Jump to content

Paroxetine


Recommended Posts

  • Administrator

How many of you actually start patients on Paxil?  I've never done it, due to other SSRIs being available and easier to stop, but one of the new NPs I work with started someone on Paxil the other day.  Is my view of the drug just too summarily negative?  What do other FP or Psych PAs think of it?

Link to comment
Share on other sites

I have had more bad outcomes and side effects with Paxil than any other SSRI - followed by Zoloft.

Weight gain, flat affect, withdrawal symptoms from one missed dose, akathisia - just not worth it.

For anxiety with depression I prefer Lexapro - more subtle, weight neutral, no withdrawals that I have seen.

I think Paxil had an OCD preference but I haven't used it for such.

Paxil is also category D for pregnancy so I don't want patients getting pregnant on it. Lexapro still carries a C rating.

Also more sexual dysfunction with Zoloft over Paxil and both over all others.

 

  • Like 2
Link to comment
Share on other sites

I tend to not use Paxil as first line actually usually start with Zoloft. Most of my pts are on Medi-Cal (Medicaid) and Zoloft is covered as first line. I have had great experience with managing it and though it has more AEs than say Lexapro or Celexa most of my pts have done pretty well with it. Maybe I'm just lucky? Lol

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

 

  • Upvote 1
Link to comment
Share on other sites

  • Moderator

I use it sometimes (IM and Psych)  all males - would not tend to use in females

mostly have gone to Lexapro for SSRI (and even some elavil/remeron if sleep is a major issue)

Wellbutrin for depression and ADHD

sometimes zoloft but titration is a pain 50, 100, 150, 200 blah...  

prozac still use for people that are not consistent with takeing -  LLLOOOONNNNNGGGGGG half life makes inconsistent dosing nicee

  • Upvote 1
Link to comment
Share on other sites

I use it sometimes (IM and Psych)  all males - would not tend to use in females
mostly have gone to Lexapro for SSRI (and even some elavil/remeron if sleep is a major issue)
Wellbutrin for depression and ADHD
sometimes zoloft but titration is a pain 50, 100, 150, 200 blah...  
prozac still use for people that are not consistent with takeing -  LLLOOOONNNNNGGGGGG half life makes inconsistent dosing nicee
Great recs... Kids tend to do well on Prozac...

Sent from my SAMSUNG-SM-G891A using Tapatalk

Link to comment
Share on other sites

wow, kids on any SSRI - surprised of that with the increase of suicidal thoughts and attempts....    I pretty much avoid SSRI under 23 - wellbutrin instead 

 

 

Do you see a lot of kids with MH issues? Prozac is the usual first line ssri for childhood depression and anxiety or an adjunct tx with stimulants for ADHD and has shown to be the most tolerated and efficacious for children.  In fact Prozac is recommended before any other SSRI and wellbutrin.

But you're right ssri's increase risk of SI 

 

And wellbutrin carries the increased risk for sz.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

 

 

 

 

  • Upvote 1
Link to comment
Share on other sites

Many of my patients are older and polypharmacy as well.

Prozac and Paxil are NOT recommended in elderly. Long half life and nasty side effects.

Lexapro does a better job but can lower sodium. Can be a tricky balance.

I am grateful for the Pharm Ds at work who can do the interaction profiles on those when the Med list hits 13+ trying to balance Parkinson’s, CHF, DM and the whole fruit basket of stuff.

My biggest challenge some days is med box bingo during bridge games when Thelma samples Louises RLS meds to see if they help........ 

  • Like 1
Link to comment
Share on other sites

So, to summarize so far, no one except Ventana would start with Paxil as first line SSRI in any patient population, and him only in certain populations?  Anyone else like Paxil? Anyone else avoid Paxil entirely?

I have used it for pts with more activation/anxiety sxs and (anecdotally) have found it to help with depression/GAD pts who are predominantly insomniacs.

 

Treating MDD and starting meds is really a symptom based approach. There is no one size fits all as you know.

 

So while I usually don't start with Paxil I will not rule it out like I wouldn't completely rule out other meds if appropriate.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

Link to comment
Share on other sites

On 12/20/2018 at 10:04 PM, Reality Check 2 said:
Many of my patients are older and polypharmacy as well. Prozac and Paxil are NOT recommended in elderly. Long half life and nasty side effects.

Lexapro does a better job but can lower sodium. Can be a tricky balance.

I am grateful for the Pharm Ds at work who can do the interaction profiles on those when the Med list hits 13+ trying to balance Parkinson’s, CHF, DM and the whole fruit basket of stuff.

My biggest challenge some days is med box bingo during bridge games when Thelma samples Louises RLS meds to see if they help........ 

 

All SSRI's by the way can alter sodium levels so use with caution with thiazides and I usually avoid in the setting of SIADH. I usually check BMP q3-6 mos on my MDD pts on SSRI esp elderly 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

 

 

Edited by Joelseff
Link to comment
Share on other sites

I avoid starting Paxil in basically anyone. Lots of drug interactions, nasty "discontinuation" (aka withdrawal) syndrome, and many adverse effects. I have had luck getting several elderly patients off of it as well. I have seen a few psychiatrists/psych NPs swear by it for very severe anxiety disorders who have failed other options, though I think it's probably just the sedating effect of the med that the patient is perceiving as reducing their anxiety.

Edited by Lexapro
Link to comment
Share on other sites

On 12/20/2018 at 9:49 AM, LKPAC said:

I've had good luck with Wellbutrin.  generic is cheap.  Works well, few s/e.  helps anxiety and depression both.  flexible dosing. easy to come off of it.

I love it for depression. I have not had good success with Wellbutrin alone for anxiety. Typically have to add in Buspar or another medication for anxiety.

Link to comment
Share on other sites

My seriously anxious patients tend to get just WHACKED on wellbutrin - it makes them meaner and edgier and generally intolerable. I prefer Lexapro for GAD with the rare zoloft patient. 

Lots of buspar in my world and then a boatload of atypicals. 

I don't ever start Paxil but have inherited patients on it. Our BHS dept handles it mostly. I don't like it but some patients are ok on it - for now.

Link to comment
Share on other sites

  • 2 years later...
  • Moderator

Wellbutrin is not really any good on anxiety (no indication either)

Paxil great for weight gain in females, not much lese

Buspar - placebo effect is 30% - not much beyond that

 

honestly the antipsych meds are most helpful for the severe cases, but everyone shys away from even low dose, which is unfortunate

 

Link to comment
Share on other sites

I try to tailor antidepressants to presentation and best guess of which neurotransmitter would be most helpful to supplement. Monotherapy with Wellbutrin XL I usually use only for people presenting with low energy, poor concentration and poor motivation but an absence of traditional depression symptoms such as guilt and low self esteem, etc. I also use it pretty heavily as a first line for adult ADHD symptoms.

 

My preferred SSRI is escitalopram and I find that because it is the most selective for serotonin and doesn't really affect dopamine or norepi much that it combos very well with Wellbutrin which affects dopamine and norepi without touching serotonin.

 

Seizure risks with Wellbutrin are somewhat overstated per research. I am always cautious and never use it in someone with current seizures but it really doesn't lower seizure threshold as much as people proclaim.

 

I rarely use paxil. Most FDA indications are just based on what the manufacturer went after, and most of the SSRIs are equivalent other than A. Side effects and B. Slight interaction with other neurotransmitters (ex: prozac tends to affect all 3 and thus can be more activating)

 

Add on medications for resistant depression that I've find work very well are lamictal and abilify. Seroquel also helps especially with anxiety but it has to be higher than 200mg otherwise it's just expensive benadryl.

Edited by Komorebi
  • Like 2
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More