Last Updated on November 15, 2022 by
Alternative to Meds Editorial Team
Medically Reviewed by Dr Michael Loes MD
Table of Contents:
What is Paxil and Why is it Prescribed?
Paxil© (generic paroxetine) entered the drug market in 1992. Other brand names include Aropax© and Seroxat©.3 Paxil is available in immediate-release and extended-release (Paxil CR) forms. This medication is classed as an SSRI type of antidepressant. SSRIs are primarily discussed as serotonergic, that is, targeting the transmitter serotonin. However, chronic or long-term Paxil use also targets many other neurotransmitters including acetylcholine, histamine, dopamine, GABA, noradrenaline, and glutamate as examples.27,33 Paxil is FDA-approved to treat a wide variety of disorders, including MDD (major depressive disorder), OCD (obsessive-compulsive disorder), PD (panic disorder), SAD (social anxiety disorder), GAD (generalized anxiety disorder, and PTSD (posttraumatic stress disorder).15 It is also prescribed off-label to treat numerous other disorders, including binge eating, hot flashes associated with menopause, paraphilias (examples are sexual interest in children, exhibitionism, sexual sadism, voyeurism), Raynaud phenomenon (fingers turning blue when triggered by cold or stress), fibromyalgia, and others.2
Paxil is frequently prescribed for anxiety due to its sedating and calming effects. There can be dangerous drug-drug interactions if taking other medications at the same time as Paxil. Always ensure your healthcare provider knows exactly what other drugs you are taking.21
Drinking alcohol while taking Paxil is not recommended. In some cases, combining Paxil and alcohol can be lethal and can induce serotonin syndrome, agitation, disorientation, and other risks.11
How Long is Paxil Prescribed?
Guidelines for physicians, psychologists, and psychiatrists treating depression speak in terms of months and years of medication-based treatment, yet long-term clinical trials are few. The entire round of Paxil drug trials lasted 8, 10, or 12 weeks, and one study did follow-ups for “up to one year,” (no other specifics provided) before commercial approvals were granted.15 Apart from pre-marketing trials, some medical authorities have given guidelines. But guidelines that are authored by recipients of grants or other monies from the drugmakers, the question of bias must come into play.21
Of further concern, a plan to accelerate drug approvals WITHOUT requiring safety confirmation studies was put in place in 1992, the year that Paxil came to market, allowing drug companies to sell new drugs in the US without knowing whether they are safe or not. There was a requirement to complete post-market safety and efficacy trials to retain approval status, but according to a 2022 article in The Lancet, these were often ignored. In 2022 new legislation was passed to begin to enforce these confirmation trials more stringently.
Given the paucity of long-term trials and the aforementioned laxness of the drug approval process, it is not surprising that SSRIs have been prescribed for the last 30 years without any truly rigorous oversight. These factors make it impossible to provide authentically reliable guidelines on how long one should take Paxil. But statistics show that the overarching trend has been to prescribe antidepressants for an indefinite time horizon, typically years or for life.22
The “Science” of SSRIs
The mechanism by which SSRIs like Paxil operate is unknown, according to drugmakers and the FDA.15 You can correctly say that is “the science” of SSRIs.15 The clever advertising angle that has been overlaid on the matter suggests that a deficiency of serotonin causes depression, panic attacks, hot flashes, and the many other things they are prescribed for. And the idea passed along to consumers is that SSRIs improve that deficiency and that’s what you do — take an SSRI to fix the symptom.23
Serotonin is one of the body’s many neurotransmitters, or chemical messengers, that relay messages to and from the neurons that make up the central nervous system. No drug can create serotonin. Serotonin is a natural hormone that regulates thousands of functions in the body such as mood, energy, and sleep.
SSRIs block serotonin, making it accumulate at the synaptic cleft, instead of continuing on through its natural course throughout the body. While in theory, higher serotonin availability would improve mood, energy, and sleep, such improvements that do occur are short-lived. In fact, artificially concentrated serotonin levels will soon degrade and become waste products, resulting in a deficiency. Whether one had or did not have a serotonin deficiency prior to SSRI treatment, one will surely develop one as a long-term effect of Paxil or similar drugs. This phenomenon has been clearly demonstrated in clinical studies.24,25
Common Long-term Effects of Paxil
A broad set of data has accumulated over the last 30 years on the most common long-term effects of Paxil. Not everyone reacts in the same way. There can also arise more serious, rare long-term effects that can, unfortunately, become chronic and debilitating, A common outcome is for a depressed person to become manic or some other undesirable manifestation after medication, and their diagnosis may be changed to Bipolar, for example. This can introduce further complexities and errors in treatment. It is advisable to understand as much as possible what can occur after being on an SSRI for a significant period of time. Paxil affects more than serotonin and these long-term effects may be better understood by relating them to the various neurotransmitters the drug affects. A more expanded description follows this list.
Common long-term effects of Paxil can include:
- Acetylcholinergic effects
- Serotonergic effects
- Dopaminergic effects
- Histaminergic effects
- GABA-ergic effects
- Noradrenalinergic effects
- Glutaminergic effects
- Paradoxical effects
- Anticholinergic effects — This set of symptoms may arise from disruption of the acetylcholine neurotransmitters and can include slowed gastrointestinal motility, (constipation, urinary retention), increased heart rate, sedation, delirium, heat intolerance, fever, blurred or impaired vision, and others.28
- Serotonergic effects — Serotonin is a major transmitter in the body affecting thousands of functions and behaviors. The reactions to increased serotonin vary widely and include cardiovascular effects like high blood pressure or racing heart rate. Physical manifestations may include developing glaucoma, dermatitis, seizures, tremors, migraines, decreased bone density, and nausea, Psychiatric-type symptoms can include akathisia, increased energy and impulsivity leading to taking action on suicidal thoughts, delirium, mania, hallucination, insomnia, agitation, irritability, and others. Serotonin dysfunction is also associated with memory, anxiety, apathy, crying spells, and emotionally triggered asthma.29.30
- Dopaminergic effects — Dopamine is the “reward” chemical. A state of dopamine dysfunction is associated with decreased executive functions, lowered impulse control, mania, elevated heart rate, and increased blood pressure in the brain which can lead to stroke or other injuries.31
- Histaminergic effects — Paroxetine also affects the histamine neurotransmitters. Disruption of this hormone can negatively affect the airway and respiration, the mucous membranes (throughout the body) which may present as allergic symptoms or rashes, can affect the heart and circulation of blood, vascular dilation or constriction, and many other manifestations. 32
- GABA-ergic effects — GABA is a primary inhibitory transmitter that affects a multitude of spinal cord, neurologic and psychiatric conditions. Dysfunctional GABA can present in significant ways that include seizures, liver dysfunction, and muscle movement disorders.34
- Noradreanalinergic effects — When noradrenaline (basically adrenaline) becomes dysregulated the manifestations can include agitation, arousal, fear response, panic, and the fight or flight response.35
- Glutaminergic effects — Glutamate comprises the most abundant amino acid in the brain. It functions as an excitatory hormone, but in a tightly-coordinated fashion with other neurotransmitters that regulate how much glutamate needs to be active along the nerves in the brain. When glutamate becomes dysregulated the results can include over-excited responses such as fear, panic, dread, movement disorders, and anxiety. Also found troubling is the paradoxical reversals of such symptoms, such as low mood or muscle paralysis and stiffness, associated with chronic use of GABAergic medications.36
- Paradoxical effects — SSRIs are prescribed to quell anxiety and stop panic attacks. However, paradoxical effects which are poorly understood can also occur. Increased frequency of panic attacks, anxiety, and brain zaps or “shivers” are such paradoxical effects that can occur with short-term and long-term use in some persons. These manifestations can also occur when attempting to discontinue SSRI treatment. Without proper treatment, these manifestations may linger for a very long time.38-40
