From the Guidelines
Paxil (paroxetine) can cause mental status changes and indolence (sluggishness or laziness) as side effects, and if you're experiencing these symptoms, contact your healthcare provider immediately as these could indicate serious adverse reactions, such as serotonin syndrome, which can be triggered by elevated brain serotonin levels, especially when combined with other serotonergic medications 1. These effects typically occur within the first few weeks of starting treatment or after dose adjustments. Common mental status changes include confusion, agitation, mood swings, and in some cases, increased suicidal thoughts, particularly in young adults and adolescents, with a pooled absolute rate of 1% for suicidal ideation across all antidepressant classes and all non-OCD anxiety indications 1. The indolence or fatigue often manifests as excessive tiredness, lack of motivation, or feeling mentally slowed down. These effects occur because Paxil affects serotonin levels in the brain, which influences mood, energy, and cognitive function. Never stop taking Paxil suddenly as this can cause withdrawal symptoms; your doctor may recommend gradually tapering the dose if discontinuation is necessary. Alternative antidepressants might be considered if these side effects are severe or persistent, and some patients find these side effects diminish over time as their body adjusts to the medication, typically within 2-4 weeks. It is essential to note that serotonin syndrome symptoms can arise within 24 to 48 hours after combining medications and are characterized by mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity, and treatment is hospital-based and includes discontinuation of all serotonergic agents and supportive care with continuous cardiac monitoring 1. Additionally, caution should be exercised when combining two or more non-MAOI serotonergic drugs, including antidepressants, opioids, and other pain medications, stimulants, and cough/cold/allergy medications, to avoid serotonin syndrome 1. In the context of treating premature ejaculation, daily SSRIs, such as paroxetine, are recommended as first-line agents of choice, but patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs as this may precipitate SSRI withdrawal syndrome 1.
From the FDA Drug Label
The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including treatment with PAXIL, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). In patients receiving another serotonin reuptake inhibitor drug in combination with monoamine oxidase inhibitors (MAOIs), including reversible MAOIs such as linezolid and methylene blue, there have been reports of serious, sometimes fatal, reactions including hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, and mental status changes that include extreme agitation progressing to delirium and coma.
Mental status changes can occur in patients taking Paxil, particularly in those taking concomitant serotonergic drugs or MAOIs. These changes can be symptoms of serotonin syndrome or NMS-like reactions, which can be life-threatening.
- Symptoms of serotonin syndrome may include:
- Mental status changes (e.g., agitation, hallucinations, coma)
- Autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia)
- Neuromuscular aberrations (e.g., hyperreflexia, incoordination)
- Gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea)
- Risk factors for serotonin syndrome or NMS-like reactions include:
- Concomitant use of serotonergic drugs or MAOIs
- Use of antipsychotics or other dopamine antagonists
- History of bipolar disorder or other psychiatric conditions 2
From the Research
Mental Status Changes and Indolence on Paxil
- The studies reviewed do not directly address the topic of mental status changes and indolence on Paxil 3, 4, 5, 6, 7.
- However, some studies mention side effects of Paxil, such as sedation, which could potentially contribute to indolence 4, 5.
- Paroxetine, the active ingredient in Paxil, is a selective serotonin reuptake inhibitor (SSRI) that is used to treat various psychiatric disorders, including depression, anxiety, and obsessive-compulsive disorder 3, 5.
- The efficacy and safety of paroxetine have been compared to other SSRIs in several studies, which found similar effectiveness and side effect profiles 4, 6, 7.
- One study found that paroxetine was associated with a higher incidence of withdrawal symptoms compared to other SSRIs 7.
- Another study found that paroxetine was effective in preventing relapse or recurrence of depression for up to 1 year, and maintained a therapeutic response over 1 year in obsessive-compulsive disorder and up to 6 months in panic disorder 5.