Paroxetine is an oral drug which is designed to combat depression. Technically, it is a selective serotonin reuptake inhibitor (SSRI), a neurotransmitter that participates in the generation of positive moods; However, paroxetine is better known for a very different reason.
Due to its history, it became popular to treat a type of anxiety known as social anxiety disorder or social phobia, which at the time was interpreted as a sign of extreme shyness, and for this reason it is known as the anti-shyness drug.
Paroxetine went on the market in 1992. by the North American pharmaceutical giant GlaxoSmithKline (GSK) under the trade name Paxil. Its sales were much lower compared to other antidepressant drugs such as Prozac or Zoloft, so the company engineered a powerful advertising campaign in 1999 to change this.
The advertising focused on a different use for paroxetine. The company was responsible for publicizing a new type of anxiety that was beginning to be studied, known as social anxiety disorder which they associated with those people who show shyness. All this, because his drug was the only one on the market that was clinically proven to treat this type of anxiety.
Thanks to this, its sales improved compared to previous years; Transforming paroxetine into the “anti-shyness” drug turned out to be very profitable.
The advertising campaign controversy
Nowadays we know that social phobia is generated in shy people, but not all shy people have this kind of anxiety. Shyness is not a disorder but a personality trait, and it can be overcome by following some guidelines, without any need for medication.
The controversy of the story basically has to do with the advertising campaign for paroxetine, which incites debate about the extent to which the pharmaceutical industry is capable of making profits from its products, in this case “popularizing” an anxiety disorder that was beginning to become widespread. studied at the time, in its desire to surpass the competition… and although this could generate confusion and stigmatization for people who are shy due to their personality.
Paroxetine is an antidepressant drug that acts on serotonin reuptake receptors, preventing their function to prolong the presence of the neurotransmitter in the synaptic space in which it is released. In depression it has been seen that there are low levels of serotonin, substance involved in generating positive moods so by maintaining the little serotonin released it helps prolong its effects.
Furthermore, in in vitro studies of rat brains, it was observed that the effect of paroxetine It is several times greater than sertraline (Zoloft) and significantly more potent than fluoxetine (Prozac).
Pharmacokinetics of the psychotropic drug
Paroxetine is administered orally in the form of a tablet, suspension (liquid) or capsules, with complete absorption carried out by our digestive system. Within the body, it is widely distributed, including in the CNS (it can pass the blood-brain barrier), where will be fixed on the serotonin receptors of neurons.
The half-life of the drug in the body of an adult is 21 hours, a time that must be taken into account due to its interactions with other medications. Paroxetine is metabolized in the liver into various metabolites, and it has been seen that none of them have an effect on the body, that is, they are harmless.
Its exit from the body is carried out mainly through the kidneys (62%) through urine, and the rest is excreted through feces in the form of bile. For these reasons, and as is the case with many medications, It is not recommended to be treated with this drug if you suffer from liver or kidney failure.
Paroxetine is indicated to mainly treat episodes of major depression, especially when other SSRI-type antidepressants have not had an effect, since it has been seen that this drug has greater potency than others in its class. Other uses in treatments are in the following cases:
Also There is a variety of paroxetine capsules, under the trade name Brisdelle. which is used as a non-hormonal remedy to treat hot flashes experienced by women going through menopause. In the latter case, the mechanism that the drug uses to prevent hot flashes is not known.
Paroxetine Side Effects
Treatment with paroxetine can cause adverse reactions, like the vast majority of drugs. Being a substance that works on a messenger as important as serotonin, its list of side effects is quite long :
It should be noted that during the clinical trials of this drug it was observed that in short-term trials carried out in children and adolescents, increased suicidal, self-injurious behavior and hostility so it is not recommended for these ages.
Contraindications
The main contraindication of paroxetine (like the rest of the SSRIs) has to do with not taking it together with another antidepressant drug of the MonoAmino Oxidase Inhibitor (MAOI) type.
The reason for this is because serotonin is degraded by the enzyme monoamine oxidase A. If the enzyme is deactivated, serotonin concentrations increase and can cause serotonin syndrome, a clinical condition that can be fatal. Therefore, you always have to wait a period between treatment with MAOIs and SSRIs.
Another contraindication to paroxetine is taking it together with other tricyclic antidepressants. since the drug inhibits the liver enzyme that is responsible for eliminating tricyclic antidepressants from the body. The effects of paroxetine on this enzyme can last up to a week after stopping treatment, so great care must be taken when changing medications. The main adverse effect of this interaction is a symptom of toxicity, although in some cases sudden death has occurred.
Paroxetine is also not recommended for people who are hypersensitive to it, as well as if they have a history of mania. This is because all antidepressants can transform depression into mania in people predisposed to it.
Besides, Treatment with this drug is totally prohibited in pregnant women. since it has been seen that it generates malformations in the cardiovascular system of fetuses in their first months of development or various problems in neonates if medicated during the last months of pregnancy with paroxetine. In terms of breastfeeding, in principle its excretion through milk is minimal, but the boy or girl must be observed for greater safety.
Finally, the use of paroxetine may cause drowsiness or dizziness as we have seen, so it is not recommended to carry out potentially dangerous activities, such as driving or operating heavy machinery.
Paroxetine and shyness
Paroxetine is an antidepressant that, as part of a marketing campaign, became popular in its use to help with the social anxiety disorder that some shy people suffer from, although it apparently spread to its use in overcoming shyness. Among the medical community, there is a debate about whether it really works or not.
Doctors who oppose the use of drugs to treat this type of anxiety maintain that current treatments do not generate any real change in the patient, that is, after stopping the medication they experience anxiety again. There has even been a rebound effect, further increasing the anxiety they suffer when trying to socialize.
Other arguments on which they are based are lack of knowledge of the long-term effects of current drugs used for this purpose, since they are relatively new. Along with this, the long list of known side effects caused by paroxetine causes concern.
