Paxil vs effexor
Before talking about women’s depression, you need to say a few general words about this mental disorder. Depression can occur as a symptom of serious diseases (stroke, Parkinson’s disease). Occurs depression medication caused side effects of some drugs. Physicians are aware of severe endogenous depression associated with mental illness (it is inherited).
But most of all, speaking of this illness, have in mind psychogenic (neurotic) depression – an inadequate psychological reaction to some life circumstances. This type of depression acts selectively: its population – mostly women.
Why?
The fact is that in essence the woman initially set to the worst in the negative. Apparently this is connected with the strong>paxil anxiety role she has to play in the family. Physiologically woman arranged so that the chances of falling into depression, she more than men.
Psychological well-being are directly related to the content in his body withdrawal from paxil
. If it is not enough, it undermines the mental stability of people. So, for women it is almost two times less than men.
There are four main types of female depression.
Postpartum depression.
After childbirth, many women experience anxiety, uncertainty, and emptiness. In 10 percent of them develop into postnatal depression, which may begin in the first week after birth, and during the first half. Its main symptoms are: irritability, when a woman from the first day starts yelling at the child, or, conversely, a complete indifference to him. This is the worst kind of female depression. It is associated not only with the psychological burden of responsibility for the life of a tiny helpless creature, and physically demanding to care for him, but with the hormonal changes after childbirth. Observed that postpartum depression often develops in women who suffered from it before or during pregnancy.
Premenstrual syndrome (PMS).
At 20, and according to some data – 40 per cent of women in the second phase of the menstrual cycle, there are clearly associated with mood changes – acute anxiety, suspiciousness, irritability, tearfulness, persistent insomnia. This is compounded by the lack of (or perversion) of appetite, constant physical discomfort. If equipped to deal with such things a woman can not afford, it will help the doctor.
Menopausal depression.
It arises from the fading-bearing and the cessation of menstruation. Here, physiological and psychological factors are linked inseparable. On the one hand, powerful hormonal changes, affecting all body systems, on the other – the same powerful psychological front of change: the children have grown, the house was empty. Help here can only time and a sense of reality. Of course, there is effective medication help – hormone replacement therapy (paxil memory loss
).
Seasonal affective disorder.
Seasonal depression is known to 40 per cent of our countrymen, most of whom are women. Called it a lack of sunlight, which would determine the level of paxil withdrawl symptoms already mentioned. Here is the easiest way out – to light in the dark autumn and winter days, bright light. Who has the opportunity, can arrange a vacation in tropical countries – for example, in Cyprus.
DIAGNOSIS
Isolation of depression, bad mood, a pessimistic view of things from depression is not easy. There are few of the most striking features that characterize the disease. If the majority of them do not disappear within two weeks, it has reason to seek medical attention.
Neurotic depression is characterized by:
* Permanent gloom
* Loss of interest in life
* Forgetfulness, absent-mindedness
* Fatigue, physical weakness, prostration
* Slow motion, reducing the rate of speech
* Persistently guilt
* Suicidal thoughts or actions
* Appetite disturbance
* Disturbed sleep: recovery in the 4-5 am and the inability to sleep
* A sharp decline in sexual activity and sexual desire, until the complete indifference to the partner and the disappearance of orgasm.
TREATMENT
In most cases, unable to cope with depression through psychotherapy. Particularly successful is the treatment of the case, if the patient is aware that she needs help and is ready to cooperate with the doctor. There are about 300 of psychotherapeutic techniques, so find a suitable for each particular case presents no difficulty. In cases where psychotherapy does not give the desired effect, appointed by the medication. Modern antidepressants are effective and safe and in combination with psychotherapy can give (and give) a very decent results
Paxil withdrawal symptoms
I take Paxil at a dose of 20 mg for 2 years.
I feel good. There used to be the strongest PA.
Cancel reception fails. All returned. My doctor advised me to change the Paxil to Lexapro.
Is it a good idea. Thank you.
If paroxetine helps you, then, from my point of view, to change it to another product not worth it. The question of “gathering” with an antidepressant, in your case with Paxil, it is very difficult and important. I think that you can try to try to “get away” with Paxil as follows:
Reduce every 3 weeks the dose of 5 mg.
At the lowest dose of Paxil, which you state will be more or less satisfactory, but it may be 15, and 10 and 5 mg, would have to “sit” from one to 3 months and only then try to completely stop treatment.
But you can also go and escitalopram (Lexapro).
In the case of such a decision, pause between the last taking Paxil and start receiving escitalopram in one day.
After a pause, start therapy with 2.5 mg once a day regardless of meals. If 2.5 mg escitalopram Your state will be as good as at the 20 mg Paxil, then continue to increase the dose is not necessary.
If 2.5 mg is not enough, then after 2-3 weeks of treatment of 2.5 mg escitalopram have to increase the dose of the blood pressure up to 5 mg.
Sorry, I do not fully describe the problem. The fact that simultaneously with the improvement of the state I appeared drowsy.
In addition, the weight began to increase. Stop taking drugs, I can not because I can not properly cope with their work.
They suggested that I gradually reduce the dose of Paxil while gradually increase the Lexapro.
Questions:
1. Does Lexapro has fewer side effects?
2. What dose of Lexapro is similar to 20 mg Paxil?
3. Which of the two drugs is preferable for the treatment of panic disorder?
Escitalopram is very clean, almost completely devoid of side effects and high-serotonergic antidepressant last generation.
Maximum dose of escitalopram 20 mg, Paxil 60 mg.
If you try to find a match in doses that’s not strictly true, we can roughly say that 30 mg of Paxil equivalent to 10 mg escitalopram and 20 mg – 5 mg – 7.5 mg.
Sitting on Lexapro more than 3 – years. tried to go three times already. I understand, the main problem work. I am a businessman, worry about everything and more problems at work, the condition worsens.
We again attempted to vanishing, changing the structure of work, more piled on managers. Two weeks passed and too heavy, panic attacks come against fatigue. What recommend. Thank you in advance
I buy paxil medication hence it is difficult to advise anything. At a dose of Paxil, you have all these 3 years?
PAXIL (Paroxetine)
Paxil 40mg 90 Tabs only $4.90 + Free EMS shipping
Paroxetine hydrochloride hemihydrate 22.8 mg, including paroxetine 20 mg.
Other ingredients: calcium dihydrogen dihydrate, sodium karboksikrahmal type A, magnesium stearate.
The composition of the envelope: opadry White YS-1R-7003 (hypromellose, titanium dioxide, macrogol 400, polysorbate 80).
Registration number of Paxil: P № 016238/01 27.05.05
Pharmacological action
Antidepressant. Refers to a group of selective serotonin reuptake inhibitors.
The mechanism of Paxil action based on its ability to selectively block the reuptake of serotonin (5-hydroxytryptamine / 5-HT /) presynaptic membrane, with the associated increase in free than the content of this neurotransmitter in the synaptic cleft and increased serotonergic action in the CNS responsible for the development timoanalepticheskogo (antidepressant) effect. Paroxetine has low affinity for m-holinoretseptorami (has a weak anticholinergic activity), a1-, a2-and b-adrenoceptors, as well as dopamine (D2), 5HT1-like, 5HT2-like and histamine H1-receptors. According to the study of behavior and EEG paroxetine revealed weak activating properties when it is administered in doses higher than those required for inhibition of serotonin reuptake. Paroxetine does not affect the cardiovascular system, does not violate psychomotor function, not depressing the central nervous system. In healthy volunteers it causes no significant change in the level of blood pressure, heart rate and EEG. The main components of psychotropic activity profile are the antidepressant Paxil and pacifying action. Paroxetine may cause weak activating effects in doses exceeding those required for inhibition of serotonin reuptake. Generic paxilIn the treatment of depressive disorders, paroxetine demonstrated efficacy comparable to the effectiveness of tricyclic antidepressants. Paroxetine has therapeutic effectiveness even in those patients who have not responded adequately to previous standard therapy. Patients had improved after 1 week after starting treatment, but superior to placebo only for 2 weeks. Levee paroxetine no negative impact on the quality and duration of sleep. Moreover, when an effective therapy to improve sleep. During the first few weeks of paroxetine improves the condition of patients with depression and suicidal thoughts. The results of studies in which patients received paroxetine for 1 year showed that the drug effectively prevents recurrence of depression. With the appointment of Paxil panic disorder in combination with drugs that enhance cognitive function and behavior, has proved more effective than monotherapy with drugs that enhance cognitive-behavioral function, which is aimed at their correction.
Indications
- Depression of all types, including reactive depression, endogenous depression and severe depression accompanied by anxiety (the results of studies in which patients received the drug for 1 year, show that it is effective in preventing relapse of depression);
- Treatment (including maintenance and prophylactic therapy), obsessive-compulsive disorder (OCD) in adults and in children and adolescents aged 7-17 years (proved preservation of efficacy in the treatment of the ROC for at least 1 year and prevention of relapse ROC);
- Treatment (including maintenance and preventive therapy) for panic disorder with agoraphobia and without it (effectiveness of the drug remains within 1 year, preventing the recurrence of panic disorder);
- Treatment (including maintenance and prophylactic therapy), social phobia in adults and in children and adolescents aged 8-17 years (effectiveness of the product stored in long-term treatment of this disorder);
- Treatment (including maintenance and preventive therapy), generalized anxiety disorder (effectiveness of the drug remains in long-term treatment of this disorder, preventing relapses of the disorder);
- Treatment of posttraumatic stress disorder.
Dosage regimen
For adults with depression average therapeutic dose is 20 mg / day. For lack of efficacy dose may be increased to a maximum of 50 mg / day. Increasing the dose should be gradually – by 10 mg at intervals of 1 week. Dose Paxil should be reviewed and if necessary change within 2-3 weeks of therapy and thereafter as long as we do not receive adequate clinical effect. For adults with obsessive-compulsive disorder average therapeutic dose is 40 mg / day. Treatment should begin with 20 mg / day, and then gradually increase the dose of 10 mg every week. When there is insufficient clinical effect dose may be increased to 60 mg / day. Children aged 7-17 years a drug is prescribed in the initial dose of 10 mg / day, gradually increasing to 10 mg every week. If necessary, the dose may be increased to 50 mg / day. For adults with panic disorder average therapeutic dose is 40 mg / day. Treatment should begin with the use of the drug in a dose of 10 mg / day. Generic paxil is used in a lower initial dose in order to minimize the possible risk of acute panic symptoms, which may occur in the initial phase of therapy. You may increase dose to 10 mg weekly to get the same effect. For lack of effectiveness of the dose may be increased to 60 mg / day. For adults with social phobia average therapeutic dose is 20 mg / day. When there is insufficient clinical effect dose may be increased gradually to 10 mg weekly to 50 mg / day. Children aged 8-17 years a drug is prescribed in the initial dose of 10 mg / day, gradually increasing to 10 mg every week. If necessary, the dose may be increased to 50 mg / day. For adults with generalized anxiety disorder average therapeutic dose is 20 mg / day. When there is insufficient clinical effect dose may be increased gradually to 10 mg weekly to a maximum dose of 50 mg / day. For adults with post-traumatic stress disorder average therapeutic dose is 20 mg / day. When there is insufficient clinical effect dose may be increased gradually to 10 mg weekly to a maximum of 50 mg / day. In elderly patients, treatment should start with a dose for adults; further dose may be increased to 40 mg / day. In patients with acute disorders of the liver and kidneys (CC less than 30 ml / min) dose should be reduced to the lower limit of the range of doses. The course of treatment must be long enough. Patients with depression or the ROC should receive treatment within a period of time sufficient for the disappearance of all symptoms. This period can take several months for depression, and at the ROC and panic disorder – even longer.
Paxil side effects take 1 time per day in the morning with meal. Tablets should be swallowed whole, without chewing, drinking water.
Cancel drug
Avoid abrupt withdrawal of the drug. The daily dose should be reduced to 10 mg weekly. After reaching a daily dose of 20 mg in adults or 10 mg in children and adolescents, patients continue to receive this dose for one week and then drug overturned completely.
If withdrawal symptoms develop during dose reduction or drug discontinuation, it is advisable to resume reception previously assigned dose. In the following should be further reduction in dose, but more slowly.bad side effects of paxil
Side effects
Side effects are usually moderately expressed. With continued therapy side effects are reduced in intensity and frequency of occurrence and usually do not lead to cessation of treatment. We used the following criteria for evaluating the frequency of occurrence of adverse events: common (> = 1% and <10%), uncommon (> = 0.1% and <1%), rare (> = 0.01% and <0.1%), very rare (<0.01 %). including individual cases. Occurrence of frequent and infrequent side effects was determined on the basis of generalized data on the safety of the drug in more than 8000 people participating in clinical trials (it counted for the difference between the frequency of side effects in the paroxetine group and the placebo group). Occurrence of rare and very rare side effects was determined on the basis of post-marketing data (regarding the frequency of reports of such effects than the true frequency effects themselves).
From the digestive system: Very common – nausea, decreased appetite, often – dry mouth, constipation, diarrhea, rarely – increased liver enzymes, very rare – gastrointestinal bleeding, hepatitis (sometimes with jaundice), hepatic failure (with the development of side effects liver whether cessation of therapy should be resolved in cases when there is a prolonged increase performance of functional tests).
From CNS: Frequently – drowsiness, tremor, fatigue, insomnia, dizziness, rarely – confusion, hallucinations, extrapyramidal symptoms, rarely – mania, seizures, akathisia, very rarely – a serotonin syndrome (agitation, confusion, diaforez, hallucinations, hyperreflexia , myoclonus, tachycardia, tremor). Patients with movement disorders or those taking antipsychotics – extrapyramidal disorders with oro-facial dystonia.
The part of the organ of vision: often – blurred vision, very rarely – acute glaucoma.
Since the cardiovascular system: Infrequent – transient increase or decrease in blood pressure (usually in patients with arterial hypertension and anxiety), sinus tachycardia, very rarely – peripheral edema.
On the part of the urinary system: rarely – urinary retention.
From the blood coagulation system: Infrequent – bleeding into the skin and mucous membranes, bruising, very rarely – thrombocytopenia.
On the part of the endocrine system: rarely – gipoprolaktinemiya / galactorrhea and hyponatremia (mainly in older patients), which is sometimes caused by a syndrome of inadequate secretion of antidiuretic hormone. Allergic reactions: seldom – angioedema, urticaria, rarely – skin rash.
Other: very often – sexual dysfunction often – increased sweating, yawning, very rarely – photosensitivity reaction.
Adverse symptoms observed in clinical trials in children
In clinical trials in children following side effects occurred in 2% of patients and were found in 2 times more frequently than with placebo: emotional lability (including self-harm, suicidal thoughts, suicide attempts, tearfulness, mood lability) , hostility, decreased appetite, tremor, increased sweating, hyperkinesia, and agitation. Suicidal thoughts, suicide attempts mainly observed in clinical trials in adolescents with marked depressive disorder, in which the effectiveness of paroxetine is not proven. Hostility was observed in children (especially under the age of 12 years) with obsessive-compulsive disorder.
Contraindications
- Simultaneous reception of MAO inhibitors and the period of 14 days after their cancellation (MAO inhibitors should not be administered within 14 days after treatment paroxetine);
- Simultaneous reception thioridazine;
- Hypersensitivity to paroxetine and other components of the drug.
Pregnancy and lactation
In experimental studies revealed no teratogenic or embryotoxic action of paroxetine. Data on a small number of women who took paroxetine during pregnancy, suggest that there is no increased risk of congenital anomalies in newborns. There were reports of premature births among women who received paroxetine (Paxil) during pregnancy, but a causal link with taking this medication is not installed. Paxil should not be used during pregnancy, except in cases when the potential benefits of treatment exceed the possible risks associated with taking this medication. Need to monitor the health of newborns whose mothers took paroxetine in late pregnancy, as there are reports of complications in children (although a causal relationship with taking this medication is not installed). Describe respiratory distress, cyanosis, apnea, seizures, temperature instability, feeding difficulty, vomiting, hypoglycemia, arterial hyper-or hypotension, hyperreflexia, tremor, irritability, lethargy, constant crying, and sleepiness. Some reports have described the symptoms as manifestations of neonatal withdrawal syndrome. In most cases described complications arose immediately after childbirth or soon after (within 24 h). Paroxetine in small amounts excreted in breast milk. Therefore should not be used during lactation, except in cases when the potential benefits of treatment exceed the possible risks associated with taking this medication.
Paxil Cautions
Patients with depression worsening of symptoms and / or the emergence of suicidal thoughts and suicidal behavior (suicidality) may occur irrespective of whether they received antidepressant medication. This risk persists as long as there will not be achieved marked remission. Improving the patient’s condition may be absent in the first week of treatment and more, so the patient should be closely monitored for early detection of clinical worsening suicidality, especially early in treatment, as well as in times of dose changes (increase or decrease). Clinical experience in the use of all antidepressants shows that the risk of suicide may increase in the early stages of recovery.
Other mental disorder for which the use of paroxetine, may also be associated with increased risk of suicidal behavior. Addition, these disorders can be a comorbid condition associated with major depressive disorder. Therefore, when treating patients suffering from other mental disorders, they should observe the same precautions as in the treatment of major depressive disorder.
At greatest risk of suicidal thoughts or suicide attempts are patients with a history of suicidal behavior or suicidal thoughts, young patients, and patients with pronounced suicidal thoughts prior to treatment, and therefore all of them require special attention during treatment. Patients (and staff) to warn of the need to monitor the deterioration of their condition and / or the emergence of suicidal ideation / suicidal behavior or thoughts of self-harm in the event of these symptoms to seek immediate medical help. Sometimes treatment paroxetine is accompanied by akathisia, which manifests a feeling of anxiety and psychomotor agitation, when the patient cannot sit or stand, with akathisia the patient usually experiences subjective distress. The probability of occurrence of akathisia is highest in the first few weeks of treatment. In rare cases, against the backdrop of paroxetine treatment may be serotonin syndrome or symptoms similar to neuroleptic malignant syndrome (hyperthermia, muscle rigidity, myoclonus, autonomic disorders, with possible rapid changes in vital signs, altered mental status, including confusion, irritability, agitation is extremely difficult , progressing to delirium and coma), especially when paroxetine is used in combination with other serotonergic drugs and / or neuroleptics. These syndromes represent a potential threat to life, so when they arise paroxetine therapy should be stopped and start supporting palliative care. Given that paroxetine should not be given in combination with serotonin precursors (such as L-tryptophan, oksitriptan) in connection with the risk of serotonin syndrome.
Major depressive episode may be the initial manifestation of bipolar disorder. It is generally accepted (although not proven in controlled clinical trials) that treating such an episode, only one anti-depressant may increase the likelihood of accelerated development of a mixed episode in patients at risk of bipolar disorder. Before starting treatment with antidepressants should be carefully screened to assess the risk in this patient with bipolar disorder, such screening should include the collection of detailed psychiatric history, including information about the presence of family cases of suicide, bipolar disorder and depression. As with all antidepressants, paroxetine has not registered for the treatment of bipolar depression. Paroxetine should be used with caution in patients with a history of mania.
Treatment of paroxetine should be started cautiously, not earlier than 2 weeks after cessation of therapy MAO inhibitors, the dose of paroxetine should be increased gradually to achieve optimal therapeutic effect.
The frequency of seizures in patients taking paroxetine, is less than 0.1%. In the case of a convulsive seizure paroxetine therapy should be stopped.
There is only limited experience with the simultaneous application of paroxetine and electroconvulsive therapy.
Reported hemorrhages in the skin Indianapolis birth defects related to paxil lawyer and mucous membranes (including the gastro-intestinal bleeding) in patients taking paroxetine. Therefore, paroxetine should be used with caution in patients who received both drugs increase the risk of bleeding in patients with a known propensity for bleeding and patients with diseases predisposing to bleeding.
After discontinuation of the drug (especially harsh) have often been reported dizziness, sensory disturbances (paresthesia), sleep disturbances (vivid dreams), anxiety, headache, infrequent – agitation, nausea, tremors, confusion, increased sweating, diarrhea. In most patients, these symptoms were mild to moderate, but in some patients they may be severe. Typically, withdrawal symptoms occur in the first few days after discontinuing the drug, but in rare cases – when you accidentally skip a dose. Typically, these symptoms are independently within two weeks, but some patients – up to 2-3 months or more. Therefore it is recommended to gradually reduce the dose of paroxetine (over several weeks or months before its complete abolition, depending on the needs of the patient).
The emergence of withdrawal symptoms does not mean that the drug causes dependence.
The children paroxetine withdrawal symptoms (emotional lability, suicidal ideation, suicide attempts, mood changes, tearfulness, nervousness, dizziness, nausea, and abdominal pain) occurred in 2% of patients on the background of lower doses of paroxetine or after its complete abolition, and met 2 times more often than in the placebo group.
The drug should be used with caution in hepatic failure, renal failure, angle-closure glaucoma, heart disease, epilepsy.
If it is observed against the background of paxil withdrawal symptoms increase in liver remains for a long time, receiving the drug should be discontinued.
Paxil cr did not potentiate the effect of alcohol on psychomotor functions, however patients taking Paxil, it is recommended to refrain from alcohol.
Paxil use in Pediatrics
Paroxetine is not indicated for children less than 7 years in the absence of data on the safety and efficacy of the drug in this category of patients. Controlled clinical study on the use of paroxetine to treat depression in children and adolescents aged 7 to 18 years have not proved its effectiveness, so the drug is not indicated for use in this age group.
In clinical trials, adverse events associated with suicidality (suicide attempts and suicidal thoughts) and hostility (predominantly aggression, deviant behavior, and anger), often observed in children and adolescents treated with paroxetine, compared with those of patients in this age group who received placebo. There is currently no data on long-term safety of paroxetine for children and adolescents who would deal with the influence of drugs on the growth, maturation, cognitive and behavioral development.
Paxil effects on ability to drive vehicles and manage mechanisms
Paxil therapy not cause cognitive impairment or psychomotor retardation. Nevertheless, as in the treatment of any psychotropic drugs, patients should exercise caution when driving or working with moving machinery.
Paxil overdose
The available information on overdose paroxetine demonstrated the wide range of security.
Symptoms: increased above side effects, as well as vomiting, dilated pupils, fever, change in blood pressure, involuntary muscle contractions, agitation, anxiety, and tachycardia. Patients usually do not develop serious complications, even with single dose to 2 g of paroxetine. In some cases, develop coma and EEG changes, very rarely; death occurs when the combined use of paroxetine with psychotropic drugs or alcohol.
Treatment: Standard measures used in little rock birth defects related to paxil attorney an overdose of antidepressants (gastric lavage through artificial vomiting, appointment of 20-30 mg of activated charcoal every 4-6 hours during the first days after the overdose). The specific antidote is known. It has shown maintenance therapy and monitoring of vital body functions.
Paxil interactions
Absorption and pharmacokinetics of paroxetine did not change at all or changes only partially under the influence of food, antacids, digoxin, propranolol and ethanol. With simultaneous use of Paxil with MAO inhibitors, L-tryptophan tramadol, linezolid, drugs of the selective serotonin reuptake inhibitors, lithium, St. John’s Wort preparations perforated may develop serotonin syndrome. Metabolism and pharmacokinetic parameters of reasons to switch to higher dose of paxil may change while the application of drugs that induce or inhibit protein metabolism. With simultaneous use of bad side effects of paxil with drugs inhibiting the metabolism of enzymes used doses should be limited to the lower boundary of the normal level. , In combination with drugs induce the metabolism enzymes (carbamazepine, phenytoin, rifampin, phenobarbital), does not require changes in the initial doses of Paxil. Subsequent correction doses should be based on clinical effect. With simultaneous use of Paxil with drugs metabolized by isozymes CYP2D6 (tricyclic antidepressants / amitriptyline, nortriptyline, imipramine, desipramine / phenothiazine neuroleptics / thioridazine, perphenazine / antiarrhythmics of class IC / propafenone, and metoprolol flekainid / risperidone), there is an increase in their concentrations in blood plasma. The combination of Paxil with terfenadine, alprazolam and other drugs that are substrates for CYP3A4 isoenzyme, does not cause adverse reactions. Daily administration Paxil increases the level in plasma. In the presence of anticholinergic symptoms dose should be reduced. Paxil did not potentiate the effect of ethanol on psychomotor functions, however patients taking Paxil, it is recommended to refrain from taking etanolsoderzhaschih drugs. In an application in epilepsy Paxil with anticonvulsants (carbamazepine, phenytoin, and sodium valproate) were observed effect on the pharmacokinetics and pharmacodynamics of the latter. Unlike paxil alcohol antidepressants, which inhibit the seizure of norepinephrine, paroxetine inhibits the much weaker antihypertensive effects. In an application with short-acting sleeping pills are not observed more side effects.
