Paroxetine dangers

Due to the frequent unwanted effects and, in case of tranylcypromine, the numerous and dangerous interactions MAO-inhibitors are more and more replaced by the much less problematic SSRIs. Compounds belonging to this group are citalopram, escitalopram, fluoxetine, paroxetine and sertraline. They are used clinically in the therapy of depression, bulimia and obsessive-compulsive disorders. All SSRIs show a slow onset of action (1-2 weeks). They may induce insomnia and weight loss. The antidepressant ven-lafaxine inhibits both, serotonin and noradrenaline re-uptake and might therefore additionally induce hypertension. 

Because the hver metabolizes TCAs, drugs that inhibit or induce hepatic microsomal enzymes may alter plasma tricyclic levels. This is particularly true of CYP 2D6 inhibitors. In some individuals, this interaction may result in dangerously high levels of the TCA when a potent 2D6 inhibitor, such as paroxetine, is coadministered. 

Even worse, GSK made sure that Study 329 was eventually published in a whitewashed form in the prestigious Journal of the American Academy of Child and Adolescent Psychiatry (Keller et ah, 2001). The title left no doubt about the scientific nature of the study Efficacy of Paroxetine in the Treatment of Adolescent Major Depression A Randomized, Controlled Trial. The conclusion to the lengthy analysis, a mere one sentence long, left no doubt about what the reader was supposed to learn Paroxetine is generally well tolerated and effective for major depression in adolescents. That one sentence, so prominently displayed as the last line of the abstract, was a drug company public relations triumph, one bound to vastly increase the off-label prescription to children of their ineffective, dangerous drug. 

Via CYP450 2D6 inhibition, paroxetine could theoretically increase concentrations of thioridazine and cause dangerous cardiac arrhythmias... 

CYP450 2D6 inhibitors including paroxetine, fluoxetine, duloxetine, bupropion, sertraline, citalopram, and others can raise thioridazine to dangerous levels... 

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