With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. We have already covered lithium, along with anti-seizure and atypical antipsychotics commonly used as anti-manic medications or mood stabilizers in bipolar disorder. Last week, we introduced our coverage of SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants with a post on Prozac (fluoxetine). This week, we continue our series on SSRI antidepressants with this post on Paxil (paroxetine hydrochloride).
As a group, the SSRI’s share many of the same potential benefits and potential negative side effects, so we encourage you to read the Prozac post first to get up to speed about general information relating to SSRI’s, including how SSRI’s work and important cautions about using any antidepressant to treat depression in bipolar. In this post, we focus on Paxil’s unique profile in treating bipolar depression and depression in general.
Paxil’s potential benefits are identical to those of all SSRI’s:
Most people on Paxil take 10 to 40mg but it can be as high as 60 or 80 mg per day or up to 75 mg for Paxil CR (controlled release). Your doctor will work with you to determine an effective dosage.
Like most medications in its class, Paxil can potentially cause any of several negative side effects. The most serious are the following:
Other less serious side effects can include the following (Note: Many of these side effects are transient and occur when first taking these medications but do not persist.):
Remember: Any antidepressant can take 2-3 weeks or even longer to become fully effective; it may take several weeks to work up to a therapeutic dose. This means that your depression may not lift for several weeks. I often tell patients that however they feel in the first two weeks is unlikely to be how they feel in a month – so if they are feeling some early side effects, hold on because they will likely get better. Patience is important in getting these medications to work, but if you have any concerns about how you are feeling, you should contact your doctor. You will most likely have a follow-up visit with your doctor within a month or less of starting the medications; this is a good time frame for checking in to see if benefits have started or if side effects have faded or persisted.
Paxil has a reputation for causing more sedation and weight gain than the other SSRI’s. In my practice, I have certainly seen evidence of this, However, Paxil is a powerful and effective antidepressant and anti-anxiety medication, and I do use it frequently. Paxil has a specific FDA indication for social anxiety, and I have found it to be extremely helpful in people with this condition – even with severe symptoms. Social anxiety can co-exist with bipolar disorder.
I avoid using it first line in children, primarily because it was one of the first SSRI’s that was found to have some increased risk of suicidal thoughts in children.
For more about Paxil, visit GlaxoSmithKline’s PaxilCR page.
If you’ve taken any form of Paxil for bipolar depression or are a doctor who has prescribed it, please share your experiences, insights, and observations.
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From Psych Central's website:
PsychCentral (February 20, 2009)
From Psych Central's Dr. Candida Fink & Joe Kraynak:
Bipolar Disorder Medication Spotlight: Effexor (Venlafaxine) | Bipolar Beat (May 19, 2009)
Last reviewed: 20 Feb 2009