Paxil

What we Don't Understand about Paxil

Paxil is in a class of medications known as SSRIs (Selective Serotonin Reuptake Inhibitors). In essence, these medicines prevent the body from reabsorbing serotonin, thus allowing it to stay in the system and boost moods for longer periods. SSRIs are used to combat depression, which often coexists with low levels of serotonin in the brain.

The problem is, not everything about Paxil is understood. There are certain effects from the medication that warrant further study, and have even lead to black-box labeling as with other SSRIs.

For example, the FDA has released a Public Health Advisory explaining that Paxil and derived drugs are category D pregnancy medications — a higher risk class for medicines prescribed to pregnant women. The same advisory explained that studies have shown infants exposed to Paxil in the womb have as much as double the risk for being born with a heart defect as children not so exposed. Many of these were defects such as a ventricular septal defect (hole in the heart walls), but some were more serious such as the dreaded and severe persistent pulmonary hypertension of the newborn (PPHN), which often is fatal.

Further complicating things is the reported potential link between Paxil and personality modification.

The basic assumption is that changes to a patient's personality when taking Paxil can be attributed to the medicine lifting the patient's “bad mood.” However, there are certain studies that show this may not be the case at all. In fact, this paper from the National Institutes of Mental Health suggests there might be a reason to suspect Paxil is directly altering the patients' personalities. So instead of correcting a problem, it's changing the underlying psychology.

This result is troublesome because of prior papers suggesting that Paxil might be responsible for aggravated suicidal thoughts and actions. As mentioned here, Paxil and related SSRIs have a demonstrated link to such behaviors, even though none has been successfully completed.

Given that Paxil may be fundamentally altering the patients' personalities instead of simply lifting a bad mood, this could suggest that the increased suicidal behaviors are equally deep changes, which is certainly a cause for caution — as evidenced by the fact that Paxil now carries the same black-box warning about suicidal ideation as other drugs in its class.

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sources

http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm051731.htm

http://www.nimh.nih.gov/science-news/2010/effects-on-personality-may-be-mechanism-of-antidepressant-effectiveness.shtml

http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml