When in recovery from a substance use disorder, you will explore its causes, effects, and the ways to address them. The causes can include past traumas, difficult life situations, toxic relationships, and underlying mental health issues. For this last category, there are many treatment options, one of which is the antidepressant Paxil.
What Is Paxil?
With the generic name paroxetine, Paxil is used to treat major depression, post-traumatic stress disorder (PTSD), generalized and social anxiety disorders, and obsessive-compulsive disorder. All of these can be factors that lead to or worsen a substance use disorder.
According to the FDA, Paxil falls into a class of drugs called selective serotonin reuptake inhibitors (SSRIs), putting it in the same family as Celexa (generic name: citalopram), Lexapro (escitalopram), Prozac (fluoxetine), and Zoloft (sertraline hydrochloride). While antidepressants in general are the most prescribed medications in the United states, Paxil is currently the fifth most prescribed antidepressant medication overall.
A Brief History of Paxil
Paxil was approved for human use by the U.S. Food and Drug Administration (FDA) in 1992. While some side effects were recorded throughout the late 1990s, it became the first SSRI to be prescribed for the treatment of panic disorders and agoraphobia. It was developed by GlaxoSmithKline and is distributed by Apotex.
Paxil is included in the so-called “second generation” antidepressants. It now comes in its standard formula under the names Paxil, Aropax, Brisdelle, Deroxat, Paxetin, Pexeva, Sereupin, and Seroxat. It has recently been reformulated into an extended-release version called Paxil CR. The generic version of standard-release Paxil entered the U.S. market as paroxetine in 2003.
How Does Paxil Work?
Of the current SSRIs, Paxil has been proven to have the highest reuptake rate of serotonin (a neurotransmitter that has been linked to depression when it is too low). What that means is that it increases the amount of serotonin that is utilized in the brain, thereby lessening the severity of depression caused by low serotonin.
Serotonin has many functions in the human body. These include:
- Balancing the sleep-wake cycle
- Regulating mood and emotions by creating a sense of calm and relaxation
- Speeding and slowing metabolism
- Adjusting hunger and overall appetite
- Assisting cognition and enhancing concentration
- Regulating much of the brain and body’s hormonal activity
- Controlling body temperature
- Supervising blood clotting
- Balancing out dopamine and norepinephrine, two other neurotransmitters key to controlling mood and emotions
Unlike many other neurochemicals, serotonin can only be manufactured in the brain. When the serotonin receptors do not work as they should (by under-producing through a process called “reuptake”), only the brain can correct the problem. Paxil and other SSRIs were designed to assist the brain in this process. The important thing to note is that Paxil is considered the most potent of the SSRIs, a fact that carries both advantages and cautions when it comes to your mental health.
How Long Does It Take for Paxil to Work?
Like other SSRIs, it takes time for Paxil to build up to effective levels in your system. While functions like appetite, energy levels, and sleep regulation may be improved in the first two weeks of treatment, the effects on depression, motivation, and anxiety usually take six to eight weeks.
Some people on antidepressants become frustrated because it is hard to see mood improvement as it occurs slowly over the course of weeks. It is very important to stick with the medication and never go off it without a doctor’s supervision because the side effects of doing so can be dangerous. Paxil is especially known for severe withdrawal symptoms if you stop taking it suddenly. That does not mean it is necessarily more dangerous than other SSRIs, though, especially under a doctor’s oversight.
Are There Any Side Effects?
Before reviewing side effects, it is important to note three things. First, side effects run the gamut from mild to severe with the severe side effects usually being the rarest. Aside from your doctor, the FDA provides the best guidance for understanding and managing medication side effects. According to the FDA, side effects can occur when you first start taking a medication, when you increase or decrease the dosage, and when you quit the medication after being on it for an extended period.
Second, it is important to note that, while some side effects are common, you will not experience every single side effect on the list. For a better understanding of how and why drug companies list side effects and how those listings are regulated, you can consult the FDA website.
Third, side effects may only be temporary as your body adjusts to the new medication or dosage. If you go off a medication (with a doctor’s supervision), those side effects will go away the vast majority of the time.
The more common side effects of Paxil may include:
- Asthenia (weakness or lack of muscle strength and endurance)
- Constipation or diarrhea
- Drowsiness and trouble waking
- Sexual dysfunction, including trouble getting or keeping an erection, delayed ejaculation, and decreased libido
Less common side effects include:
- Acute anxiety
- Blurred vision
- Dilated blood vessels, sometimes with decreased blood pressure
- Higher risk of infection
- Severe erectile dysfunction (impotence)
- Paresthesia (abnormal skin sensations like stinging, burning, and itching)
- Problems with concentration
With any of the less common or rare side effects, you should consult your doctor. If you are at all concerned about even minor side effects, contact your physician. Symptoms like, fever, chills, chest congestion, swelling, and rash could indicate an allergic reaction. If you experience any of these last symptoms, you should contact your doctor immediately or go to the emergency room.
When you first begin to take an antidepressant, you may experience strange dreams and disruptions in your sleep pattern. While these are relatively rare side effects, they are usually nothing to be concerned about and will go away over time.
Very common side effects occur in 10% or more of patients. Insomnia is the only symptom listed in this category. Common side effects are those that occur in 1-10% of patients. Uncommon side effects occur in 0.1-1% of patients. Rare side effects happen in less than 0.1% of people who take Paxil.
What Else Should I Know About Paxil?
The FDA is very careful in regulating medications and monitoring side effects. It often takes years of animal and human testing before a medication makes it to the market. While Paxil is among the most powerful antidepressants, the FDA has deemed it to be safe. For more information on the FDA’s approval process, you can click here.
While you should always advocate for yourself in a medical setting, if a doctor prescribes a drug like Paxil, it is worth trying it to see if it benefits you. Doctors are trained to weigh the benefits and drawbacks of a medication and to look for counter indications (reactions to other medications or certain diseases and disorders).
Are There Alternatives to Paxil?
Paxil may be the first medication your doctor recommends. It can also be suggested after you have tried other antidepressants and SSRIs. If earlier medications have not worked for you, it is important to remember that each medication is different. Because one drug didn’t help you, that does not mean that Paxil won’t. However, there are alternatives to Paxil that you and your doctor may consider.
- Celexa (citalopram) is prescribed almost exclusively to treat depression. It has also been shown to boost energy levels and an overall sense of well-being. Side effects may include blurred vision, dry mouth, and weight gain.
- Lexapro (escitalopram) is related to Celexa, but can be prescribed at higher dosages while retaining its effectiveness. It is used to treat both anxiety and depression in adults and major depression in people over the age of 12. Side effects include tolerance to the drug (and reduced effectiveness), blurred vision, headaches, mood swings, and weight gain (especially in children).
- Prozac (fluoxetine) is among the stronger SSRIs and is used to treat major depression, bulimia, and obsessive-compulsive disorder (OCD). It has generally the same side effects listed among the other SSRIs. Because of the risk of birth defects, pregnant women should not take Prozac.
- Zoloft (sertraline) is currently the most prescribed antidepressant in the United States, and it is often the first one doctors will try with a patient. It is used to treat major depression, panic, anxiety, and OCD. Side effects include drowsiness, nausea, tremors, and insomnia.
Will Paxil Help Treat My Substance Use Disorder?
While Paxil and the other SSRIs are not used to treat substance use disorders directly, they are often prescribed for some of the underlying causes or “triggers” of substance use disorders. Sometimes, these triggers are other disorders or mental health issues. When there are two or more disorders present in a single patient, they are called “comorbid” (which has nothing to do with the word “morbid” meaning “fatal”).
People often develop substance use disorders because of another mental health disorder such as depression, anxiety, panic, or OCD. People may choose to use a substance to self-medicate, which can be very dangerous. Substances used in self-medicating include alcohol, illicit drugs, and prescription drugs.
By treating the underlying issues that can cause, complicate, or worsen a substance use disorder, the chances of recovery are increased while the chances of relapse are decreased. This is where medications like Paxil can help you.
What Other Treatments Are Offered?
When dealing with a substance use disorder, doctors and mental health professionals will often suggest other forms of treatment to enhance the efficacy of medications like Paxil. One-on-one psychotherapy is often recommended. Often called “talk therapy,” this form of treatment teaches you coping mechanisms for difficult emotions and life situations. A therapist may employ cognitive-behavioral therapy (CBT) to help address addictive tendencies, choices, and behaviors. By becoming conscious of those behaviors, it becomes easier to preempt them, thereby helping to prevent relapse.
Group therapy can also work in tandem with antidepressants. The point of any therapy is to develop ways of coping with the causes of a substance use disorder. Just as “two heads are better than one,” group therapy is a setting where you can gain several perspectives on substance use and how to avoid it.
All forms of psychological intervention or counseling can address both the direct and indirect causes of a substance use disorder. These causes can include depression, anxiety, PTSD, acute stress disorder, difficult life circumstances, insomnia, schizophrenia, and chronic pain. Therapy can help treat all of these.
Studies have shown that psychotherapy and SSRIs are relatively equal in their effectiveness in treating depression, anxiety, and panic disorders. They are made even more effective when they are used in tandem with each other. This is one of the reasons why several approaches are often employed when a person is in recovery. Besides therapy and antidepressants, other treatments include meditation, exercise, art therapy, exposure to nature, pain management, and the use of anxiolytic (anti-anxiety) medications like benzodiazepines.
Your Treatment Options
If you are suffering from a substance use disorder, it is important to remember that you are not alone. The National Survey on Drug Use and Health (NSDUH) has shown that 19.7 million Americans over the age of 12 are currently struggling with a substance use disorder. That makes up 10% of young adults and 38% of adults over 18 who are currently struggling.
You have many resources at your disposal, and you can get to many of them quickly. If you need immediate help, you can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) Hotline at 1-800-662-HELP (4357). You can also contact Granite Recovery Centers at 855-712-7784. At Granite Recovery Centers, you will have access to various resources, including antidepressants like Paxil, individual and group therapy, and out-patient and in-patient rehabilitation services.