Paroxetine (Paxil) versus ...
- Paroxetine vs Escitalopram
- Paroxetine vs Amitriptyline
- Paroxetine vs Mirtazapine
- Paroxetine vs Trazodone
- Paroxetine vs Clonazepam
- Paroxetine vs Venlafaxine
Based on "Essential Psychopharmacology"
written by Stephen M. Stahl, MD, PhD
During taper and cessation of treatment paroxetine (Paxil) is associated with significantly more discontinuation symptoms than other SSRI antidepressants.
Major depressive disorder
Amitriptyline and paroxetine appear to have similar antidepressive efficacy. However, in clinical study amitriptyline showed a greater degree of retardation reduction 12, 13, 14.
Mirtazapine and paroxetine are equally effective for the treatment of depression after 6 weeks of therapy 1.
Mirtazapine has faster onset of overall therapeutic efficacy than paroxetine. In particular mirtazapine has an earlier onset of improvement of anxiety symptoms in depressed patients 3.
In comparative study of mirtazapine and paroxetine in elderly depressed patients the median time to response was 26 days for mirtazapine and 40 days for paroxetine. Patients treated with mirtazapine showed more reduction in Ham-D Factor I (Anxiety/Somatization) and Factor VI (Sleep Disturbance) scores 2.
|Results of comparison of mirtazapine and paroxetine in major depression 1||Paroxetine||Mirtazapine|
|Regimen||20-40 mg/day for 6 weeks||15-45 mg/day for 6 weeks|
|Mean HAM-D-17 total score at week 1||
|HAM-D-17 responders (> or = 50% decrease from baseline) at week 1||
|HAM-D-17 responders at week 4||
|Most common side effects||Nausea, vomiting, tremor, and sweating||weight increase and influenza-like symptoms|
|Conclusion: Mirtazapine and paroxetine were equally effective after 6 weeks of therapy|
Major depressive disorder
Trazodone and paroxetine show equal effectiveness at reducing symptoms of depression and promoting remission. Paroxetine has slightly faster onset of efficacy. Trazodone provides extra advantage in depressed patients with sleep difficulties 5.
Side effects: Adverse reactions with trazodone are mainly of the nervous system, and with paroxetine mainly gastrointestinal 5.
Clonazepam is a benzodiazepine with anxiolytic, anticonvulsant, muscle relaxant, and hypnotic properties.
Clonazepam is superior to paroxetine with respect to the frequency and nature of side effects.
|Results of randomized trial with clonazepam and paroxetine in panic disorder 7||Paroxetine||Clonazepam|
|Weekly panic attacks at week 4||
|Clinical improvements at week 8 on Clinical global impression improvement scale||
|Anxiety severity||significantly reduced with clonazepam versus paroxetine at weeks 1 and 2, with no difference in panic disorder severity|
|Adverse events rate||
|Most common side effects||drowsiness/fatigue (81%), sexual dysfunction (70%), nausea/vomiting (61%)||drowsiness/fatigue (57%), memory/concentration difficulties (24%), sexual dysfunction (11%)|
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- 12. Stuppaeck CH, Geretsegger C, Whitworth AB, Schubert H, Platz T, Ko"nig P, Hinterhuber H, Fleischhacker WW. Paroxetine versus amitriptyline in depressed inpatients. J Clin Psychopharmacol. 1994 Aug;14(4):241-6. PubMed
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Published: March 31, 2008
Last reviewed: February 22, 2017