• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Is Paxil the Best SSRI for Anxiety?

Is Paxil the Best SSRI for Anxiety?

August 30, 2019
Chris Aiken, MD
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Chris Aiken, MD Dr. Aiken has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
Dear Dr. Aiken: Your review of Paxil’s risks in the May issue failed to mention a benefit that’s unique to this drug. Isn’t it the best SSRI for anxiety?

Dr. Aiken: Paroxetine’s (Paxil’s) reputation as the anti-anxiety SSRI got off to a running start. It was first launched for panic disorder in 1996, two years before its approval for depression, and went on to gain approval in 4 other anxiety disorders. A rumor began to percolate that paroxetine was a better choice for anxious patients, and it continues to be spread. For example, Stephen Stahl highlights it on his website: “In clinical practice, many clinicians use [paroxetine] for patients with anxious depression.”

The data tells a different story. In head-to-head comparisons, paroxetine works as well as other serotonergic agents in anxiety disorders, and sometimes worse. That includes around a dozen large, head-to-head trials in generalized anxiety disorder, social anxiety disorder, panic disorder, and major depression with anxiety. It fared no better than sertraline, citalopram, venlafaxine, and clomipramine, and was consistently outperformed by escitalopram (Sanchez C et al, Int Clin Psychopharmacol 2014;29:185-196). Overall, paroxetine has only modest anxiolytic effects (effect size of 0.3), and anxiety does not predict whether a depressed patient will respond to it (Sugarman MA et al, PLoS One 2014;27(9):e106337).

Paroxetine does hold more FDA-approvals in anxiety disorders than most other antidepressants: panic disorder, generalized anxiety disorder, social anxiety disorder, PTSD, and OCD. Those approvals came with a license to market, and that marketing may be responsible for its clinical lore. Side effects may have also assisted in its reputation. Paroxetine causes more fatigue than other SSRIs, and sedative effects can be conflated with anxiolytic effects (Nevels RM et al, Psychopharmacol Bull 2016;46:77-104).

Paroxetine does stand out in a few ways that aren’t so desirable. It has higher rates of weight gain, sexual dysfunction, withdrawal problems, anticholinergic effects, congenital malformations, and CYP2D6 drug interactions than other SSRIs (Marks DM et al, Expert Opin Drug Saf 2008;7:783-794). Our May 2019 issue added another risk to that list: dementia. There may be patients who respond uniquely to paroxetine, but anxiety is not a reliable guide to finding them.
General Psychiatry
KEYWORDS antidepressants anxiety anxiety disorders generalized-anxiety-disorder panic-disorder pharmaceutical_industry pharmacology pharmacology-tips practice_tools_and_tips psychopharm-myths psychopharmacology psychopharmacology_tips ptsd social-anxiety-disorder ssris
Aiken eic 150x150
Chris Aiken, MD

Psychopharm Commandment #6: MAOIs

More from this author
www.thecarlatreport.com
Issue Date: August 30, 2019
SUBSCRIBE NOW
Table Of Contents
CME Post-Test - How to Talk about Medication, TCPR, September 2019
Is There a Case for Cannabis in the Treatment of Pain?
Is Paxil the Best SSRI for Anxiety?
A New Contraindication for Ambien and the Z-Hypnotics
A New Way to Talk to Patients about Medication
Mirtazapine Augmentation: Running Low on Rocket Fuel
DOWNLOAD NOW
Featured Book
  • MFB6eCover.jpg

    Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

    Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
    READ MORE
Featured Video
  • therapist_canstockphoto9201097.jpg
    General Psychiatry

    Using SAMe In Clinical Practice with Garrett Rossi, MD

    Read More
Featured Podcast
  • canstockphoto4921771.jpg
    General Psychiatry

    Psychopharm Commandment #6: MAOIs

    MAOIs rank high in efficacy and are pretty well tolerated too, as long as you watch for two critical interactions.

    Listen now
Recommended
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png
  • Approaches to Autism Intervention

    January 31, 2022
    canstockphoto2240982_child-bubbles_thumb.jpg
  • Currently Available Cannabis Products

    September 1, 2022
  • Interpreting Assessment Discrepancies from Multiple Sources

    October 17, 2022
    ChildAssessment.png

About

  • About Us
  • CME Center
  • FAQ
  • Contact Us

Shop Online

  • Newsletters
  • Multimedia Subscriptions
  • Books
  • eBooks
  • ABPN Self-Assessment Courses

Newsletters

  • The Carlat Psychiatry Report
  • The Carlat Child Psychiatry Report
  • The Carlat Addiction Treatment Report
  • The Carlat Hospital Psychiatry Report
  • The Carlat Geriatric Psychiatry Report

Contact

info@thecarlatreport.com

866-348-9279

PO Box 626, Newburyport MA 01950

Follow Us

Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

© 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.