Paroxetine: the "anti-shyness drug"

Paroxetine is an oral drug which is designed for fight depression. Technically, it is of the selective reuptake inhibitor type. serotonin (SSRI), a neurotransmitter that participates in the generation of positive mood states; however, paroxetine is better known for a very different reason.

Due to its history, it became popular to treat a class 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-shy drug.

The history of paroxetine

Paroxetine came onto the market in 1992. by the North American pharmaceutical giant GlaxoSmithKline (GSK) under the trade name of Paxil. Its sales were much lower compared to other antidepressant drugs such as Prozac or ZoloftSo the company devised a powerful advertising campaign in 1999 to change this.

The advertising focused on a different use for paroxetine. The company was in charge of publicizing a new type of anxiety that was just 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 deal with this kind 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 ad campaign controversy

Today 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 can be overcome by following some guidelineswithout any need for medication.

The controversy in the story basically has to do with the advertising campaign for paroxetine, which incites debate about how far the pharmaceutical industry is capable. to get benefits from their products, in this case "popularizing" an anxiety disorder that was beginning to be studied at the time, in their desire to surpass the competence... and despite the fact that this could generate confusion and stigmatization about people who are shy due to their personality.

The mechanism of action

Paroxetine is an antidepressant drug that acts on serotonin reuptake receptors, preventing their function to prolong the presence of the neurotransmitter in the brain. synaptic gap in which he is released. In the depression It has been seen that there are low levels of serotonin, substance involved in the generation of positive mood states, so by keeping the little serotonin released 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 psychoactive drug

Paroxetine is taken orally as a tablet, suspension (liquid), or capsules, with complete absorption by our digestive system. Within the body, it is widely distributed, including in the CNS (can pass the blood-brain barrier), where will fix on the serotonin receptors of the neurons.

The half-life of the drug in the body of an adult is 21 hours, a time that has to be taken into account due to its interactions with other drugs. 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 with many medicines, It is not recommended to treat yourself with this drug if you suffer from liver or kidney failure.

Therapeutic indications

Paroxetine is indicated to treat primarily major depressive episodes, especially when other antidepressant of the SSRI type have not been effective, since it has been seen that this drug has greater potency than others of his class. Other uses in treatments are in the following cases:

• obsessive-compulsive disorder
• Panic disorder with or without agoraphobia
• Social anxiety disorder or social phobia.
• Panic disorder.
• Post Traumatic Stress Disorder.

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 in women going through the menopause. In the latter case, the mechanism used by the drug 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:

• Increased cholesterol levels, decreased appetite.
• Drowsiness, insomnia, aggressiveness, abnormal dreams.
• Decreased concentration, dizziness, tremors, headache.
• Blurry vision.
• Nausea, constipation, diarrhea, dry mouth.
• sweating.
• sexual dysfunction.
• Asthenia, weight gain.

It should be noted that during the clinical trials of this drug it was observed that in short-term trials conducted in children and adolescents increased suicidal, self-injurious, and hostile behavior, so it is not recommended for these ages.

contraindications

The main contraindication presented by paroxetine (like the rest of the SSRIs) has to do with not take it together with another antidepressant drug of the MonoAmino Oxidase Inhibitor type (MAOI).

The reason for this is because serotonin is broken down by the enzyme monoamine oxidase A. If the enzyme is deactivated, the concentrations of serotonin grow and can even cause the serotonin syndrome, a clinical picture that can be fatal. Therefore, you always have to wait a period between a treatment with MAOIs and SSRIs.

Another contraindication of paroxetine is to take 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 cessation of treatment, so great care must be taken when changing medications. The main adverse effect of this interaction is a symptom of toxicity, although sudden death has occurred in some cases.

Paroxetine is also not recommended in 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 who are 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 you were medicated during the last months of pregnancy with paroxetine. In a matter of lactation, 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 for its use to help with social anxiety disorder that some shy people suffer from, although it seems to have spread for its use in overcoming shyness. Among the medical community, there is a debate about whether or not it really works.

Physicians opposed to the use of drugs to treat this type of anxiety maintain that current treatments do not generate no real change in the patient, that is to say, that after the cessation of the medication they return to present the anxiety. A rebound effect has even been seen, further increasing the anxiety they suffer when trying to socialize.

Other arguments on which they rely 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 that paroxetine generates causes concern.