bipolar Disorder writes that you should be feeling some sort of positive effect within two weeks. If you don’t feel any sort of relief for your depression and/or anxiety disorder at 20mg for Paxil or 25mg for Paxil CR, move on to something else. I’m going with that, because of Paxil’s potency and the nasty discontinuation syndrome, if it’s not working after two weeks, screw it.
Days to Reach a Steady State: Good freaking luck pinning this one down. Seriously, this is a problem with Paxil (paroxetine hydrochloride), and is one of the reasons why the withdrawal is so bad. With the CR version you’ll probably get a steady state in two weeks. With the immediate release Glaxo promises steady state in 10 days, but that was based on a study involving all of 15 men.
When you’re fully saturated with the medication and less prone to peaks and valleys of effects. You still might have peaks of effect after taking many meds, but with a lot of the meds you’ll have fewer valleys after this point. In theory anyway.
Paxil’s Half-Life & Average Time to Clear Out of Your System: For the CR version the mean average half-life is 15-20 hours. So it’s out of your system in about 4-5 days.
Now, as for the immediate release version. I could not get a firm number on the half-life. The only information Glaxo published in the PI sheet came from a study of 15 men, and that gives a half-life of 21 hours. There’s a shitload of contradictory information on the Internet ranging from 2-96 hours, with the consensus and the US Army agreeing on a 26-hour half-life. And we thought pinning down Lamictal’s (lamotrigine) half-life was tough. But wait! 26 hours is the same as Lamictal’s (lamotrigine) and Zoloft’s (sertraline). Coincidence? Or did someone just pull a number out of their ass?
How to Stop Taking Paxil, Paxil CR: Your doctor should be recommending that you reduce your of the CR dosage by 12.5mg every four days. You should probably make it five days because Paxil’s discontinuation syndrome is so harsh. That means putting up with the suck-ass side effects for longer, but trust me, it really sucks less this way. Based on the 15-20 hour half-life. If your doctor says something that’s slower than that, go for it! I’m all for slower discontinuations. Four to five days is the fastest you can step down the dosage. For more information, please see the page on how to safely stop taking these crazy meds.
This is part of the reason why the discontinuation for Paxil sucks more ass than any other SSRI (keep in mind that Effexor (venlafaxine) is not an SSRI and it has the reputation for the worst discontinuation syndrome.). If you can’t pin down the half-life, you and your doctor can’t work out an effective discontinuation schedule, and if the half-life varies wildly it’s possible that if you do everything right on paper it’s still going to suck when you actually discontinue Paxil! OK, so given the 21-26 hour half-life, that means for the immediate release version you are going to get a pill splitter and you are going to step down by 5mg a week. If you’re still having problems with the last 5-10mg a day you can try switching to the oral suspension (the liquid form) to try going down a milligram at a time. There’s also the option to switch to Prozac (fluoxetine) for a couple of weeks.
If you’ve worked your way up to a particular dosage, it’s usually best to spend this many days at the next lowest dosage before going down the next lowest dosage before that and so forth. This is the least sucky way to avoid problems when stopping any psychiatric medication. Presuming you have the option of slowly tapering off them.
Comments: Be sure to read the sections on antidepressants and especially SSRIs if you haven’t done so already.
Approved by the FDA to treat depression in December 1992, Paxil (paroxetine hydrochloride) is either the most potent or second most potent of the SSRIs, depending on which study you read (and including the one from A Primer of Drug Action Paxil wins three out of four). Hence its being approved for, and thus being reasonably effective for, just about everything SSRIs are thrown at.
The thing I really liked about Paxil (paroxetine hydrochloride) was that it completely eliminated my libido. It was gone. In a way I was eleven years old again. Nothing else has dealt with my bipolar hypersexuality so effectively. I was ready to brush up on my French and take the Trappist orders at l’Abbye de Scourmont for a life of contemplation and brewing the world’s best beer. While it wasn’t a complaint for me, that is an all-too-common occurrence for many people that can be problematic. Just to prove that anything is possible with these crazy meds, these case studies show how some SSRIs can be aphrodisiacs. Unfortunately the Paxil (paroxetine hydrochloride) also made my depression and anxiety vastly worse, so I wasn’t able to get out of bed to do anything at all. But that’s just me. Well, OK, that’s a lot of people, as it can make the symptoms worse, but anything that affects my serotonin is just going to suck as far as I’m concerned. The fact that the immediate release form of Paxil (paroxetine hydrochloride) is approved for so many disorders shows that it’s effective for at least 20% of the population with a variety of complaints, so it does something without making it too harsh to take.
You just have to be very strict with your med compliance, so Paxil (paroxetine hydrochloride) and teenagers or anyone who is a flake don’t mix. It works like this: You skip a dose of Paxil (paroxetine hydrochloride). That starts the discontinuation syndrome because the half-life can be so wacky. It also means when you do take the med the next time it doesn’t work quite as well as it did the first time. So you don’t feel all that right when it does work again. Which makes you think something’s wrong and makes you that much more likely to skip another dose. Lather, rinse, repeat. See where that’s going? After a few iterations it’s no wonder that teenagers, who really have much less of a clue about something like SSRI discontinuation syndrome are ready to kill themselves. They keep taking their meds, not really but they take the meds on their schedule and that’s all that matters, and they feel worse!
Hey, at least someone is officially recognizing that the discontinuation syndrome is especially bad, and that you may want to take some Prozac (fluoxetine) to take the edge off of the final stages of discontinuation.
Everyone I’ve read who knows about these things (Dr. Preskorn’s site for all things antidepressant, Dr. Stahl’s Essential Psychopharmacology and Essential Psychopharmacology of Depression and Bipolar Disorder, and Dr Julien’s A Primer of Drug Action) agree that Paxil (paroxetine hydrochloride) is the most potent of all the SSRIs you have to be sure that you’re really depressed.as.fuck and feel like Whale Shit at the Bottom of the Ocean, or have similarly bad symptoms for the other disorders for which it’s approved. Otherwise you may want to evaluate another medication first. But if things really are that bad, and serotonin reuptake is the answer, then Paxil (paroxetine hydrochloride) is the med to try, because per the same references, only Zoloft (sertraline) will come close in potency.