“Antidepressant from Hell” - this is the title under which an article was published in the journal Psychopharmacology bulletin about a drug called PAXIL (active ingredient paroxetine) in 2016. Today we’ll try to figure out what’s so “hell” about this drug. Paroxetine was developed and patented by the Danish company A/S Ferrosan (in the UK - in 1973, in the USA - in 1977). The drug belongs to the SSRI with a strong anti-anxiety effect. Action of the drug: Inhibits the reuptake of serotonin, increasing serotonin transmission Causes desensitization (restoration) of serotonin receptors Weak anticholinergic effect (blocks acetylcholine receptors) Weak inhibition of norepinephrine reuptake Inhibits the enzyme nitric oxide synthetase, which is responsible for more frequent comparison with other SSRIs, sexual dysfunction. Indications for use are the same as for other drugs in this group... The drug is quite effective, but it also has a large number of side effects: Sexual dysfunction. Especially in men, compared to other SSRIs, paroxetine is a leader in this direction. Weight gain. Among the SSRIs, paroxetine is the most likely to cause this side effect. It is sometimes used for weight gain in depression. Cannot be used during pregnancy According to WHO, patients taking paroxetine have the most severe withdrawal problems compared to patients taking other antidepressants. GlaxoSmithKline for a long time denied the problem of addiction to paroxetine. Paroxetine withdrawal syndrome can be so persistent that in these cases patients have to reduce the dosage very slowly. SSRI-associated apathy is more common than with other SSRIs, especially after 1 year of taking the drug. Insomnia, tremors, headaches, dry mouth, drowsiness also occur quite often... My opinion: the drug is effective for anxiety and depressive disorders, however, the range and severity of side effects among all SSRIs is one of the most negative, so I prescribe the drug quite rarely.