Starting Dose of Paxil (Paroxetine) for Depression and Anxiety
For an adult well-nourished male with significant anxiety and depression, start Paxil at 20 mg once daily in the morning. 1
Dosing Rationale
The FDA-approved starting dose for paroxetine in major depressive disorder is 20 mg/day, which also serves as the minimal effective dose and the optimal dose for most patients 1, 2. This same 20 mg/day starting dose applies to generalized anxiety disorder and post-traumatic stress disorder 1.
Key Dosing Principles
- Single daily dose: Administer once daily, typically in the morning, with or without food 1
- 20 mg is both starting and target dose: For most patients, 20 mg/day will be sufficient and no dose escalation is needed 2
- Dose increases if needed: If inadequate response after 1-3 weeks, increase in 10 mg increments at weekly intervals, up to maximum 50 mg/day for depression or generalized anxiety disorder 1, 2
Special Consideration for Panic Disorder Component
If panic symptoms are prominent, note that the FDA recommends a lower starting dose of 10 mg/day for panic disorder specifically, with gradual titration to the target dose of 40 mg/day 1. However, since your patient presents with "significant anxiety and depression" rather than panic disorder specifically, the standard 20 mg starting dose for depression/generalized anxiety is appropriate 1.
Clinical Context
- Therapeutic effect timeline: Full antidepressant and anxiolytic effects may be delayed, typically requiring several weeks of consistent administration 1, 3
- Well-tolerated profile: Paroxetine at 20 mg/day is generally well-tolerated with common side effects including nausea, sexual dysfunction, somnolence, headache, and sweating 4, 5, 6
- Efficacy data: In clinical trials, 88% of patients achieved significant reduction in depression scores and 73% achieved remission (HAM-D ≤10) at 6 weeks with 20 mg/day 6
Important Caveats
Do not use the 10 mg starting dose unless your patient is elderly, debilitated, or has severe renal/hepatic impairment—none of which apply to a "well-nourished adult male" 1. The evidence clearly establishes 20 mg as the appropriate starting dose for the general adult population with depression and anxiety 1, 2.