A Canadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder
Abstract
Background Recent studies have suggested clinical differences among selective serotonin reuptake inhibitors. In a 12-week randomized, multicenter, double-blind trial, the antidepressant and anxiolytic efficacy of the selective serotonin reuptake inhibitors paroxetine and fluoxetine was compared in patients with moderate to severe depression.Methods A total of 203 patients were randomized to fixed doses (20 mg/day) of paroxetine or fluoxetine for the first six weeks of therapy. From week 7-12, dosing could be adjusted biweekly, as required (paroxetine 20-50 mg/day, and fluoxetine 20-80 mg/day). The mean prescribed doses were paroxetine 25.5 mg/day (range 20.0-40.2 mg/day), and fluoxetine 27.5 mg/day (range 20.0-59.5 mg/day). Emergence of motor nervousness or restlessness was assessed using the ESRS scale for akathisia.Results Both active treatments demonstrated comparable antidepressant efficacy (HAM-D, CGI). Anxiolytic activity of the two drugs (COVI, STAI, HAM-D) was also comparable. However, paroxetine was found to be superior to fluoxetine on two subscore measures at week 1 of therapy (HAM-D Agitation item, p < 0.05; Psychic Anxiety item, p < 0.05), with no differences detected after week 2. The overall incidence of adverse effects was comparable in the two treatment groups. Constipation, dyspepsia, tremor, sweating and abnormal ejaculation were more common in paroxetine-treated subjects, whereas nausea and nervousness were more frequent in fluoxetine-treated patients. Weight loss was more common in the fluoxetine versus paroxetine group (11.88% versus 2.94%, respectively). ESRS scores for akathisia were low throughout the study and showed little change.Limitations Differences observed between the two drugs in antianxiety effects were limited to two measures of anxiety among several others.Discussion The data indicate that paroxetine and fluoxetine have comparable antidepressant and anxiolytic efficacy. Paroxetine appears to produce an earlier improvement in agitation and psychic anxiety symptoms compared with fluoxetine.
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Case reports of new withdrawal symptoms (hypomania, anxiety, restless sleep, nightmares, depersonalization, formication, headache) after discontinuation of trazodone were published.
“Case reports of new withdrawal symptoms (i.e., hypomania, anxiety, restless sleep, nightmares, depersonalization, formication, headache) after discontinuation of trazodone were published [98-101].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [100]
A recurrent disabling withdrawal symptom described in the literature and online by patients is a sensory symptom of electric shock sensations and electric-like waves.
“A recurrent disabling withdrawal symptom described in the literature and online by patients is a sensory symptom of electric shock sensations and electric-like waves [1,12,22,26] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
There is increasing evidence for postwithdrawal disorders with SSRI long-term use.
“We now have increasing evidence for postwithdrawal disorders with SSRI long-term use [6,15,16,26,37] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
Data from controlled trials, case reports, and online patient reports show that paroxetine is most likely to be associated with new withdrawal symptoms, and fluoxetine the least.
“Data from controlled trials [15,20,29] , case reports [16] , and online patient reports [26] show that paroxetine is most likely to be associated with new withdrawal symptoms, and fluoxetine the least.”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
Postwithdrawal disorders may resemble rebound symptoms being more severe than the original symptoms, but these disorders persist at least 6 weeks in contrast to rebound symptoms.
“They may resemble rebound symptoms being more severe than the original symptoms, but these disorders persist at least 6 weeks in contrast to rebound symptoms and [6,15,16,26,37] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
In another study, we analyzed online reports from individuals who described postwithdrawal disorders after SSRI discontinuation.
“In another study, we analyzed online reports from individuals who described postwithdrawal disorders after SSRI discontinuation [26] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
The most frequent persistent postwithdrawal disorder symptoms reported online were disturbed mood, depression, emotional liability, mood swings, irritability, anxiety, insomnia, impaired concentration, and impaired memory.
“The most frequent persistent postwithdrawal disorder symptoms reported online were disturbed mood, depression, emotional liability, mood swings, irritability, anxiety, insomnia, impaired concentration, and impaired memory.”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
There were online cases of persistent postwithdrawal disorders found after the discontinuation of paroxetine, citalopram, escitalopram, and fluvoxamine, but not sertraline or fluoxetine.
“There were online cases of persistent postwithdrawal disorders found after the discontinuation of paroxetine, citalopram, escitalopram, and fluvoxamine, but not sertraline or fluoxetine [26] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [26]
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- Authors
- Chouinard, G., Saxena, B., Bélanger, M.-C., Ravindran, A., Bakish, D., Beauclair, L., Morris, P., Vasavan Nair, N. P., Manchanda, R., Reesal, R., Remick, R., & Colleen O'Neill, M.
- Affiliations
- Institut universitaire en santé mentale de Montréal (CA)
- Hamilton Psychiatric Hospital (CA)
- Royal Ottawa Mental Health Centre (CA)
- University Hospital (CA)
- St. Paul's Hospital (CA)
- Corresponding author
- Chouinard, Guy
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 1999-07
- Volume
- 54
- Issue
- 1-2
- Pages
- 39-48
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2043807054
- Cited by
- 57
- References
- 34
- Citations by year
- 2024: 2 · 2020: 2 · 2019: 1 · 2015: 2 · 2014: 3 · 2013: 7 · 2012: 3
- FWCI
- 2.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- paroxetine, fluoxetine, major depressive disorder, selective serotonin reuptake inhibitors, antidepressant efficacy, anxiolytic effects, agitation, psychic anxiety, akathisia, adverse drug reactions, weight loss, dose adjustment
- MeSH terms
- Adult, Anxiety, Major Depressive Disorder, Dose-Response Relationship, Drug, Female, Fluoxetine, Humans, Male, Psychiatric Status Rating Scales, Severity of Illness Index, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Paroxetine
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