Talk:Paroxetine/Archive 1

Links

I don't think "official" should be used in "The official paroxetine site" link (paroxetine.com). How is it "official"?

• The content is nothing special-- and nothing that can't be found elsewhere.
• It has google adverts plastered over it in prominent places. *Furthermore, it seems to be run by phamaceuticalword.com/ pharmapromo.com.

Spam?

Increased Cholesterol & Paroxetine

I'm hesitant to edit the article directly as I've no medical background, but I've discovered two studies that indicate Paroxetine can lead to increased cholesterol levels in otherwise healthy patients. This seems an important enough issue to be mentioned here.

[[1]] "Blood samples were collected at baseline, after 8 weeks of paroxetine administration, and post-discontinuation in 18 healthy male volunteers. RESULTS: In the 16 of 18 patients whose plasma levels of paroxetine indicated an unequivocal compliance to treatment, paroxetine administration induced an 11.5% increase in low-density lipoprotein cholesterol (LDL-C), which normalized after paroxetine discontinuation."

[[2]] "We examined serum cholesterol and plasma catecholamine levels in PD before and after paroxetine treatment. The serum cholesterol and plasma catecholamine levels were not different between the PD patients and control subjects before the treatment. However, the levels of total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were significantly increased in the 28 PD patients after 3 months of paroxetine treatment, whereas the body mass index and plasma catecholamine levels were unchanged."

Citation reference

"Paroxetine is a phenylpiperidine derivative which is chemically unrelated to the tricyclic or tetracyclic antidepressants. In receptor binding studies, paroxetine did not exhibit significant affinity for the adrenergic (α1, α2, β), dopaminergic, serotonergic (5HT1, 5HT2), or histamine receptors of rat brain membrane. A weak affinity for the muscarinic acetylcholine and noradrenaline receptors was evident. The predominant metabolites of paroxetine are essentially inactive as 5-HT reuptake inhibitors." Care to provide citation/reference pls? Uniearth 23:00, 14 November 2006 (UTC)

Rewrite

This page needs a serious rewrite. Not only does it contain numerous subtle flaws and biased statements, it is generally misleading and strongly worded to dissuade readers against paroxetine's usage. A more thorough, analytical model should be implemented, to better inform of paroxetine's use. I think part of the problem is that there have been too many people posting their own views on this page, and wording them to resemble facts. Wikipedia is not a forum, it's an encyclopedia. And as such, every article needs to be totally unbiased and devoid from any subjective views. --Prisonnet 14:41, 1 November 2006 (UTC)

"Both of the studies concluded that Paxil is significantly more effective than the placebo control group." where is this referenced from? the recent documentary on bbc2 stated that it was no more effective than a placebo, both cannot be right.

The BBC2 Panorama documentary, The Secrets of Seroxat, was correct. Overall, it is no better than placebo. Only studies showing positive benefit, however slight, were submitted to the FDA. The trials where paroxetine fared worse (or far worse) than placebo were not revealed and were kept sealed by GSK.

It has to be significantly more effective than placebo, or it would not be approved by the FDA and similar drug-monitoring bodies. Sometimes individual studies do not adequately demonstrate or disprove efficacy, which is why repeated studies are done with the largest possible groups. --72.192.118.171 18:06, 8 March 2007 (UTC)

I use Paroxetine for symptomatic relief for PTSD following witnessing a friend's death on the road. The notion that it works only as a placebo is completely ludicrous. It's been a lifesaver, and, in my case had an immediate and physically notable effect on my nervous system, which levelled out over a period of weeks. Not that I believe it should be used without due care and adequate supervision... I was cranky for the first month, to put it mildly. From speaking with others taking the drug, the concensus is that it creates in the user an increased propensity towards generally transgressive behaviour, which includes suicide. I do feel that, overall, a little more balance is required in the article, as there are certainly good and bad things about the use of paroxetine, rather than nothing at all as has been suggested.For what it's worth I speak as someone who lost a family friend to an overdose (of unknown motive) whilst taking the drug, and began to self-harm after going on it myself. Beg your pardon my subjectivity, but I feel it's relevant. 82.45.245.131 (talk) 00:01, 3 October 2008.

Any Thoughts?

I realise this isn't a discussion board, but my case seems unusual, particularly as a known side effect of the drug is a reduced sex drive. Anyway, my doctor prescribed me Paxtine (20mg per day paroxetine) as a solution to impotence. I'm just beginning it now - I have a high sex drive/libido naturally, and my problem is most likely anxiety related which this drug is supposed to be able to cure. Just thought it was weird/unusual case. Such a use of the drug certainly isn't mentioned in the article. Any thoughts? (unsigned)

I've also been on Paroxetine, 20mg per day for depression, and I've found my sex drive has increased alot, rather than decreased.. I think that the decreased sex drive can be a side effect of withdrawl, rather than the drug itself. (unsigned)

In the first case, your doctor may feel that a reduced sex drive might actually decrease your anxiety and therefore address the cause of your impotence. In the second case - decreased sex drive can also be a symptom a depression, in which case, getting rid of the depression might improve your response, to the point where the drug's own libido-squashing effect is eclipsed. (I'm not a doctor, but I'm well familiar with Paxil.) 72.70.26.80 11:30, 17 March 2007 (UTC)

Biased

This page is terribly biased against paxil.

The side-effects, possibilities of suicidal ideation, and withdrawl symptoms (although worse with paxil) are portrayed on this page as only being consequences of taking paxil, whereas all effects of paxil can occur with any ssri.

In addition, these effects of SSRIs are known to be more individual than with most other medications, with some patients receiving absolutely no side effects, and others having numerous ones. This page does not reflect that, but rather implies that all the side effects with occur with everyone taking it.--Prisonnet 20:39, 29 June 2006 (UTC)

- I have taken Prozac for 6 months and never felt any discontinuation effect. I have been on Paxil for only 4 months and the withdrawal is killing me. I feel intense electric shocks every 5 secs that are sometimes intense enough to make me lose balance or have Parkinson's disease like body tremors. Paxil withdrawal is HELL, no bias there.

Editing by GSK?

A suspicious number of the editors of this article have only ever made edits to this article, all of which are edits to make the article more favorable to GSK.

I think you're right. I had made a few written observations concerning some of the outright LIES (concerning efficacy and "trial" results) presented in this article and they were immediately deleted. And I mean within a few minutes. Makes one wonder if GSK is constantly monitoring this wiki page as a form of damage control. Sections of the page are an blatent advertisement by GSK to promote Paxil. This is an encyclopedia article about the generic chemical paroxetine. Not an advertising platform for GSK to persuade people to "Eat More Paxil."

Request that article be locked? This is a real concern for some of us that want to be sure we are reading the real Wikipedia article and not some GSK propaganda...24.251.84.221 12:41, 19 October 2007 (UTC)

Yes, this article DOES need to be locked. On May 12, 2006, the FDA itself finally released a warning that Paxil makes depressed ADULTS suicidal. Period. Said paroxetine-medicated people are 6.4 times MORE LIKELY to have suicidal thoughts (ideation) as compared to placebo. This is now (and always has been) fact. Quite a contrast to the "remarkable efficacy" touted in this article. Well, of course... That "information" comes straight from GSK's fraudulent "trials" As well as straight from GSK's ever-so-twisted sense of morality combined with its insatiable appetite for profit. LOCK IT! And let's get these facts straight. We need truth and facts here. Not Pharma propaganda like mentioned above.

Brain zaps

I'm surpised nobody's mentioned "brain zaps". The "zaps" are most likely some sort of seizure associated with Paxil withdrawl. They feel like electric shocks inside your head. Many people report them. A simliar condition may result from consumption of MDMA.

True, but its better way to drug yourself than MDMA i think so...

- Paxil withdrawal is real torture. I couldt believe no mentions of the zaps either , thats why i added it. Its not merely "zaps" it really feels like an intense electric shock, intense enough to litteraly throw you off balance or make you have parkinsons disease like body tremors. It is utterly irresponsible for a drug company to market such a drug without telling patients UPFRONT what they are getting into. The withdrawal is 10x more unpleasant than the reasons why i started taking this medicine. Being shy and feeling ackward in social gatherings will feel like a blessing from god once i am trough with the withdrawal... those drugs makers are terrorists, they are torturing me and they actually demanded money for doing so. Incredible... Paxil is the worst drug i have EVER taken, legal or illegal.

The "zaps" are mild and very infrequent. It reminds me of the sensation when you are dreaming you fell out of bed and get startled... it is more like a startle than an electric shock.

Withdrawal

I know someone who was on Paxil. His doctor switched him over to Effexor, and didn't have him taper off use of Paxil. He didn't notice any withdrawal after he stopped using Paxil.

JesseG 03:32, 2 Jun 2004 (UTC)

Personally, I have been on 150mg a day (Slow Release form) for nearly a year. Didnt notice any real withdrawal after a rather quick stop.

Really? I can't go an 25 or so hours without feeling withdrawl symptoms. The-dissonance-reports 03:56, 12 December 2005 (UTC)

not everyone experiences withdrawal. as stated in the article, about 1/3 of users experience withdrawal, so it's not odd that you might personally know someone who stopped with no problem. but a full third of users experiencing from mild to severe withdrawal is a serious problem, especially in a widely prescribed drug.

I was on a low 25-50 dose for around 6-7 months (I think) and I experienced withdrawal. Shocks, anxiety, strange sounds..etc

I was under Paxil during eight months (20 mg per day), and I ended the treatment cold turkey, so I experienced some withdrawal symptoms like the electric shoks, sweating and headache. This caused me to take the medicine for one more month, but this time I ended the treatment gradually and I experienced no withdrawal symptoms at all. So I think if people inform themselves more about the drug and how they should quit it, all this problem about withdrawal would end.

I have been on Paxil for years and the only reason I'm still on it now is because of "The Zaps". I've tried a few times to just deal with them, but it's really difficult.

I have experienced Paxil withdrawals as well including dizziness, a severe feeling of weakness, and terrible brain "zaps". I'm still cutting down and even just a few mg reduction results in the onset of these symptoms within 36 hours. I was on 20-40 mg for five years and I am now taking 7.5 mg. They initially adminstered the drug to me at age thirteen. I believe more should be said about its use in children and the possiblility of severe withdrawal. I have spoken to people who have experienced permanent gastrointestinal problems because of the drug.

D. Scott 2006-12-13

I've been taking Paxil CR for a while now. I have had the unable to reach orgasm issues as well as the loss of sex drive. The loss of sex drive seems to have gone away, and I find that the frequency that you have intercourse seems to inflate or deflate the affects of the unable to orgasm. The more frequent, the longer it took to reach orgasm, if at all. It was almost like a numbing of the nerves in the genitals, so to speak.

That's why GlaxoSmithKline is now trying to promote Paxil as a "treatment" for premature ejaculation. ANYTHING to squeeze another sacred dollar out of their evil concoction. Take a serious and no doubt troubling side effect and spin it once again to seem like a benefit of some kind (think Viagra's "four-hour erection" tactic). Sure, you may last longer in bed. If that is your goal. However, will that man REALLY know what he'll be getting himself into? Having to endure the myriad of other side effects as well as the Hellish withrawals? Most likely not. But, hey, GSK stock will rise. And that's always been the main objective, right?

As for withdrawls, I never got the brain zaps, but I do get dizziness and a feeling of disorientation if I forget to take it for over 24 hours, and I get a lesser feeling when I'm trying to cut down the dosage (I went from 50mg of the CR to 25, now back to 50mg). I'm taking it for OCD primarily, and anxiety as a secondary (brought on by the OCD).

Studies

Whever one says "recent studies have shown," it would be best to give citations, especially when the results are controversial, as any new results concerning a widely-used drug like Paroxetine would be.

I agree, I took the UK form of seroxat for a year and coming off was hell , I cannot comprehend how they can class it as non-addictive, surely when you take another pill to make the side effects go away and therefore chill you out , it is a simple fix, or is it me.

Simply put the drug has a high dependency on depression and when the user stops , unless supported by another SSRI it will cause all of the above and more in my experience.

I am a current user and i have started going trew the effects of withdraw. i lost my medical and could not afford my medication. I was feeling so bad i did'nt even leave my room. my family ended up borrowing the money. because at the point of time i was even in tears and could'nt stand because i would get dizzt and fall. what i am saying is i know there are withdraws and i will go trew them again because my refills are out and i can not get to a doctor until 26 september. so for anyone out there beaware because i was not informed of the side effects or the withdraw issues that the medicen had. —Preceding unsigned comment added by 71.114.169.221 (talk) 00:51, 4 September 2008 (UTC)

Suicide risks

I was under the impression that the reason the medicine appeared to make people prone to suicide was that the ideation was already there, but they didn't have the energy before to carry out their plans. The medicine gave them that energy to attempt or complete suicide.

JesseG 02:59, Nov 20, 2004 (UTC)

Not true IMHO. My wife was given Seroxat for Post-natal depression. During this period she gained significant body mass (not through eating) and attempted suicide twice. There is no family history or pathological history of this from her.

I can only assume that the drug altered her seratonin levels in a negative fashion and affected thyroid function. Three consultants have concluded that this was not caused by any stress/trauma/post-operative conditions relating to the birth.

Our intention is to sue GSK (who ironically I worked for a few years back) but we are still battling the immediate problems caused by it.

Sorry - i'm not a *registered* wikipedia user.

A new book was published in 2008 called Side Effects, by Alison Bass, (she's a former reporter with the Boston Globe). Her work uncovering certain bits of information should absolutely be looked at. I'm halfway through it, and another drug that's heavily covered in the book is Prozac.

GravityIsForSuckers (talk) 02:00, 13 December 2008 (UTC)

I will respond here to mwalla's links on suicidality ([3] and [4]). Both are to studies of patients diagnosed with clinical depression, which mwalla notes is already a risk factor for suicide. Paroxetine is widely prescribed for other disorders, for example generalized anxiety and social anxiety disorders, so the studies do not provide a representative sample of paroxetine customers. Also, as LiteratureGeek described, even if the net effect is fewer deaths in a given population, the drug might be preventing some deaths but causing others. The FDA-mandated boxed warning is based on the fact that paroxetine can definitely cause suicidal ideation and may thus increase the risk of actual suicide. Aggregate sums from non-representative populations do not change the characteristics of the drug itself.TVC 15 (talk) 08:36, 26 January 2009 (UTC)

Link to serotonergic

I removed the link to serotonergic from the pharmacology section which is currently (probably inappropriately) a redirect to Noradrenergic and specific serotonergic antidepressant. --Overand 00:01, 26 Apr 2005 (UTC)

I've seen it cause a successful suicide. Pharmaceuticals are so synthetic... do YOU know what's in them?

All antidepressants have the potential to incite suicidal ideation. The fact is, they've saved far more lives than they've cost. --Prisonnet 18:08, 8 March 2007 (UTC)

Side effects

In my case, one of the side effects was weight gain. From a slightly underweight 61kg (at 1.80m) to 70kg. I didn't gain any weight at all in the prior years (took it at age 20-21). Also excessive transpiration seems quite common (at least that's what my psychiatrist told me). This should of course be regarded as purely anecdotal. Personal accounts have reported that this drug has caused blackouts followed by extreme rage.

I believe I am not sleeping well because of this drug. My sleeping patterns have been dramatically effected after starting this medicine. Though I feel better in the day, I'm not sleeping well.

I've had the same issues. I took this medicine when I was 16-18, no side effects until after I got upped to 60 mg. Within two months of upping the dosage, I had gone from 105 pounds to 158 pounds. I quit taking Paxil because the weight gain caused more anxiety and depression than I'd had in the first place, and after quitting the drug, I lost 55 pounds in a matter of three months (with no change in diet or exercise). I'm 20 now, and I've recently gone back on Paxil for panic disorder. Going back on this medicine is so difficult the first few weeks. I can't sleep more than 2 hours at a time, and I'm never hungry anymore, yet I feel energetic. It's worth it to me personally though, because I'd rather have severe insomnia than have panic attacks any time I leave my home. I'd tried psychotherapy, changes in diet, Xanax, and many other things, and Paxil has been the only thing that made any real difference.

NPOV - let's clean up

This article is poorly written and POV. Rather than primarily informing, it emphasizes controversies without explicitly grounding discussion on credible publied sources and is overly influenced by personal anecdote. A recent retrospective study suggests increased suicide risk results in adults from taking paroxetine.[5] This may well stimulate a flurry of low-quality edits here just when readers will be consulting this article for an "encyclopedic" perspective. Let's clean up our act quickly and have a respectable presentation readied for the onslaught. Myron 06:30, 23 August 2005 (UTC)

The discussion on addiction rests on misapplication of the term and should be eliminated as being misleading. The Wikipedia article provides the currently accepted definition: "uncontrolled, compulsive use despite harm". Paroxetine is not associated with craving and does not produce pleasure or dramatic short-term relief of pain or anxiety. Physical tolerance occurs to certain adverse effects but not to the desired effect (i.e., there is no tachyphylaxis) — the "poop-out" phenomenon is not classified as tolerance — so that another criterion for addiction is not satisfied. Thus addiction is not an issue with paroxetine and does not even deserve mention (any more than one would discuss addiction with regard to aspirin). While physical withdrawal reactions are a major concern with paroxetine, more so than with other serotonin reuptake inhibitor drugs, mention of this belongs under the heading of adverse effects. Myron 07:32, 24 August 2005 (UTC)

Personal accounts have reported that this drug has caused blackouts followed by extreme rage.

This article is not POV. If your concern is that the article is repeating anecdotal information, it warns the reader of that. However, Paxil withdrawal syndrome is not speculation based on a few scattered user reports. It is documented in at least the following journal articles:

Independent Reports: 1993

Is there a serotonergic withdrawal syndrome? Biol Psychiatry 1993;33:851-2. Mallya, White, Gunderson.

Paroxetine (Paxil) "We have received 78 reports of symptoms occurring on withdrawal of paroxetine, including dizziness, sweating, nausea, insomnia, tremor and confusion. Such reactions have been reported more often with paroxetine than with other SSRIs. Reactions tended to start 1-4 days after stopping paroxetine and in several patients resolved on re-instating treatment. Paroxetine should not normally be discontinued abruptly". 1993 Committee on Safety of Medicines & Medicines Control Agency (Great Britain)

1995

Withdrawal syndromes after paroxetine and seatrain discontinuation. J Clin Psychopharmacol. 1995 Oct;15(5):374-5 Fava GA, Grandi S.

A possible paroxetine withdrawal syndrome. Am J Psychiatry. 1995 Apr;152(4):645-6. Phillips.

Paroxetine withdrawal syndrome. Am J Psychiatry. 1995 Jan;152(1):149-50 Pyke.

Potential withdrawal syndrome associated with SSRI discontinuation. Ann Pharmacother. 1995;29:1284-1285. Lazowick, Levin.

1996

More cases of paroxetine withdrawal syndrome. Br J Psychiatry. 1996 Sep;169(3):384. Pacheco, Malo, Aragues, Etxebeste.

Antidepressant withdrawal syndrome. CNS Drugs. 1996;5:278-292. Lejoyeux, Adès, Mourad, Solomon, Dilsaver.

1997

Paroxetine withdrawal syndrome in a neonate. Br J Psychiatry. 1997 Oct;171:391-2 Dahl, Olhager, Ahlner.

Paroxetine discontinuation syndrome in association with sertindole therapy. Br J Psychiatry. 1997 Apr;170:389 Walker-Kinnear, McNaughton.

Antidepressant withdrawal syndrome. Br J Psychiatry. 1997 Mar;170:288 Young, Currie, Ashton.

Newer antidepressants and the discontinuation syndrome. J Clin Psychiatry. 1997;58(suppl 7):17-22. Haddad

Possible biological mechanisms of the serotonin reuptake inhibitor discontinuation syndrome. J Clin Psychiatry. 1997;58(suppl 7):23-27. Schatzberg, Haddad, Kaplan, Lejoyeux, Rosenbaum, Young, et al.

SSRI Withdrawal Syndrome 1997, American Society of Consultant Pharmacists, Inc. Skaehill, Welch

1998

Treatment of disequilibrium and nausea in the SRI discontinuation syndrome. J Clin Psychiatry. 1998 Aug;59(8):431-2 Schechter.

Withdrawal syndrome associated with abrupt discontinuation of SSRIs. J Am Pharm Assoc (Wash). 1998 Jul-Aug;38(4):500-1 Wincor.

Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry. 1998 Jul 15;44(2):77-87 Rosenbaum, Fava, Hoog, Ascroft, Krebs.

Withdrawal syndrome caused by selective serotonin reuptake inhibitors. Schweiz Rundsch Med Prax. 1998;87:345-348 Bryois, Rubin, Zbinden, Baumann.

Selective serotonin reuptake inhibitor discontinuation syndrome: putative mechanisms and prevention strategies. Can J Psychiatry. 1998 Jun;43(5):523-4. Rojas-Fernandez, Gordon.

1999

Selective serotonin reuptake inhibitor discontinuation syndrome: putative mechanisms and prevention strategies. Can J Psychiatry. 1999 Feb;44(1):95-6. Benazzi.

2000

Withdrawal syndrome after the use of serotonin reuptake inhibitors. Tidsskr Nor Laegeforen. 2000 Mar 20;120(8):913-4. Fagan.

Serotonin discontinuation syndrome: does it really exist? W V Med J. 2000 Mar-Apr;96(2):405-7. Nuss, Kincaid.

Paroxetine withdrawal syndrome. Ann Med Interne (Paris). 2000 Apr;151 Suppl A:A52-3. Belloeuf, Le Jeunne, Hugues.

Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry Neurosci. 2000 May;25(3):255-61. Black, Shea, Dursun, Kutcher.

It is serious enough of a concern that it merits more than a mere notation as a "side effect."

I removed the section about "lasting sexual dysfunction." I have never seen a credible source showing permanent, adverse effects of SSRIs. Please, leave the unwarranted claims off of Wikipedia and stick to the science. Furthermore, since when do Paxil withdrawal symptoms last from "months to years?" I believe it's accepted that SSRI Discontinuation Syndrome resolves, at most, after a few weeks without restarting medication. This article certainly needs a clean-up--the author obviously has a strong bias against SSRIs, as also evidenced by condescending language such as, "As soon as you pop a pill..." The "addictive potential" section is especially poorly written. Perhaps the work of Scientologists playing around on Wikipedia? --AJ

Unfortunately, AJ, the "science" must be analyzed for credibility as well. There are few studies showing adverse effects of paroxetine because such studies are not in line with the interests of GlaxoSmithKline. Thus, we need to become competent consumers of research and selectively analyze each research study to see what Pharma connections its authors hold. Additionally, I think the "scientology" comment is out of line; simply because someone does not believe the hype about pharmaceuticals does not make them a scientologist. Your comment is akin to saying that if someone likes fried chicken, they must be black. It's faulty logic like this that leads the world into trouble. -Alex

AJ, you say: "I believe it's accepted that SSRI Discontinuation Syndrome resolves, at most, after a few weeks without restarting medication." I'm sorry, but this is incorrect. Perhaps the reason for the confusion is that persisting adverse effects from previous SSRI use are not the same thing as what is referred to as "discontinuation syndrome". That syndrome is a direct consequence of rapid neurological change from stopping the medication, and yes the obvious symptoms (such as "zaps") generally resolve within a month. Longer-term issues are a consequence of alterations made to the brain during chronic SSRI use (and, especially in the case of paroxetine, the endocrine system), rather than a "withdrawal syndrome" as such. This condition is closer to a post-acute withdrawal syndrome, and is characterised by a non-linear recovery - good "windows" and relapses - and yes, it CAN include sexual dysfunction. It comes with a host of physical symptoms, so has nothing to do with relapse into the original condition. The reason it is underreported is that most long-term SSRI users, faced with post-withdrawal issues, end up back on an SSRI or another psychotropic drug, usually at a doctor's suggestion. As time goes on, and more and more long term SSRI users attempt to cease treatment altogether (either because of poop-out, spiralling side-effects or actual recovery from the initial illness), this condition becomes more common. In 1995, you would have been right to query it, as it was indeed very rare. In 2007, you are somewhat behind the times if you cast doubt on long-term damage from the chronic use of these medications. I do agree that much of the phrasing in this article is very poor and unscientific, but that's a separate issue. And the "scientologist" remark is extraordinarily ignorant. MrBronson 22:02, 22 March 2007 (UTC)

Although things are now more correctly cited, this article is still heavily biased against Paroxetine's use. DirectorStratton 04:30, 1 March 2006 (UTC)

I can't help but wonder how many of the charges of bias are written by GSK or its sockpuppets.

Paroxetine experience over 12 years of therapy

Paroxetine has allowed me to feel "normal" for the first time in my life. I began taking paroxetine 12 years ago. I started taking 10mg once every day. I now take 25mg CR everyday.

After taking paroxetine for approxinmately 4 years, I tried to taper down and stop taking it. For me, this caused the "zaps" within days. I also had auditory hallucinations, vertigo to the point of not being able to drive or even walk at times and complete loss of libido. Fromj a psychological side, the acute mood swings returned almost immediately as did the depression.

I tapered down over the course of two months with no adjunctive chemical therapy. I continued to see my Psychologist. After four more months of what I experienced as a worsening of my physical and mental conditions and despite continued psychotherapy, I restarted paroxetine with 20mg every day.

Except for the increase in somnolence and returned ejaculatory disability, I returned to "normal". The somnolence passed in about six to eight months. Viagra allowed me to maintain an erection for long enough to have a reasonably normal sex life.

I did try to stop paroxetine therapy once more, about four years ago. Not by choice, but because I lost my medical insurance. At the time, before the patent expired and generic paroxetine was available, it would have cost me over three hundred dollars a month for the medication.

Again, I tapered down over a course of 3 months. Within weeks of decreasing the daily intake, I was acutely unstable physically, mentally and emotionally. This six months was much worse than the earlier attempt and by far worse than I'd been before starting paroxetine therapy. I did continued therapy sessions with a psychologist. For my own sake and that of my family, I began taking paroxetine again.

I can only relate the facts of my own experience. In discussing SSRI treatment with other people that I know who take SSRI's, my experience is not unique.

I will continue to take paroxetine now for two reasons. One, because this particular medication seems to allow my body and brain to act and react in the real world in a more "normal" fashion. Two) because the side effects of not taking it are so debilitating.

To say that a drug makes one behave or think "normally" is close to a contradiction-in-terms in my opinion. It is simply impossible for one to judge the nature of "normal" personal existence as one lacks experience of another individual's subjectivity. Surely you mean that you are placed on a plateau by the drug - it is this "high" which is the reason for your satisfaction and not any imagined normalisation effect. The drug achieves its purpose by reducing the user's consciousness of the moral value of his own actions; he is taken on a rollercoaster ride where his inhibitions are suspended which approaches zombification of the subject. The reason the user persists with the drug is that it makes him less aware of his own identity and ego as does any drug illicit or otherwise. By reducing "anxiety" - which is, after all, a mundane affection - it reduces pain. Of course, the user (and the drug company for that) will try to cover his guilt for enjoying the psychological dissociation by describing the effect as "normalisation"; a conclusion which is clearly absurd. These are a few reflections on the drug from a Freudian perspective. --Nicander 07:34, 13 March 2006 (UTC)

Okay...I agree that Paxil apparently seems to have a big problem with withdrawal effects. However, there are also many ways to get around that, such as switching to Prozac and weaning off of that (whose SSRI discontinuation syndromes are almost non-existent)--there's no reason to simply stay on Paxil forever because of the withdrawal effects. However, it's also possible that the feelings of instability came from returning depressive symptoms (which is likely, given that many mildly depressed people have no trouble weaning off). Your argument about if a person can be more "normal" while taking a medication is a decade-old moral debate that simply doesn't have a clear answer. Just some thoughts/advice, but of course, I'm not a psychiatrist. --AJ

seroxat

Dont EVER take this drug, my father took 10mg of seroxat for the first time and after 12 hours he tried to kill himself by hanging!!!!!!!!!!!!!!! When my mother found him, she unhooked him from the rope, he was alive, but acted like he was in trance or something (he didnt respond, his eyes were going from left to right). If someone from your family got it prescribed, steal it and burn it, or make sure you watch him day and night.

So, this page is terribly biased against Paxil (Seroxat). GOOD!

I spent nearly eight years in a haze of exhaustion courtesy of this foul drug. The only thing worse than the side effects was trying to withdraw.

In the end I withdrew with the aid of Citalopram but not before my marriage was in tatters and my life nearly ruined.

It's interesting that my G.P. now refuses to prescribe it on the grounds of the side effects and withdrawal symptoms.

There are other, far better anti-depressants on the market. If your doctor does prescribe this for you then please take my advice, rip up the script and find yourself a more enlightened doctor.

I have no axe to grind with GSK. I would like to say this is purely my experience but everyone I know who was prescribed this drug (during the late'90's) experienced a measure of the same side effects and withdrawal problems.

Seroxat? Just don't go there.........

Compliance:

"Paroxetine users should not discontinue and resume treatment with more than a few days' gap between dosings, as paroxetine decreases in effectiveness if it is stopped for a significant amount of time, and then resumed."

I would like a reference for this. Of course effectiveness decreases if you do not take the medication at all. But does it have any long term repercussions?

Warnings

Everyone who is adding ridiculous warnings about 'birth defects' and such need to stop immediately. Adding this section, besides being biased, is not needed. Paroxetine is in pregnancy category D, so of course it's going to cause birth defects. Just like ibuprofin, aspirin, and warfarin can cause birth defects. The warning already exists in its pregnancy class, it is not appropriate nor necessary to include this section in any medical article of an already pregnancy-scheduled substance. The same applies for suicide warnings. Besides being already stated on the page, all antidepressants already carry this warning.--Prisonnet 18:29, 24 August 2006 (UTC)

Negative side effects

It has not been mentioned that seroxrat may lead to violent or self harming behaviour that could even be described as physchotic, if you have any worries then contact your GP or primary health care provider, REMEMBER! there is no obligation for you to take an SSRI if you feel that it may not be in your best intrests, it is better to go through a week of cold turkey from this drug than to find yourself under arrest for assault or murder (written by 82.7.91.80, moved by Dirk Beetstra ^{T C} 06:29, 29 August 2006 (UTC))

I have experienced increased hostility (including 'blackouts')on Seroxat (paroxetine). It me took almost a year to taper off the drug gradually, using the liquid formulation, and severe moodswings persisted for at least four months after that. Most of the evidence linking paroxetine to increased hostility is anecdotal; my GP (who has an active interest in mood disorders) stated that "of course it's well-known that biopolar individuals can be very unpleasant on Seroxat"--if only I had known... No scientific reference, but a lot of personal comments can be found on this website: http://www.mcmanweb.com/article-219.htm Note that many patients report excessive and uncharacteristic alcohol cravings on this medication. [Denni Schnapp--not a registered wikipedian]

Molecular Weight

Although Molecular formula for Paroxetine is given, the informed molecular weigh (374.8) corresponds to Paroxetine Hydrochloride hemihydrate: C19H20FNO3.HCl. 1/2 H2O. Paroxetine (alone) should be 329.37

Chemistry Equation To Withdrawal Adverse Experiences (removed***)

Hypothesis suggests neuron/receptor damage a more likely cause for suicide than the simple pre-existing suicidal ideation claim and deserves study into consumption and elimination of Fluorine by exact weights of each.

A durable *Teflon like molecule develops from the fluorine-carbon bond in Paroxetine. Certain atoms should not be in the nervous system beyond the blood-brain barrier because they would cause disruption of delicate meninges and receptor damage upon chemical breakdown and synthesis.

The presence of halogens which need only one valence electron to fill their outer electron shells causes an incorrect synthesis, leaving non-transportable molecules to cause what must occur by laws of atomic, chemical and physical properties such as long-term or permanent receptor blocking or burning of delicate meninges by molecular Fluorine.

Not all SSRI compounds contain Fluorine. Prozac has three atoms in contrast to Paxil's one. Fluoxetine is less profitable to Paroxetine, damaging the buyer more quickly. Only natural molecules of carbon hydrogen nitrogen and oxygen are acceptable to the nervous system for normal function**.

Low levels of Seratonin proportionally decrease normal neuronal activity and chemistry in the first instance where an SSRI only magnifies problems.

Low levels of Seratonin have been associated with several disorders, notably depression, migraine, bipolar disorder and anxiety.

Dare we trust what is currently approved? Give some thought to that question before answering. Anyone just reading the facts might become suicidal let alone someone who has been damaged by the very system which causes such extreme societal pressures. Inappropriate trials conducted for cost and gain considerations without regard for the few is or should be well known.

When you fly in first class, it's easy to forget the dots[6]

• Teflon: A carbon-fluorine chain.

• • That no similar and transportable, halogen containing molecules are found in normal and healthy individuals who have never taken such SSRI drugs and the result of the presence of molecular Fluorine supports an acceptable theory.

• • • Citing data from the World Health Organization, "Paxil has the highest incidence rate of withdrawal adverse experiences of any antidepressant drug in the world". Is this not a factual quote?

Given that the recommendation for discontinuation syndrome is factual, I am appalled. Doesn't anyone think for their own self, blindly following such arbitrarily achieved guidelines of a corrupt system. Phenothiazine-derivative drugs are from DuPont introducing Phenothiazine as an insecticide in 1935.

Isn't Flourine used to help it cross the blood brain barrier, why don't they just add an acetyl group instead?

Codeine and Paroxetine?

I know this isn't really a discussion board, but i've been put on paroxetine in the past few days. Sometimes I get bad headaches, I take an OTC tablet (2) known as nurofen plus (200mb ibuprofen + 12.8mg codeine) which helps a lot. I've heard that Paroxetine actually stops the effects of codeine. Does anyone know much about this, and if it's true, are there any equally effective alternatives for pain relief? Timeshift 12:56, 2 November 2006 (UTC)

Timeshift, I took codeine for a cough while on paroxetine; the codeine didn't work. It actually had a bit of a backwards effect -- it made me hyper. Who knows, though. The folks at www.paxilprogress.org are helpful; perhaps ask them? -- Alex

I am appaled by the quality of this entry

The statement: "In common with previous editions, the programme presented an entirely one-sided picture of events, and could be argued was little more than a television broadcast on behalf of Baum Hedlund, the lawyers acting against GSK" is completely out of place. The tone used is unprofessional and unfortunate. It raises the question if the writer is taking parts on this issue. As stated before, gsk is being sued for millions of dollars over this drug; it is in inappropriate for wikipedia to profess biased opinions about this matter, the drug, the company, or other people involved in this dispute.

Pharmaceutical Assassination

I will attempt to get USA Today's permission to reprint here.

The dark side of psychiatric drugs - The United States of Violence: A Special Section - Cover Story USA Today (Society for the Advancement of Education), May, 1994 by Tanya Bibeau [7]

Alphaquad 05:18, 7 March 2007 (UTC)

Unacceptable sources to be deleted

Mewstarget.com website, seroxat secrets website, Paxil protest website, Hugh James solicitors website are not acceptable sources according to the Wikipedia guidelines, and I am deleting them.

Wikipedia:Reliable sources guideline (WP:RS) states: "Articles should rely on reliable, third-party published sources with a reputation for fact-checking and accuracy. Sources should be appropriate to the claims made."

Wikipedia:Self-published sources guideline (WP:SPS) states: "Anyone can create a website or pay to have a book published, then claim to be an expert in a certain field. For that reason, self-published books, personal websites, and blogs are largely not acceptable as sources."

Paul gene 13:10, 2 September 2007 (UTC)

I've added the bit about Robbie Williams back in as the report in the Sun does clearly mention Seroxat: "The singer finds it impossible to get to sleep until 4 or 5am due to insomnia and is on sleeping pills. He is hooked on the powerful and controversial anti-depressant Seroxat, which has been linked to suicidal tendencies in teenagers." Experimentalchimp 16:19, 8 September 2007 (UTC)

I've also put in some information on the UK lawsuit, which is similar to some of the sections you removed. It's rewritten and should conform to (WP:RS). The whole controversies section is probably in need of a rewrite as it's a bit of a mess at the moment, but hopefully having correctly sourced information there's a starting point. Experimentalchimp 23:30, 8 September 2007 (UTC)

The trade names are in alphabetical order.

I'm replying here to the comment below in order to save others' time, and changing the caption for the same reason. Me-pawel's original caption said to "get the names correct," in line with the comment below that Chile appears several times. Apparently, Me-pawel didn't notice that the list of trade names is alphabetical. The country of Chile appears repeatedly because paroxetine is sold under multiple trade names there. If there is a way to create a table in WP that can be sorted, then it would be helpful to have columns for 'trade name', 'country,' and 'region', but I haven't seen that anywhere. Meanwhile, I checked the listed trade names for Chile and confirmed all except Traviata, which I can neither confirm nor disprove.TVC 15 00:51, 13 September 2007 (UTC)

I don't know much about Paxil, but just by looking at this page I see several errors alone in the name section. For example:

Aroxat or Aroxat CR in Chile,

a little under that we have

Bectam in Chile,

More under that we have

Seretran in Chile

and...

Pamax in Chile,

and...

Traviata in Chile,

and finally

Posivyl in Chile,

So we have six different names for Chile alone. Adding to this we have "Cebrilin in Latin America" and the last time I checked Chile was in Latin America. Please help clean this up. (Me-pawel 05:43, 6 September 2007 (UTC))

comments by User:TVC 15 and User:Skinwalker

I've removed some of the GSK POV marketing puffery from the third sentence. (Previously, I had tried to balance it with court rulings and press reports of customer experience, but "Skinwalker" deleted that.) AJ's comments are undated, but clearly outdated. Also, AJ's comment above that there is no reason to continue taking paroxetine when switching to another SSRI will obviate withdrawal symptoms is misleading: SSRI's are prescription drugs so customers can't just buy a different one, they have to go back to a doctor for permission, and the doctors have been deceived by GSK marketing into believing that there are no withdrawal symptoms; GSK's prescribing information says to taper, not switch, so even the minority of doctors who have read of the "discontinuation symptoms" are given wrong information by GSK as to how to deal with it.TVC 15 17:13, 8 September 2007 (UTC)

"Skinwalker" struck again, deleting again the link to GSK's prescribing information on "discontinuation syndrome" and calling it "trial attorney puffery." I continue to try to assume good faith, but that is difficult when someone mis-characterizes a document mandated by government regulation as puffery, and keeps deleting it. "Skinwalker" also changed the sourced, factual statement that the drug causes withdrawal to a "he said/she said" as if it were unknowable or a difference of opinion. It is a proven fact; the BBC even reported a study showing the drug causes withdrawal symptoms in a majority of patients starting after as few as two weeks. (That would make it more "habit forming" than cocaine.) I will not speculate as to why "Skinwalker" keeps deleting factual statements unfavorable to GSK even when they are PUBLISHED BY GSK, but it would be interesting to investigate. GSK went to great lengths to tell the whole world initially that paroxetine was "not habit forming," but even after being forced to disclose the information on withdrawal syndrome, GSK disguises it ("discontinuation symptoms") and buries it, leading misinformed doctors to continue prescribing it because they have not read the updated prescribing information. If by some chance "Skinwalker" is working for GSK (which I do not assume), then (s)he may be exposing the company to charges of contempt.TVC 15 01:57, 10 September 2007 (UTC)

First off, please read the neutral point of view guidelines carefully, especially the section dealing with undue weight. The "he said, she said" approach is necessary for neutral writing. We give GSK's opinion, and then we give their opponent's position (or the other way around, I don't care which). We should not give undue deference to one point of view over another, regardless of your personal bias. Putting phrases like "serious discontinuation symptoms" in scare quotes in the lead paragraph is not very neutral. Finally, I'd like to state that I do not work for GSK, nor do I have any financial relationship with them. Your insinuation of "charges of contempt" border on a legal threat, which is quite frowned upon here. I'm willing to work with you on incorporating legitimate criticism into the article, but you need to assume good faith. Cheers, Skinwalker 16:17, 10 September 2007 (UTC)

Thanks for adding to the discussion - at last. If you read the top of this page, you will note that it says, "Please read this talk page and discuss substantial changes here before making them." You have made many changes to the article, but as far as I can tell you never provided any discussion until now. The discussion section includes several observations from different authors noting pro-GSK bias, so I am pleased that mine finally drew you in. As noted in my previous comments, I did assume good faith - despite the difficulty of that when you seem to favor a pro-GSK POV that even GSK has abandoned. With regard to conflicting opinions, however, your statement is simply incorrect. The withdrawal syndrome is an established scientific fact, admitted by GSK, backed by linkable studies in reliable sources, and concluded litigation. The only difference is whether to call it a "discontinuation syndrome" (GSK) or "withdrawal syndrome" (everyone else) so I used both ("he said, she said," you should be pleased). Your accusation of "personal bias" is therefore unwarranted and unappreciated. Your reference to legal threat is likewise misplaced. That policy states, "Do not make threats or claims of legal action against users or Wikipedia itself on Wikipedia." GSK is not, to my knowledge, a WP user, and no one has threatened WP itself. I am glad to read that you do not have any financial relationship with GSK, and I will continue to assume good faith, but please recognize proven facts and do not try to bury them.TVC 15 18:00, 10 September 2007 (UTC)

Hey, we all have a personal bias. I was simply noting that, not accusing you of it. My personal view of or bias toward these SSRIs is somewhat complicated. I was on venlafaxine, which also induces SSRI withdrawal, for several years. It was a huge help in terms of mood, but it was extremely unpleasant to miss a dose, and even more unpleasant to finally stop taking when it had outlived its usefulness. So I know personally the benefits and drawbacks of these medications, and I want to assure you that I am not trying to bury criticism of them.

What irks me about most, if not all, SSRI pages on wikipedia is the constant soapboxing and non-neutral commentary. People do not realize that blogs are not reliable sources, nor internet petitions. I'm not talking about you, specifically, most of these observations come from other SSRI pages I edit. The sourcing for this article, I think, is much better now - there are medical citations and good secondary sources from the BBC and so forth. My instinct is to use the phrase that the source uses, and if there is a discrepancy to neutrally note it. A sentence that begins something like "The BBC refers to seroxat's withdrawal symptoms, which GSK calls discontinuation syndrome..." is actually pretty damning, and uses neutral language to boot. At any rate, I suspect our differences may be more about specific wording that anything else. Can you make a proposal on how we can better cover the withdrawal/discontinuation issue? Cheers, Skinwalker 18:24, 10 September 2007 (UTC)

Here is what the article says currently:

Many psychoactive medications can cause withdrawal symptoms upon discontinuation from administration. Substantial evidence has shown that paroxetine has the highest incidence rate and severity of SSRI discontinuation syndrome of any medication of its class. That fact contrasts with GlaxoSmithKline's marketing of the drug, which initially emphasized that it was "not habit forming."[1],[2] (As of 2007, GlaxoSmithKline's prescribing information eschews the term "withdrawal" in favor of the phrases "serious discontinuation symptoms" and "discontinuation syndrome."[3]) Common paroxetine withdrawal symptoms include repeated electrical shock sensations of the brain and body (see "brain zaps"), vertigo and hot flashes.[16] For those experiencing extreme and unusual difficulty discontinuing paroxetine, it is recommended that an SSRI with a longer half-life, such as fluoxetine, be administered for approximately two weeks, then discontinued, to lessen symptoms.[17][18]

I think that covers it fairly well. BTW, the NY Times is currently running an interesting series on pain medication, especially morphine, which is cheap and effective but widely banned due to addiction concerns; the prohibition extends even to patients who are terminally ill (thus not worried about addiction) and writhing in pain.[8] I don't mean to suggest that the risk of withdrawal symptoms by itself makes paroxetine an evil product; what irks me most about it is GSK's initial marketing of the product as "not habit forming" when in fact it clearly is. BTW, I meant to correct my earlier statement: although GSK does now admit a risk of "discontinuation syndrome" in its prescribing information (having been forced to by regulators), the concluded litigation involves only minors; they are still litigating over adults. Also, I don't mean to suggest the FDA is perfect; they continue to say patients should taper off paroxetine, when in fact studies have shown that to be useless for the patient (useful only for the manufacturer which gets to sell more paroxetine even to people who have decided to quit); the WP article links to reliable sources that publish the better approach, which is to switch to an SSRI with a longer half-life and taper off that. (Generally speaking, the longer the half life, the easier it is to quit. venlafaxine has an even shorter half-life than paroxetine, and you would probably have had a much easier time quitting if you had simply switched to an SSRI with a longer half-life as noted in the article.) Unfortunately, drug makers won't tell you to switch to a competitor's product, and customers can't just go to the pharmacy and buy a different product, they have to pay a prescriber for another visit and try to persuade him/her that (a) the "not habit forming" drug is in fact habit forming, and (b) the solution is to follow the advice on WP not the FDA's advice. To the extent that we all have a personal bias, mine is against deceptive marketing and incorrect advice that customers are not allowed to ignore. WP offers a rare opportunity to make accurate information from reliable sources readily available, even if the reliable sources are medical journals that many doctors no longer take the time to read.TVC 15 06:39, 11 September 2007 (UTC)

I'm organizing (without substantively changing) the withdrawal section into a paragraph on symptoms and solutions and a paragraph on history. Also I've been looking for an article I read long ago that talked about the history of how the drug became so popular. (The WP article previously stated, without sources, GSK's POV that it's popular because it's so wonderful, but there is a contrary history backed by litigation: the drug became popular due to clever marketing and the difficulty of withdrawal.) As I recall, financial analysts covering GSK initially expected the drug to sell poorly because better drugs were already available and the short half-life would cause problems like withdrawal; then, GSK got the drug approved for previously rare diagnoses like "generalized anxiety disorder," and advertised those conditions on TV around the time of 9/11; nearly everyone was generally anxious and paroxetine was the only drug approved specifically for that purpose, so it became the most popular drug of its kind and the company's #1 seller; GP's and even nurses prescribed the "non-habit-forming" drug without hesitation, and later press coverage reported harrowing anecdotes of children and adults who couldn't stop taking the drug because of the previously undisclosed withdrawal syndrome. I think the WP article covers the later history fairly well now, but I would still like to find the article describing the financial analysts' forecasts and GSK's subsequent marketing the drug for previously rare diagnoses.TVC 15 19:59, 20 September 2007 (UTC)

Removed Robbie Williams quote

The following sentence about Robbie Williams is unacceptable: "On the 12th Of February 2007 singer Robbie Williams checked himself into rehab to kick his addiction to Seroxat."

First all, the original Sun's article says only that: "He is hooked on the powerful and controversial anti-depressant Seroxat". "Hooked" in this context is just a term of tabloid journalism, which, if considered impartially, means only that RW has been taking Seroxat. His supposed addiction is something the journalist is trying to imply, but takes care not to say directly. Furthermore, this quote does not say anything about RW checking into rehab with the expressed purpose of "kicking" that specific addiction.

Second, Wikipedia:Biographies of living persons recommends that, "Editors must take particular care adding biographical material about a living person to any Wikipedia page.'" and "Be very firm about the use of high quality references. Unsourced or poorly sourced contentious material – whether negative, positive, or just questionable – about living persons should be removed immediately and without discussion from Wikipedia." The quote from The Sun is clearly a contentious material, and The Sun is not a high quality reference.

Third, this material is irrelevant in a pharmacology article. Wikipedia:Biographies of living persons recommends that "Editors should avoid repeating gossip. Ask yourself whether the source is reliable; whether the material is being presented as true; and whether, even if true, it is relevant to an encyclopedia article about the subject." Paul gene 11:11, 24 September 2007 (UTC)

It is important to view Paroxetine side-effects in proportion to the benefits for the individual. In some cases, the side-effects might outweigh the benefits, in others the benefits might greatly outweigh any discomfort caused by the side effects.- I suffered all my life from depression probably caused by a combination of genetic causes and unresolved childhood trauma, leading to chaotic life style, alcohol abuse and various degrees of self-destruction. Paroxetine has helped me to quit using alcohol exessively, and improved my life quality immensly. I experience side effects such as dry mouth, decreased libido, and some irregularities of my sleep pattern, but I gladly accept these over the destructive power depression and the side effects of alcohol abuse. I believe that this drug, or maybe also other similar medications, can save lifes. I tried other medications, but Paroxetine proved most effective for me personally. I believe that depression can be a genetic disorder, because my father died of alcoholism, one of my brothers struggles with alcohol abuse issues, my sister is addicted to a strong narcotic and alcohol,and my other brother killed himself at the age of 28 as a result of heroin addiction. We all have one thing in common: depression. Each of us was/ is trying to find a remedy for the depression. I believe that if my brother, who killed himself in the 70's where research in this field wasn't advanced, had had the chance to be treated for depression prior to forming the heroin addiction this worst outcome of depression could have been avoided. I am thankful for Paroxetine. I discontinued Paroxetine when I found out that I was pregnant, and I don't recall any problems with the discontinuation. Under circumstances other than pregnancy it should be discontinued gradually, to me that is common sense, and would apply to any other drug or substance. Any sudden and radical change for the body might cause discomfort. Medications of such impact should never have to be discontinued involuntarily because of health insurance issues, which is a political problem that can now be countered by purchasing generic versions or purchase of the drug at less costly locations.--Mooresabine (talk) 12:23, 14 December 2008 (UTC)

Controversial?

In the opening description, the last sentence is "The prescription of this drug is controversial because of side effects such as suicidal ideation (thoughts of suicide) and withdrawal syndrome which have resulted in legal proceedings against the manufacturer."

This statement is too strongly worded. It is one of the most widely prescribed drugs, how can that be controversial. Soda pop has caffeine, but it is so common as not to be "controversial". Cigarettes are common and controversial because there is a causuational link between smoking and cancer. There is no causational link between paxil and suicide. Legal proceedings do not justify controversy, what drug or company does not face legal proceedings as a matter of ordinary life?

Wow, where to begin? The comment above is unsigned, but I would suggest reading the article sections on Controversy and especially the section on Withdrawal. At least in the US, a federal case is by definition a controversy (or else the complaint gets dismissed for failure to show a genuine case or controversy), and beyond that you have the reprimand from the industry trade group, the black box warning from the FDA, the reliably sourced history of suppressing information and misleading consumers, and so on. To call it controversial is putting it mildly. Stronger terms might include fraudulent, murderous, etc. As noted above, many of the current prescriptions result from the fact that the drug is habit forming, which the manufacturer had previously denied. Reliable newspapers have published individual patient stories reporting the harrowing withdrawal syndrome, including in children, forcing them to keep taking the drug despite its side effects. The BBC reported on a study that found paroxetine more addictive than cocaine. Also, heroin was originally marketed as a children's cough suppressant; it was popular for a while, but became increasingly controversial and was eventually banned (replaced by alcohol-based substitutes, which were also popular but have since become controversial too, at least in children). Popular and controversial are not antonyms. To the contrary, when a popular product is found to have flaws that had been concealed by the manufacturer, the degree of controversy can be directly proportional to the degree of popularity.TVC 15 (talk) 19:46, 9 January 2009 (UTC)

The "controversy" may have caused more suicides than it saved, as the blackbox warning prevented the appropriate administration of paxil which is believed to have lead to an increase in the suicide rate merely over fears of the "controversy". http://www.aacap.org/galleries/LegislativeAction/News_33_2007_0102.pdf

To compare withdrawl or dependency from paxil to that of cocaine is absurd.

Your use of "absurd" is surprising here: how can you understand the difference between two things without comparing them? Unless you have experienced both, how would you know which is worse? Even if you have experienced both, how would you know which is more likely to occur without reading the statistics? Read the study reported by the BBC, and let the evidence drive the conclusion. As for effects on the overall suicide rate, the same drug can have different effects in different people, so paroxetine may have prevented some suicides while causing others. The purpose of the black box warning is to alert prescribers, parents, and patients so they can look for suicidal ideation or behavior and thus save lives that would otherwise be put at risk by the drug. The definition of "controversy" requires at least two sides; GSK initially denied everything, but has now admitted the risks of withdrawal (which GSK calls "serious discontinuation symptoms") and suicide.TVC 15 (talk) 17:02, 12 January 2009 (UTC)

BTW, "Paxil" is a brand name, so if your goal is to help GSK, you might start by respecting their trademark. Generic versions now account for a majority of paroxetine prescriptions in the US; although generics are officially equivalent, they are not exactly the same.TVC 15 (talk) 17:21, 12 January 2009 (UTC)

Of course all things can be compared, but the only purpose served in comparing cocaine to "paxil" is to confuse and scare the general public. Cocaine is a banned substance while paxil is not. Cocaine is much more "controversial". Doctors prescribing paxil are likely to be concerned about suicide in the first place, I would not leave it up to the FDA to advise patients or parents in this situation, leave it to the doctor instead.

A search for "paxil" directs to this page. I do not work for GSK, why do you imply that? I and many others know it as Paxil and do not know what "paroxetine" or other chemical names.

What study reported by the BBC? I do not see the link and could not find it in a search, can you provide it? You ask me to respond to this "BBC" study but you did not respond to the Robert Gibbons study.

The article already links to at least two BBC reports. One reports a paroxetine addiction study, [9] and another finds the drug does not help teens but increases their suicide risk sixfold.[10]

In the UK (GSK's home country), the brand name for paroxetine is Seroxat. That may explain why you could not find the BBC reports searching for Paxil. If you want to find information, it helps to learn and use correct terms.

I did not imply that you work for GSK, in fact if you did you would probably be more careful of their trademarks.

The issue in this section is whether paroxetine is controversial. Obviously, it meets any serious definition (e.g., [11], controversy, [12]). Gibbons does not disprove the existence of a controversy. The drug may have some merits; it was approved and remains widely prescribed, as you say (although some number of those prescriptions reportedly result from addiction). However, the fact that some favor the drug while others oppose it is what makes it controversial.TVC 15 (talk) 18:04, 12 January 2009 (UTC)

BTW doctors in the US used to prescribe cocaine, then it became controversial and was later banned in this country. Likewise Vioxx used to be prescribed, then became controversial and was later withdrawn by Merck. GSK marketed Paxil on TV to practically everyone, not just those who are suicidal. Regardless of whom you personally would "leave it up to" to advise patients and parents (FDA, doctors, drug companies' TV ad agencies), the express goal of WP is to make knowledge available to everyone.TVC 15 (talk) 18:13, 12 January 2009 (UTC)

Of course Gibbons did not disprove anything. How would someone do that? The BBC report does not hold the same weight as a scientific study by a PhD in a peer reviewed journal. Gibbons concluded that suicide rates among those taking the drug were lower then suicide rates among those that did not get the drug. Thus, if the "controversy" served to scare people from taking anti-depressants, it may have caused more harm then good. The goal of the WP is to provide knowledge, not biased opinion. Disinformation can be dangerous.

You have repeatedly alleged bias in the article, but without support. It is not biased to report serious risks that even GSK now admits. Why do you call that "biased opinion" when it is proven fact admitted by the original manufacturer? You requested SkinWalker to lend input, but please see the discussion between SkinWalker and me above. Reliable sources report as scientific fact that the drug causes benefits and side effects; it would be biased to report one side but suppress the other. You seem to suggest _creating_ a bias by suppressing negative information, based on the possibility that the controversy "may have caused more harm then [sic] good," but that is the opposite of providing knowledge. At least you now seem to acknowledge that controversy exists, which should resolve the issue in this section.TVC 15 (talk) 19:36, 12 January 2009 (UTC)

You continue to avoid the issue I raised that the supposed "controversy" is exagerated and causes more harm than good. I have asked you three times to address the Gibbons study. You seem to prefer to rely on the BBC. Instead of attacking me or the grammatical errors in my arguments, will you please refute the Gibbons study? —Preceding unsigned comment added by 161.150.2.55 (talk) 20:26, 12 January 2009 (UTC)

I said Gibbons did not disprove the existence of a controversy. You said yourself, "Gibbons did not disprove anything." So, we agree. As for your suggestion that suppressing reliably sourced information might make some people better off, your argument is with WP generally, not me. And, please remember to sign your posts.TVC 15 (talk) 21:51, 12 January 2009 (UTC)

Why would Gibbons set out to disprove the existance of something? That is not possible. Let me quote Gibbons from the Am J Psychiatry "Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not, with a statistically significant odds ratio for SSRIs and tricyclics." Seems to resolves the controversy. The BBC is not as reliable as the Am J Psychiatry when it comes to psychiatry. Are you through playing games. While it is nice that the BBC compares SSRI's to cocaine, and doctor have prescribed cocaine in the past, it is not relevant to paxil. I am not claiming that there is no controversy, I am claiming that the controversy is over emphasized in the opening lines of the article. It should be relegated to the bottom of the article. Comparing paxil to cocaine, you are doing people are diservice with your scare tactics. —Preceding unsigned comment added by 161.150.2.55 (talk) 22:26, 12 January 2009 (UTC)

First, you are conflating paroxetine with SSRIs generally. As noted in the article, studies have shown paroxetine to be among the riskiest SSRIs (and less effective than competing products or lifestyle changes such as increased physical exercise). Second, whether reliably sourced facts are scary is not the issue. You might enjoy reading Dan Gardner's book "Risk," where he argues that after 9/11 people switched irrationally from airplane travel to automobiles, thus losing an additional 1,500 lives because airline travel is safer per mile than driving. However, unlike you, Gardner does not propose suppressing coverage of the facts (in this example, 9/11). Your argument is essentially the same as that of government censors and certain PR agencies: 'if we tell people this, it will lead them to make bad decisions (like voting for the opposition, or not buying our product), so we need to suppress it.' If facts scare you into irrational decisions, that may say something about you, but it does not justify suppressing facts from WP.TVC 15 (talk) 22:55, 12 January 2009 (UTC)

I'm not sure why the lead paragraph reference to controversy has suddenly become the subject of so much, umm, controversy. However, I have restored the key points: contrary to GSK marketing, which remains in the hands and minds of many prescribers, GSK now admits what so many (including FDA) had said for so long, i.e. the drug is habit forming (causes "serious discontinuation symptoms," aka withdrawal). Since GSK spent so much advertising the drug on TV as an anxiolytic that was "not habit forming," which was its key selling point compared to other anxiolytics, it seems appropriate to address the widespread misconception in the lead. Along the way, I removed two unsourced statements from the second paragraph. One was not even about paroxetine, and seemed instead to have been copied long ago from the Sertraline article. Please, WP is not an advertising venue, so before making edits that slant towards GSK's POV, check this discussion page to see if the topic has been addressed.TVC 15 (talk) 21:00, 14 January 2009 (UTC)

TVC 15 says "I have restored the key points: contrary to GSK marketing, which remains in the hands and minds of many prescribers, GSK now admits ..." This is not a key point about paroxetine. Perhaps this should go on the GSK page. Mwalla (talk) 22:57, 14 January 2009 (UTC)mwalla

Good luck with your efforts Mwalla. I gave up on this article some time ago, because someone has a serious case of WP:OWN over this article. I was also accused of being a shill for GSK. There's something about antidepressant articles that brings out the soapboxers. Skinwalker (talk) 23:41, 14 January 2009 (UTC)

This article has elicited many editors from all sides, but several editors have noted pro-GSK bias. As reliable sources continue to report the controversy surrounding previously concealed side effects of paroxetine, the information does not meet any of the definitions of soapboxing. However, edits that delete negative information in order to limit the article to happy talk ('the drug is popular, it helps all kinds of things, X million prescribers can't be wrong...') do meet that definition, especially example 5 (advertising).

It is a key point about paroxetine, because it relates directly to a difference between (a) reliably sourced facts and (b) widespread misinformation advertised by the original manufacturer. As the purpose of WP is to make knowledge available, a primary step is to address misinformation with accurate information. However, I appreciate your suggestion that the information should go on GSK's page. That page already has a section on the paroxetine controversy (and on that page the controversy is acknowledged to be a controversy). However, it would be a mistake to imagine that the controversy relates solely to the original manufacturer and not to the product itself. To the contrary, the mandatory black box warning and side effects of paroxetine apply equally to generic versions, regardless of manufacturer.TVC 15 (talk) 23:52, 14 January 2009 (UTC)

paroxetine vs. SSRIs generally

Mwalla, let's not revert each other and risk an edit war, let's try to focus on the facts and see if we can reach something that makes sense. The sentence that you restored about sertraline seemed to have been copied and pasted from the sertraline article. Maybe you want to use that article as a model for this one, but sertraline is a different drug, so sentences from that article can't just be copied and pasted without even changing the name of the drug. Likewise, statements about side effects in the paroxetine article need to be about paroxetine. I understand your reliably sourced statistics related to SSRIs generally, but the aggregate SSRI statistics include both better-than-average and worse-than-average drugs within the category. Paroxetine's unusually short serum half-life makes it particularly likely to cause withdrawal, a side effect for which it slowly became notorious despite the manufacturer's denials. The sentence about the drug's popularity is misleading without including the fact of addiction, because many of the people taking the drug reportedly feel involuntarily hooked on it.TVC 15 (talk) 18:56, 15 January 2009 (UTC)

Mwalla, your continued reverts are not productive. Let's try for balance and objectivity. Clearly the black box warning is important, for example.TVC 15 (talk) 19:27, 15 January 2009 (UTC)

It is still in the article. I will be here all day, try the veal. Mwalla (talk) 19:35, 15 January 2009 (UTC)mwalla

I am trying to find a compromise, and you're simply reverting. The issue is what goes in the introductory paragraph. If we are to include sales numbers (implying popularity), then balance requires including the fact that the drug is addictive. Also, the black box warning is an FDA mandate. Can you at least suggest an alternate wording that might move towards compromise?TVC 15 (talk) 19:40, 15 January 2009 (UTC)

Lets consult Skinwalker, Casliber, or someone else within the Pharmacogy project. Mwalla (talk) 19:43, 15 January 2009 (UTC)mwalla

There was already an anonymous 'request for help' on that project's discussion page, but it appears that even among people expressly interested in pharmacology, very few were willing to help paroxetine. Would you please address the issue of paroxetine vs. other SSRIs? And, given the huge advertising campaign in which GSK said paroxetine was "not habit forming," would you please explain why you think the now acknowledged withdrawal syndrome should be removed from the introduction? The cocaine article puts addiction in the intro paragraph, thus addressing the earlier misconception that cocaine was not addictive.TVC 15 (talk) 20:00, 15 January 2009 (UTC)

The dependence of drugs of addiction such as benzodiazepines and cocaine, heroin etc. is very different to the problems with SSRIs and it is misleading to use the word synonymously. In the former we see escalating usage and drug seeking behaviour. With SSRIs the problem is that there is a withdrawal syndrome. Use does not escalate nor does someone seek to use it, the main issue is the problems with stopping the medication. and yes they have been underreported historically and yes they are important. Casliber (talk · contribs) 23:08, 15 January 2009 (UTC)

To conclude, I object to the problem being dewscribed as "dependence" as it implies a connotation which is not applicable, but I am more than happy to have withdrawal and court cases in lead, though the tone may have to be more neutral. Casliber (talk · contribs) 23:10, 15 January 2009 (UTC)

Thanks for your comments. I appreciate your acknowledging the importance of the historically under-reported withdrawal syndrome, and the legitimacy of noting that and the court cases. The article text includes only one occurrence of the word "dependence," in a quote that was copied from the British Medical Journal. The connotations you listed are associated primarily with addiction. Although sources vary on the defining differences between addiction and dependence, for a drug that carries a withdrawal syndrome with "serious discontinuation effects," a neutral word is dependence, i.e. "a need for a substance so strong that it becomes necessary to have this substance to function properly."TVC 15 (talk) 23:27, 15 January 2009 (UTC)

balancing uses with side effects - see WP:NPOV

Mwalla, even a 30-second TV advertisement _for_ the drug would be required to warn of side effects. WP is supposed to provide a neutral article _about_ the drug. If you make the intro solely about the drug's benefits, but delete the side effects, then you're slanting WP even more than would be allowed in advertising.TVC 15 (talk) 21:30, 15 January 2009 (UTC)

My views

I was requested to add my views on here by Mwalla. Here they are. Paroxetine, is associated with suicide. It has for example side effects such as akasthesia and mania. Both conditions are well established as risk factors of suicide. A meta-analysis of trial data assuming there is no bias or conflict of interest, does not disprove that some patients become suicidal on paroxetine. All it proves is that people are more likely to become less suicidal rather than more suicidal. This is a limitation of meta-analysis, they do an overall interpretation of the data rather than an individual case by case analysis. Suicidal reactions to paroxetine are what is known as a paradoxical reaction. Paradoxical reactions can happen with virtually all drugs. For example, benzodiazepines can make someone more anxious, worsen seizures, make them more aggressive etc. As far as addiction goes. This is a more tricky and brings into debate, addiction versus dependence. I think that the BBC article was talking in terms of withdrawal related problems. Cocaine does not cause much of a withdrawal syndrome usually unless someone snorts the stuff all day every day for months on end. Paroxetine has a very low abuse potential but yet a fairly high risk of a withdrawal syndrome which can range from either mild to very severe. So paroxetine, does not have anything near the abuse and psychological addiction/dependence properties of cocaine but if talking in terms of a withdrawal syndrome then yes paroxetine is probably a worse offender. Perhaps that part needs to be reworded so that it is clear that it is talking about paroxetine being harder to get off of due to withdrawal symptoms than cocaine whilst also acknowledging that it has a low abuse potential. Patients need to be warned of the risks of acute side effects and withdrawal effects as well as the positive effects. The risks should not be played down or watered down, nor should the therapueutic benefits. I think that if the article includes both the positive and negative effects of the drug then that should be fine. Have a look at the benzodiazepine article, which has a good balance of the positive and negative effects of benzodiazepines.--Literaturegeek | T@1k? 22:04, 15 January 2009 (UTC)

Thank you and I agree that SSRI's are associated with suicide, primarily because suicidal people are often clinically depressed and prescribed SSRI's. If paradoxical reaction happen with all drugs, do all wikipedia drug pages contain a warning in the opening paragraph? The association with suicide remains in the article. SSRI's have not been shown to CAUSE suicide, which is the way TVC 15 makes it sound. My objection is with placing strongly worded warnings about suicide in the opening paragraph, as it may be counter productive. Clinically depressed people reseaching a medication that their doctors have prescribed do not need to be scared from taking it. See here:

http://ajp.psychiatryonline.org/cgi/content/abstract/164/7/1044 161.150.2.55 (talk) 22:10, 15 January 2009 (UTC)mwalla

Thanks Literaturegeek for your detailed and objective analysis. The Benzodiazepine article does describe dependence in the introduction: the first paragraph describes benefits, the second describes dependence. Also, as you say, a drug that reduces the risk of suicide in some patients may increase it in others; that seems especially likely where the drug is prescribed to people with (for example) generalized anxiety disorder and then causes suicidal ideation. The drug may prevent suicide in some patients but cause it in others. Also, paroxetine has been shown comparatively worse than other SSRIs in this respect, so the SSRI study cited by Mwalla above may not exonerate paroxetine specifically.TVC 15 (talk) 22:23, 15 January 2009 (UTC)

I believe that SSRIs have the potential to cause suicide in certain persons and prevent suicide in other patients and careful monitoring especially in the early stages of treatment and during dose reduction is required to minimise this risk. You have to disprove the well established correlation between mania and akasthesia and suicide before you can declare that drugs which can produce mania and akasthesia as side effects are not associated with suicide. I can accept that antidepresssants overall may reduce suicide statistically but this does not disprove individual people may be at risk of severe paradoxical reactions. Here is a simple example, you could take 1,000 people starving on an island, 10 of them are allergic to peanuts. You assign 500 people to placebo food and 500 to peanuts for 4 weeks. The results show that those who did not eat peanuts more often died of starvation whereas those who did eat peanuts lived. You could then meta-analyse this data and other similar studies and conclude that peanuts are in general a life saving food source for people in situations where they are short of food. However, this would not mean that anaphylaxis to peanuts does not occur in sensitive patients and that anaphylaxis to peanuts does not exist and that some patients would die from peanuts. Like I say the gibbons study does not disprove paradoxical reactions. There have been studies which show suicide and these have been widely reported in the media, especially in the UK. Infact GSK themselves did one study that showed increased suicide but this was in adolescents but still suggestive. Paroxetine is not only used in suicidal patients. People with anxiety disorders, OCD or moderate depression have taken it and reported suicidal reactions. As the drug has to carry a black box warning for suicide risk, I do not believe that there is undue weight by mentioning the suicidal properties in the lead.--Literaturegeek | T@1k? 22:34, 15 January 2009 (UTC)

Furthermore paradoxical reactions are not necessarily due to underlying disorders eg bipolar or whatever. Pharmacokinetic factors or just simply individual sensitivity to a drug can be the cause. Pharmacokinetic factors include metabolism and the half life. A slow metaboliser could have 2, or 3 or 4 times the blood level of someone who metabolises the drug quicker. This could lead to paradoxical reactions including altered mood, akasthesia, psychosis or mania with resultant suicidal tendencies. Equally like I say the antidepressant effects could via the therapeutic actions of the drug help someone with depression and prevent suicide.--Literaturegeek | T@1k? 22:40, 15 January 2009 (UTC)

One of the doctors in the gibbons study is financed by GSK, based on declarations of interest at the bottom of the full text paper. Whilst that does not disprove the findings, I thought that it was worth pointing out.--Literaturegeek | T@1k? 22:49, 15 January 2009 (UTC)

Literaturegeek says "I believe that SSRIs have the potential to cause suicide in certain persons " what is the source for this bold claim? The conflict of interest in the sceintific study mentioned did not preclude it from being published in a peer reviewed study. Lets review that study's main finding: patients receiving SSRI's had a lower incidence of suicide than those receiving a placebo. A warning about the association is appropriate for all SSRI's, not just paroxetine. There is adequate space devoted to this topic on the main page. Why are the risks of the medication given more emphaisis then the benfits? —Preceding unsigned comment added by 69.243.189.111 (talk) 00:16, 16 January 2009 (UTC)

FV has given a good explaination of the literature on SSRIs aand suicide below. Paradoxical reactions including suicide has been reported in the medical literature in adults but is controversial. On a personal note I have a friend who as an adult woman took paroxetine, only to treat nightmares she had which the doctor felt were anxiety induced so she wasn't very mentally ill or anything. Anyway within a week of taking paroxetine, she went off her head, shaved off all of her head, started hallucinating and hearing music and then ran into the sea to try and kill herself. She ended up as an inpatient in a psychiatric ward. She remained as an inpatient until her psychiatrist went on a week leave and saw a new psychiatrist who said that paroxetine was an evil drug and she had to come off of it. Only then did her mental state return to normal and she was discharged. I have heard of another person third hand who had a similar experience. So I have personal knowledge and also have read things in the literature and seen reports in the media. As far as the conclusions of the study saying that paroxetine reduces suicide rates, please reread what I typed above. Do I have to repeat myself? I clearly said that I accept that antidepressants may indeed overall, lower suicide rates. I never denied this! Please reread what I typed above. I am not retyping it again. As far as wiki weight,,,, maybe the benefits need to be spoken about more to get a better balance between positives and negatives and make the article more neutral.--Literaturegeek | T@1k? 21:14, 16 January 2009 (UTC)

Literaturegeek, I re-read what you typed above. Your personal beliefs and your experience with a friend are statistically insignificant in the face of peer reviewed scientific journals. Do I need to recount all of my experiences with patients on paroxetine? —Preceding unsigned comment added by 69.243.189.111 (talk) 22:01, 17 January 2009 (UTC)

Let's be clear here: the literature is inconclusive and itself mired in controversy (see e.g. PMID 15718537 and David Healy's response to the study). There is ample, seemingly reliable evidence that SSRIs may increase suicidality in children and adolescents (such as the now-famous Cochrane review Tim links to above); whether this extends to adults is, again, controversial. Many authors claim it does not; some claim it might, may, or does. There is controversy surrounding the use of clinical trial data vs. "real world" practice data. There is controversy regarding unpublished data and the bias created by under-publication of negative trials (which, unavailable, are not included in later meta-analyses). Wikipedia condenses, reproduces and reports the current state of knowledge on a subject. We can't introduce original research or draw conclusions from published research or collate data if reliable external sources haven't done so already. In a case such as this, when even the reliable sources upon which this article should be built have been called into question (perhaps rightly so, perhaps not), all we can do is present a balanced picture of the current situation. I don't think we should be leaving any definitive or strongly worded statements in the article body; there are no definitive, cut-and-dried conclusions in the literature. Fvasconcellos (t·c) 13:04, 16 January 2009 (UTC)

Fvasconcellos, thanks for linking to the PMID study. Further, the New York times reported here that suicide rates were highest before treatment and declined after treatment began. http://www.nytimes.com/2007/07/10/health/psychology/10depre.html Let's us bring in more interested users with knowledge of the current literature. I do not want to surpress the controversy, I want it placed in a subsection, not the opening paragraph as it was originally the fourth sentence. Mwalla (talk) 13:39, 16 January 2009 (UTC)mwalla

I see the lead is still being edited and reverted without discussion. Please, will everyone keep to the Talk page for now? Fvasconcellos (t·c) 22:25, 18 January 2009 (UTC)