Talk:Paroxetine/Archive 3

Archive 1

Archive 2

Archive 3

Interpretation of abstract at new link

New citation link http://www3.interscience.wiley.com/journal/118002942/abstract?CRETRY=1&SRETRY=0 points to an abstract that says in part "Results of our analysis of the FDA AERS data revealed that newer antidepressants are associated with lower rates of suicide adverse event reports compared with older antidepressants." I don't understand how that language supports the statement in today's edits that "There is no statistical proof of a casual relationship between paroxetine and suicide, but there is a relationship between depression, anxiety and suicide." Of course I'm only looking at the abstract, so maybe I'm missing something? --CliffC (talk) 20:51, 27 August 2009 (UTC)

I do not know either. Paroxetine was not mentioned in the abstract. I am moving this questionable quotation to the talk page below until the author provides full supporting quotations.

"There is no statistical proof of a causal relationship between paroxetine and suicide, but there is a relationship between depression, anxiety and suicide." The Sceptical Chymist (talk) 00:13, 28 August 2009 (UTC)

I agree that the reference should be to the actual article. The abstract does not support the statement but the actual article provides support. I am thinking of removing the text until the reference is fixed. Perhaps the entire statement should be put into a sub section? Let us remove it until consensus can be reached. Punctuallylate (talk) 10:29, 28 August 2009 (UTC)Punctuallylate

Paxil causing difficulty reaching orgasm

SSRI drugs have been noted for making it difficult for people despite ample sexual stimulation to achieve orgasm. This is a fairly widespread side effect of SSRIs. But this should be mentioned in this article for WP:NPOV. The condition is called Anorgasmia.--Tomwsulcer (talk) 15:44, 8 October 2009 (UTC)

Do you have a reliable source which includes statistical information regarding this side effect in Paroxetine? DKqwerty (talk) 16:50, 8 October 2009 (UTC)

I will work on finding a source. This is one "side effect" of paroxetine that is found to be desirable for some men who suffer from premature ejaculation and is an off-label use. Nivek2425 (talk) 13:13, 13 October 2009 (UTC)nivek2425

numbers in the lead

Hi Skeptical Chymist - let's not edit war over this. I don't understand why you think the numbers disrupt the "flow" - and besides an article is not a poem. You asked why those particular side effects were listed, the answer is because they are the most common (except for withdrawal, which is addressed in the following paragraph). The numbers address the most basic issues about the drug: safety & efficacy, providing a thumbnail view of what patients are most likely to experience (i.e. about equally likely to experience benefit and/or side effects); it might also help to add numbers on withdrawal because that is even more likely. If paroxetine were a random chemical found in soil or bricks, then the question of what will probably happen if you eat it might be less relevant, but it is a drug designed for human consumption, so the most likely effects seem pertinent to the introduction. I had wanted to include a comparison to physical exercise, since the article says paroxetine's efficacy is comparable to other SSRIs and several studies have found physical exercise (30 minutes 3x/week, or just a daily walk) more effective than SSRIs, but the linked study was deleted because it did not mention paroxetine. I will look for direct comparisons so hopefully that information can be added. The article starts with what the drug is used for, and indeed for 10-20% of patients it has some benefit, but it seems worth mentioning that the drug is equally likely to cause harm (more likely if you count withdrawal), and besides most patients would probably do better with physical exercise that costs nothing.TVC 15 (talk) 21:12, 16 November 2009 (UTC)

1. The lead should only give an overview. The excessive details are distracting. The leads in featured articles on pharmacology do not generally give efficacy numbers, see linezolid, sertraline, bupropion.

2. Percent efficacy numbers are often meaningless since they vary widely from study to study and very much depend on the study design. This is a complicated issue, which cannot adequately be addressed in the lead. Number needed to harm and number needed to treat are usually used in research not the percent values. Furthermore, a study of exercise for depression can not be blind. Thus, to be objective, you have to compare the efficacy of exercise with open-label studies of antidepressants, where they help 60-70% of patients.The Sceptical Chymist (talk) 00:58, 17 November 2009 (UTC)

bipolar disorder (help by experienced user would be greatly appreciated)

I have decided to move the following sentence to the discussion page: "In two double-blind studies of bipolar disorder patients, addition of paroxetine to a mood stabilizer had no advantages over addition of placebo."

This is not only not true, but the studies cited do not support that statement.

The first study cited clearly states that this is only the case for patients being treated with high dosages of Lithium at the same time (quote: "Antidepressants may not be useful adjunctive therapy for bipolar depressed patients with high serum lithium levels. However, antidepressant therapy may be beneficial for patients who cannot tolerate high serum lithium levels or who have symptoms that are refractory to the antidepressant effects of lithium."). The second study cited doesn't allow that conclusion, too – it just states that further research is required. (You can check that easily, just read the abstracts, they are not very long.)

However, there are a couple of studies that do find Paroxetine to be effective in bipolar patients. e.g.:

1. "Paroxetine and venlafaxine are both effective and safe in the treatment of depressive breakthrough episodes in bipolar disorder."

2.

So all available data points to Paroxetine being effective with bipolar depression, although scientists are not completely certain yet – which is the opposite of what the article states.

I'd suggest to just remove the section. It seems that at present there is neither proof nor indication that Paroxetine's effect in bipolar patients differs from those with major depression. At least the two reference-links that do prove the opposite of what the article wants them to prove have to be altered. This is close to lying, you know.

I am not very experienced in Wikipedia and my English is not very good. Could someone help me here? Have I made a mistake? Thank you.

--92.50.112.164 (talk) 16:39, 28 July 2010 (UTC)

please help with ref

I added the paroxetine tamoxifen interaction, but have a limited cite (BMJ 2010;340:c693). One web source to point at the abstract is http://www.bmj.com/cgi/content/abstract/340/feb08_1/c693 where the title and authors are found. Kd4ttc (talk) 16:52, 24 August 2010 (UTC)

How is this drug synthesized?

Someone needs to post how this drug is synthesized. 2602:306:C518:6C40:505A:5C79:DCDB:627E (talk) 12:30, 26 May 2013 (UTC)

Effectiveness

This ref [1] does not state it is better than placebo thus have reverted these changes [2]

It states "Among adults with moderate to severe major depression in the clinical trials we reviewed, paroxetine was not superior to placebo in terms of overall treatment effectiveness and acceptability. These results were not biased by selective inclusion of published studies." Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:56, 30 January 2014 (UTC)

This Cochane review of trials in kids is interesting [3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:59, 30 January 2014 (UTC)

Good catch. Didn't read interpretation. Odd to draw a different conclusion from the previous section, but I don't care to read the whole paper to see why. Seppi333 (Insert 2¢ | Maintained) 03:05, 30 January 2014 (UTC)

To determine if someone is beneficial one needs to look at all SAEs (severe adverse events). There is also the question of clinical versus statistical significance. If one does a large enough trial one can should a 1 mmHg decrease in blood pressure with say X and while that might be statistically significant it is not necessarily clinically significant for the person in question. Will look at the literature further. It is a little eye opening how much the best available literature diverges from pharmaceutical advertising in the area of psychiatry. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:15, 30 January 2014 (UTC)

Another 2012 Cochrane review "There is very limited evidence upon which to base conclusions about the relative effectiveness of psychological interventions, antidepressant medication and a combination of these interventions. On the basis of the available evidence, the effectiveness of these interventions for treating depressive disorders in children and adolescents cannot be established." [4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:24, 30 January 2014 (UTC)

With respect to "no evidence in children" we have "Ten publications, comprising a total of 2,046 patients, evaluated the efficacy of four SSRIs (fluoxetine,paroxetine, sertraline and citalopram) in child and adolescent depression. It is noted that an additional 6 trials (with a total of 1,234 patients) were not reported by the industry because of a lack of efficacy or problematic side effects, including suicidal behaviors. Meta-analyses revealed no data supporting the use of SSRIs, except for fluoxetine." [5] Have looked at a lot of the available review articles for children and all of them are hesitant like this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:42, 30 January 2014 (UTC)

Structure and Pharmacology

The benzodioxole termination of paroxetine is shared with piribedil and mdma seeming a ligand to dopamine receptors for an agonist action. Also comparing paroxetine with tedatioxetine and vortioxetine, with which the main structure is in common, paroxetine should behave as a serotonin and dopamine reuptake inhibitor, rather than as a serotonin and noradrenaline reuptake inhibitor. A piperidine is present in paroxetine and tedatioxetine (and in other comparable important wares as well), whereas in vortioxetine it is replaced by a piperazine. This point of view matches most patient's experiences, reporting potent anxiolitic and almost sedating effects of paroxetine...

79.41.235.169 (talk) 15:52, 30 June 2013 (UTC)

Without reputable sources to back them up, these sorts of speculations are completely useless for the purpose of writing Wikipedia articles. Looie496 (talk) 16:38, 30 June 2013 (UTC)

It is just a suggestion for investigation. If pharmaceutical houses do not provide with data enough, there is no way for getting a plausible view instead of myths, with the exception of linking pages! 79.20.9.3 (talk) 21:48, 30 June 2013 (UTC)

The sexual side effects are also exactly reproducible by combination of selected catecholamines steady-state levels increase and selected aminoacids steady-state levels decrease. I am pleased of holding all the data of the speculation (sic), letting you with your handful of flies. 79.31.234.1 (talk) 13:14, 18 March 2014 (UTC)

Sucidiality

I'd say it belongs in the lede. Its well established, its got a black box warning, and it's a major side effect in a class of drugs that one can hardly deny has fairly modest efficacy in most patients. If you asked me to describe paroxetine or any other SSRI in 4 sentences, I'd say

1) Modest efficacy in mild to moderate depression, probably greater in dysthmia, severe depression, and anxiety disorders. 2) Better side effect profile than tricyclics, which they largely replaced 3) Extremely widely used, about 5% of males and 10% of females in the US 4) Some enhanced risk of suicide in first 12 weeks of use.

Anything you would say that's different than that?

Technically you're cutting it a bit close here, WP:BRD suggests that you should have gone to the talk page here and not re-established your reverted comment. But its never too late to talk.... Formerly 98 (talk) 20:59, 16 May 2014 (UTC)

86.9.190.197 (talk) 10:28, 22 November 2014 (UTC) The suicidal effect is something people will want to know about in this article if they are making the decision to take this drug. I am happy for this quote of a user of 20 years to be added to the article ie my own quote. I am not a wiki expert so do not know if this is acceptable content: "My 18 years experience of taking paroxetine in high and low doses is that a suicidal effect is created in me because it puts me in neutral. Not only are the bad feelings gone but so too are the highs. I cannot get pleasure out of enjoyments & until I realized it was the tablet causing it I thought it was permanent & life had nothing left to offer me." Quote Michelle (add kandharohi for googling me) Wyatt aged 39 86.9.190.197 (talk) 10:28, 22 November 2014 (UTC)

We don't add personal stories from individuals to articl4s at Wikipedia, in part because they are not verifiable. See WP:MEDRS Formerly 98 (talk) 11:01, 22 November 2014 (UTC)

Study 329

Study 329 should be wikilinked from this article.

This BMJ article is absolutely relevant to the topic.

http://www.bmj.com/content/351/bmj.h4320

GSK is paying PR firms to act on their behalf in the media, and they are paying PR firms to edit this article to whitewash the wikilink to the study - Wikipedia is not written from a PR industry perspective, it is written for the information needs of users.

-- Callinus (talk) 11:03, 18 September 2015 (UTC)

Feel free to wikilink it, just not like that. The BMJ article fails WP:MEDRS for your use, this is not a conspiracy, read the fucking policy. Your edits are horribly sloppy given the context, you are ramrodding content into the wrong section, there are so many things wrong with how you did this. And I don't have any COIs whatsoever, so go accuse someone else (like perhaps yourself if we're speaking of whitewashing). I've reverted your edit due to the extremely clear violations, as I said above, you need to approach this differently. Garzfoth (talk) 12:35, 18 September 2015 (UTC)

References

Withdrawal - WHO ranking

The article says: "In 2001, the BBC reported the World Health Organization had ranked paroxetine as the most difficult antidepressant to withdraw from.", sourced from the article BBC News, "Anti-depressant addiction warning", 11 June, 2001. The referred article says:

"A World Health Organization report which ranked antidepressants in order of withdrawal problems found Seroxat was the hardest to come off."

"Prozac (fluoxetine) was seventh."

A news article is a rather weak source. Does anyone have a hyperlink to the WHO report to which BBC news is referring to?

For reference, some more talks on "withdrawal": Talk:Paroxetine/Archive_1#Brain_zaps, Talk:Paroxetine/Archive_1#Withdrawal, Talk:Paroxetine#Discontinuation_or_withdrawal_syndrome.3F_-_Both.21_-_Straight_from_the_horse.27s_mouth. --Dan Polansky (talk) 16:20, 10 September 2010 (UTC)

A report of WHO relevant to SSRI and withdrawal is this, and one section in particular, which contains a table with withdrawal syndrome reports:

• WHO Expert Committee on Drug Dependence – WHO Technical Report Series, No. 915 – Thirty-third Report, 2003
  • Section Annex Terminology used in reporting abuse-related adverse drug reactions

But this cannot be the report to which BBC is referring, as the BBC article is from 2001. --Dan Polansky (talk) 16:48, 10 September 2010 (UTC)

I did not find the WHO scource, but here is a comprehensive meta analysis with the same conclusion: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024727/ 178.164.136.76 (talk) 00:14, 11 November 2015 (UTC)

Paroxetine was invented by Nazis working off of Otto Loewi's stolen research. Have a nice day. — Preceding unsigned comment added by 108.69.252.105 (talk) 04:40, 15 July 2012 (UTC)