Question:
What does Paxil treat?
Depression is a biologically based disorder, although social and
genetic factors may contribute to the illness. Depression is
associated with a decreased number of neurotransmitters in the
brain (particularly serotonin and norepinephrine). These chemical
messengers help regulate several functions and thoughts, including
mood. Paxil blocks the reabsorption of serotonin and normalizes the
brain's chemical supply.
Answer:
Paxil (paroxetine hydrochloride), a new antidepressant medication,was
introduced into the United States in early 1993. It is a member of the
SSRI (selective serotonin reuptake inhibitor) family(along with Zoloft
and Prozac). These new medications are effective in alleviating the
symptoms of major depression without causing some of the harmful
side effects caused by the oldertricyclic antidepressants (TCAs).
What does Paxil treat?
Depression is a biologically based disorder, although social and
genetic factors may contribute to the illness. Depression is
associated with a decreased number of neurotransmitters in the
brain (particularly serotonin and norepinephrine). These chemical
messengers help regulate several functions and thoughts, including
mood. Paxil blocks the reabsorption of serotonin and normalizes the
brain's chemical supply.
What are the advantages of Paxil over other antidepressants?
Paxil is as effective in relieving depression as TCAs such as
imipramine. However, Paxil causes fewer adverse cardiovascular
and anticholinergic effects (dry mouth, constipation, blurred vision,
urinary retention) than the older TCAs. It does not usually cause
drowsiness, low blood pressure, or weight changes. Paxil has no
active metabolites and leaves one's system 24 hours after it enters.
SmithKline Beecham Pharmaceuticals, which makes Paxil, states
that Paxil is the most selective of the SSRI antidepressants. This
selectivity causes serotonin levels in the brain to normalize quickly,
relieving depression with relatively few side effects.
Who can benefit from taking Paxil?
Paxil is equally effective in elderly depressed patients as it is in
younger. Elderly people may turn to Paxil for relief because it does
not cause significant changes in blood pressure, unlike Effexor
and some other antidepressants.
Paxil is effective in the treatment of anxiety which accompanies
depression in some people. Those experiencing lethargy at the
beginning of treatment can also take Paxil with positive results
because Paxil does not impair psychomotor function.
What is the standard dose of Paxil?
The usual dose of Paxil is 20 mg taken once daily, usually in the
morning. Paxil comes in either 20 mg tablets (pink) or 30 mg tablets
(blue). For the depressed elderly, the recommended starting dose
is 10 mg once daily. Physicians may change the dose by 10 mg at
a time and the dose should not exceed 50 mg per day (40 mg in
geriatric patients). There should be a one week interval between
dose adjustments.
Can I take Paxil with other medications?
Paxil should not be used while taking any MAOI (monoamine oxidase
inhibitor) medication. The interaction between the two could produce
fatal results. Therefore, there should be a fourteen day interval
between stopping the MAOI and starting Paxil, or vice versa.
Patients with kidney or liver dysfunction and those taking lithium
should take Paxil with caution. Other combinations of medications
require consultation with your doctor. Alcohol consumption is best
avoided while one is taking Paxil.
What are the most common side effects of Paxil?
For the most part, the side effects of Paxil are mild and brief. The
major side effect of Paxil is nausea, which can be reduced by taking
Paxil with food. Side effects may include drowsiness, asthenia (lack
of physical strength) tremors, nervousness, dizziness, insomnia,
sweating, ejaculatory delay, and other male genital dysfunction. There
may be a slight weight loss associated with Paxil. Only a small
percentage of people have had to discontinue their use of Paxil
because of side effects.
Women who become pregnant or who are nursing an infant
should iscuss with their doctors the effects of Paxil. People
with kidney or liver dysfunction should use Paxil with caution.
How soon will I feel better?
Most people will notice improvements within a week or two,
but it may take up to six weeks for the full therapeutic effect
to be realized. Depressed mood, concentration problems,
and slowed activity improve in the first week, sleep
disturbances within the second week.
How long should I stay on Paxil?
Paxil should be continued as directed by the prescribing
physician. Paxil is effective in the treatment of both short
-term and long-term depression, and it can be beneficial
in preventing relapse into depression. Studies have shown
that Paxil is easily tolerated for up to four years. It is important
to be in close communication with the prescribing physician,
and to promptly report any unusual or distressing symptoms
or side effects.
Is financial assistance available to those who cannot afford
treatment with Paxil?
The Paxil Access to Care program allows a physician to arrange no-
cost supplies of Paxil for patients who meet specific requirements. To
be eligible, a patient must have an annual household income of less
than $25,000, have no medical insurance, and be ineligible for
government (such as Medicaid) or private programs covering
prescriptions. A physician who believes that the cost of Paxil would
pose a significant hardship on a patient or cause an inability to take
the medication as prescribed can call 1-800-729-4544 to receive a
Paxil Access to Care kit.
Effexor (generic: venlafaxine) is the newest medication
available to treat depression. Structurally different from any
other antidepressant, it affects two neurotransmitters (chemical
messengers in the brain) involved in depression: serotonin and
norepinephrine. Approved for use in the United States at the
end of 1993, its novel chemical action and low incidence of side
effects make it a significant addition to the range of medications
used to treat depression.
How is Effexor different from other antidepressants? Effexor is a
chemically unique antidepressant medication. Like the newer class
of antidepressants known as selective serotonin reuptake inhibitors
(SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), it
affects the absorption of serotonin. In addition, Effexor acts on the
norepinephrine system. No other available medication affects both
neurotransmitters without causing the side effects of the older
tricyclic antidepressants.
Are there other advantages of Effexor?
Effexor is less likely to induce seizures, to have toxic
effects on the heart, and to cause lethal reactions.
For what kind of patient would Effexor be appropriate?
Effexor is recognized as an effective front-line option
(i.e., first-time medication) for patients who have recently become
ill with depression, whether they are hospitalized or treated on an
outpatient basis. It can also be useful for patients who have had
longstanding depressive illness and have not responded adequately
to previous treatments. Almost 40 percent of so-called refractory
patients (those who have not had positive results from past treatment)
have had success with Effexor. Patients who have benefitted from
other antidepressants but have had less than complete success
may want to discuss switching to Effexor with their doctors.
What about side effects?
Relatively few side effects have been reported with Effexor.
Those that have been noted are dose-related; that is, side effects
increase as the dose increases. Very few patients have had to
discontinue the medication because of side effects.
The most common minor side effects during clinical trials include
short-term nausea (which can be reduced by taking the medication
with food), sleepiness, dry mouth, dizziness, constipation,
nervousness, sweating, weakness, ejaculation/orgasm problems,
and loss of appetite.
A small percentage (about five percent) of patients, usually
those taking higher doses, will develop elevated blood pressure.
Therefore, patients taking Effexor should have their blood pressure
checked regularly. Some agitation has been noticed at higher dosages.
How long does it take to work?
Like most other medications used for depression, Effexor may take
several weeks before it is fully effective. It is important to give
the medication sufficient time before judging whether it will work for
a given person. There is evidence, however, that Effexor may take
effect more quickly than other antidepressants.
Can Effexor be taken with other medications?
Effexor does not interact significantly with many other medications,
including lithium, diazepam (Valium), and cimetidine (Tagamet, an
anti-ulcer medication).
However, patients taking cimetidine who have high blood pressure
or liver disease or are elderly should use caution in taking Effexor
because the interaction may be more pronounced when these
disorders are present.
Effexor definitely should not be taken at same time as the MAOIs
(such as Parnate or Nardil). Interactions with these compounds
could be lethal. Patients who have been taking an MAOI and are
switching to Effexor must allow sufficient time (usually 14 days) for
the MAOI to clear out of the body. The same time should be allowed
if changing from Effexor to an MAOI. However, switching
from Effexor to other medications is easy because Effexor is
quickly removed from the body.
What is the standard dose?
The dose range is generally between 75 and 375 mg per day.
The average effective dose is about 125 to 150 mg per day. Higher
doses are necessary for sicker patients. It is recommended that the
total dose be divided into two or three doses per day and taken with
food. Dosage adjustments for elderly people are not usually necessary.
Will Effexor work for everyone?
No. Everyone responds to medications differently. Effexor will
work well for some people, and not so well for others. It is important
to give the medication a trial of several weeks and to be in close
communication with your doctor about signs of effectiveness,
side effects, and personal factors affecting one's response to
the medication.
