Paxil side effects, benefit for depression Information
November 20 2017 by
Ray Sahelian, M.D.

Paxil (paroxetine) is a SSRI medication approved by the FDA and Health Canada for the treatment of a variety of psychiatric conditions. Paxil is used for depression and for treating social anxiety disorder. Paxil has been studied extensively as a treatment for social anxiety disorder and has been shown to be somewhat effective in short-term, fixed- and flexible-dose placebo-controlled trials, as well as in long-term treatment. However, long term Paxil side effects are bothersome to many patients, particularly the effect of Paxil on libido and overall sexuality. Pregnant women and those who plan to become pregnant should avoid taking this antidepressant if possible because of the risk of birth defects.

Paxil side effects, adverse reactions
Common Paxil side effects include decreased sexual ability, nausea, constipation or diarrhea, dizziness, sleep changes, dryness of mouth, increased sweating, headache, problems in urinating, unusual tiredness or weakness. Less common Paxil side effects include anxiety or nervousness, blurred vision, decreased or increased appetite, tingling, burning, or prickling sensations. Another Paxil side effect is weight loss or gain.

Q. My wife (58yrs) has been on Paxil for approximately a year, and has experienced great results. The largest Paxil side effect is her apparent lower libido. I say apparent because the Paxil may or may not be the problem. She has no desire for sexual activity, even though we do have relations, she has no responses and no climax even with clitoral stimulations. She is extremely dry where we have to use lube, and we never had this problem before. I am also experiencing erectile dysfunction in the last year or so. But my libido is extremely high. My erections will initially be hard but do not last longer than five minutes. What can you recommend for either or both cases?
   A. We can't make specific suggestions, but we can refer you to these web pages, libido and another one on erectile dysfunction. Onions or onion juice can counteract the sexual inhibitory effect of the antidepressant.

Q. Can I take Passion Rx when I take 12.5 mg of Paxil CR daily for anxiety? My last physical I told my doctor that I have libido problems and getting firmer erections and asked him if I could take any of these sorts of herbal products that help in that area, he told me it probably wouldn’t hurt, but also mentioned he didn’t have a very wide knowledge of most herbs.
   A. SSRIs have an inhibitory effect on sexuality. We have not tested Passion Rx together with SSRIs such as Paxil, and hence we are not able to advise their use in combination since we don't have enough knowledge. If your doctor agrees for them to be taken together, the highest dose to use would be half a capsule of Passion Rx every other day. We cannot predict the response. We actually would prefer both not be taken the same day.

A 2015 study shows that women who take antidepressants in the later stages of pregnancy are more likely to have a child with autism. The study specifies one particular group of antidepressants in particular — the SSRIs, or selective serotonin reuptake inhibitors, such as Prozac, Zoloft or Paxil.

Reversing sexual side effects with food
Experimental Biology and Medicine 2013. Fresh onion juice enhanced copulatory behavior in male rats with and without paroxetine-induced sexual dysfunction. This study conclusively demonstrates that fresh onion juice improves copulatory behavior in sexually potent male rats and in those with Paxil paroxetine-induced sexual dysfunction by increasing serum testosterone levels.

SSRI Paxil and suicide
An antidepressant often prescribed to teenagers may be ineffective and unsafe for the populations it is supposed to help, according to a reanalysis of a 14-year-old study. The research, published in 2015 in the journal The BMJ, contradicts earlier findings that paroxetine -- sold under the labels Paxil, Aropax and Seroxat -- is safe for people under 25. Rather, the new research found the drug can be associated with suicide-related incidents, including suicidal thoughts and attempts, and provides no advantage over placebos.

In a letter to doctors in 2006, GlaxoSmithKline and the Food and Drug Administration warned the SSRI Paxil may raise the risk of suicidal behavior in young adults. The warning letter was accompanied by changes to the labeling of both Paxil and Paxil CR, a controlled-release version of the SSRI drug, also called paroxetine. A review of clinical trial data on 15,000 patients treated with both SSRI Paxil and dummy pills showed a higher frequency of suicidal behavior in young adults treated with the SSRI drug. The FDA reported that there were 11 suicide attempts — none resulting in death — among the patients given the SSRI drug in the trials. Just one of the placebo pill patients attempted suicide.

Paxil / Paxil CR (paroxetine HCl, GlaxoSmithKline) The Clinical Worsening and Suicide Risk subsections in the Warnings section of the Prescribing Information have been changed to include a recently conducted meta-analysis of suicidal behavior and ideation in placebo-controlled clinical trials of paroxetine in adult patients with psychiatric disorders, including major depressive disorder (MDD), other depression, and non-depression disorders. Results of this analysis showed a higher frequency of suicidal behavior in young adults treated with paroxetine compared with placebo. Further, in the analysis of adults with MDD (all ages), the frequency of suicidal behavior was higher in patients treated with paroxetine compared with placebo. All of the reported events of suicidal behavior in the adult patients with MDD were non-fatal suicide attempts, and the majority of these attempts (eight of 11) were in younger adults aged 18-30. These MDD data suggest that the higher frequency observed in the younger adult population across psychiatric disorders may extend beyond the age of 24. It is important that all patients, especially young adults and those who are improving, receive careful monitoring during paroxetine therapy regardless of the condition being treated.

Does it work in teenagers?
BMJ. 2015. Restoring Study 329: efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. To reanalyse SmithKline Beecham's Study 329 (published by Keller and colleagues in 2001), the primary objective of which was to compare the efficacy and safety of paroxetine and imipramine with placebo in the treatment of adolescents with unipolar major depression.  Neither paroxetine nor high dose imipramine showed efficacy for major depression in adolescents, and there was an increase in harms with both drugs. Access to primary data from trials has important implications for both clinical practice and research, including that published conclusions about efficacy and safety should not be read as authoritative.

Questions and testimonials
Q. I am 30 years old male and i am taking Paxil for panic disorder for 6 months now. It helps me sometimes.

Q. Does 5-HTP work as well as Paxil?
   A. Some people like 5-HTP, others get a better response from Paxil. It is difficult to predict each person's response.

Q. I was checking on Passion Rx to the low sex drive of my partner and he is and has been on Paxil for several years. But after reading your warnings, it recommends that he not take this herb with anti-depressant.
   A. Yes, see response above.

Q.  My wife is taking Paxil 25 mg and 100 mg Trazadon for sleeping with 100 mg serequl. Please let us know can she take valerian or any herbal with her medications.
   A. Herbs are much less potent than drugs, hence their effects are not noticed that much in people who are taking Paxil, Trazodone, and other potent medicines. Trazodone is a modified cyclic antidepressant.

Q. I have weaned myself down to 7.5 milligrams of Paxil a day and was wondering if it was safe for me to start taking 5-HTP along with it while I discontinue the Paxil. What do you recommend? I do not want to go on another ssri if it can be avoided.
   A. Each person has a different level of depression and different response to Paxil and other SSRI drugs. Furthermore, each person responds to natural supplements such as 5-HTP in their own unique way, hence it is not possibly to accurately recommend an exact dosage or timing regarding at what point to stop or reduce a SSRI drug and when to start 5-HTP, SAM-e, or other supplements. A general advice is to start the natural supplement in a low dose and gradually increase or decrease based on response. We also suggest medical supervision during the transition.

Q. Is it okay to take Ashwagandha while taking the antidepressant Paxil?
   A. Some people may find it to be okay, while for others side effects can occur. If you doctor approves and you try the one by Physician Formulas, start with a quarter of a capsule at first. It's always a safer option to take a portion of a capsule of a supplement if you have never tried it before.

Q. I took Paxil for about five years. Had to stop for lack of insurance. Been off for about a year. Is it possible to get back on this type of drug and expect the same results? Thank you.
   A. This is impossible to predict, one person may get good results with returning to Paxil, another person may not.

Q. I am currently coming off from taking Paxil, was on it about 6 months before that Zoloft. I have been tapering off it by cutting the dosage. Is it customary to have dizziness, and for how long? Would it be normal to take St. John"s wort , 5-HTP, Omega 3s, etc in the place of Paxil, just trying to get a natural supplement ?
   A.  Each person's depression responds differently to natural supplements. It is not possible to accurately recommend an exact dosage or timing regarding at what point to stop or reduce the Paxil drug and when to start 5-HTP, SAM-e, St. John's wort, fish oils, or other supplements. A general advice is to start the natural supplement in a low dose and gradually increase or decrease based on response.