Question. I am a 32-year-old obese male with mild depression and panic disorder. My therapist of three years has suggested that Paxil would be of great benefit to me. I have never taken any psychotropic drugs before, so I don’t know what to expect. She feels if I receive the correct dosage, it would help me with my weight problem and help restore my sex drive (over time, of course). What can I expect?
Answer. Paxil (paroxetine) is one of a group of antidepressant agents known as SSRIs; they work on a chemical in the brain called serotonin, which is involved in both mood and appetite/carbohydrate craving. SSRIs are clearly helpful in depression and panic disorder, and also help some overweight individuals lose weight. This latter effect may be due to relief of the underlying depression – which results in overeating and decreased physical activity in some cases – or to decreased craving for carbohydrates. Similarly, if an individual has a reduced sex drive (“libido”) because of underlying depression – which is very common – antidepressant medication may, indeed, correct this.
However, the SSRIs can themselves cause sexual dysfunction in perhaps 15% to 40% of patients; e.g., delayed orgasm or reduced ejaculation. At the same time, they may increase libido. Other common side effects with Paxil and similar agents include nausea (about 16% of patients), drowsiness (14%), and perspiration (9%). Some patients may feel a little agitated at first, or experience insomnia. Many of these side effects never occur in many patients, and some will diminish with time.
Overall, the “trade-offs” are worth it for most patients with significant depression and panic symptoms. Other agents, such as Effexor and Nefazodone, are also effective for depression (and probably panic disorder, though the data are preliminary), and cause fewer sexual side effects than the SSRIs. A thorough discussion of the risks and benefits of these agents should take place with your prescribing physician, prior to making your decision.