Paroxetine: the "anti-shyness drug".

A psychopharmaceutical with a controversial application: to make shy people stop being shy.

Paroxetine is an oral drug designed to combat depression. designed to combat depression. Technically, it is a selective serotonin reuptake inhibitor (SSRI), a neurotransmitter involved in generating positive moods; however, paroxetine is better known for a very different reason.

Because of its history, it was popularized to treat a kind of anxiety known as social anxiety disorder or social phobia, which at the time was interpreted as a sign of extreme shyness, and for this reason it is known as the anti-shyness drug.

The history of paroxetine

Paroxetine was launched on the market in 1992 by the US pharmaceutical giant by the U.S. pharmaceutical giant GlaxoSmithKline (GSK) under the trade name Paxil. Its sales were much lower compared to other Antidepressant drugs such as Prozac or Zoloft, so the company engineered a powerful advertising campaign in 1999 to change this.

The advertising focused on a different use for paroxetine. The company took it upon itself to publicize a new type of anxiety that was just beginning to be studied, known as social anxiety disorder, which they associated with those people who had been diagnosed with social anxiety disorder.which they associated with people who exhibit shyness. All this, because their drug was the only one on the market that was clinically proven to treat this kind of anxiety.

Thanks to this, their sales improved compared to previous years; transforming paroxetine into the "anti-starvation" drug proved to be very profitable..

The controversy of the advertising campaign

Today we know that social phobia is generated in shy people, but not all shy people have this kind of anxiety. Shyness is not a disorderIt is a personality trait, and can be overcome by following some guidelines, without any need for medication.

The controversy of the story has to do basically with the advertising campaign of paroxetine, which incites the debate on how far the pharmaceutical industry is capable of making profits from its products, in this case "popularizing" an anxiety disorder that was beginning to be studied at the time, in its eagerness to overcome the competition... and despite the fact that this could lead to confusion and stigmatization of people who are shy because of their personality..

The mechanism of action

Paroxetine is an antidepressant drug that acts on the serotonin reuptake receptors, preventing their function to prolong the presence of the neurotransmitter in the synaptic space where it is released. In depression it has been seen that there are low levels of serotonin, a substance involved in the generation of positive moods.Therefore, by maintaining the little serotonin released, it helps to prolong its effects.

Furthermore, in in vitro studies in rat brains, it was observed that the effect of paroxetine is several times greater than that of sertraline (Zoloft) and significantly greater than that of sertraline (Zoloft). is several times greater than that of sertraline (Zoloft) and significantly more potent than fluoxetine (Prozac)..

Pharmacokinetics of the psychotropic drug

Paroxetine is administered orally in tablet, suspension (liquid) or capsule form, with complete absorption by our digestive system. Within the body, it is widely distributed in the organism, including the CNS (it can pass the blood-brain barrier), where it will it will bind to the serotonin receptor receptors of the neurons..

The half-life of the drug in the body of an adult is 21 hours, a time that must be taken into account due to its interactions with other drugs. Paroxetine is metabolized in the liver into various metabolites, none of which have been found to have any effect on the body, i.e. they are harmless.

It leaves the body mainly through the kidneys (62%) in the urine, and the rest is excreted in the feces in the form of bile. For these reasons, as is the case with many drugs, it is not advisable to be treated with this drug if you suffer from hepatic or renal insufficiency..

Therapeutic indications

Paroxetine is indicated mainly to treat episodes of major depression, especially when other SSRI antidepressants have not been effective, since this drug has been found to be more potent than others in its class. Other treatment uses are in the following cases:

• Obsessive-compulsive disorder.
• Anxiety disorder with or without agoraphobia.
• Social anxiety disorder or social phobia.
• Panic disorder.
• Post Traumatic Stress Disorder.

Also There is also a variety of paroxetine capsules, under the trade name Brisdellewhich is used as a non-hormonal remedy to treat hot flashes in women who are going through menopause. In the latter case, the mechanism used by the drug to prevent hot flashes is not known.

Side effects of paroxetine

Treatment with paroxetine can produce adverse reactions, like the vast majority of drugs. Being a substance that works on such an important messenger as serotonin, its list of side effects is quite long, its list of side effects is quite long:

• Increased cholesterol levels, decreased appetite.
• Drowsiness, insomnia, aggressiveness, abnormal dreams.
• Decreased concentration, dizziness, tremors, headache.
• Blurred vision.
• Nausea, constipation, diarrhea, dry mouth.
• Sweating.
• Sexual dysfunction.
• Asthenia, weight gain.

It should be noted that during clinical trials of this drug, it was observed that in short-term trials in children and adolescents, suicidal, self-injurious and hostile behavior increased. suicidal, self-injurious and hostile behavior was increased.It is therefore not recommended for these age groups.

Contraindications

The main contraindication of paroxetine (like the other SSRIs) has to do with not taking it together with another antidepressant drug of the Monoamine Oxidase Inhibitor (MAOI) type.

The reason for this is because serotonin is degraded by the enzyme monoamine oxidase A. If the enzyme is deactivated, serotonin concentrations increase and can lead to serotonin syndrome, a clinical condition that can be fatal. For this reason, it is always necessary to wait a period between treatment with MAOIs and SSRIs.

Another contraindication of paroxetine is to take it together with other tricyclic antidepressants, since the drug inhibits the liver enzyme that eliminates tricyclic antidepressants from the body.The drug inhibits the hepatic enzyme responsible for eliminating tricyclic antidepressants from the body. The effects of paroxetine on this enzyme can last up to a week after cessation of treatment, so extreme care must be taken when changing medications. The main adverse effect of this interaction is a symptom of toxicity, although in some cases sudden death has occurred.

Paroxetine is also not recommended in people who are hypersensitive to it, as well as if they have a history of mania. This is because all antidepressants can transform depression into mania in people predisposed to it.

In addition, treatment with this drug is strictly forbidden in pregnant women.It has been seen to generate malformations in the cardiovascular system of fetuses in their first months of development or various problems in neonates if paroxetine was administered during the last months of pregnancy. As regards breastfeeding, in principle its excretion through milk is minimal, but the child should be observed for safety.

Finally, the use of paroxetine may cause drowsiness or dizziness. can cause drowsiness or dizzinessAs we have seen, it is therefore not recommended to perform potentially dangerous activities, such as driving or operating heavy machinery.

Paroxetine and shyness

Paroxetine is an antidepressant that as part of a marketing campaign was popularized for use to help with the social anxiety disorder that some shy people suffer from, although it appears to have been extended for use in overcoming shyness. Among the medical community, there is a debate as to whether or not it really works..

Doctors opposed to the use of drugs to treat this type of anxiety argue that the current treatments do not generate any real change in the patient, i.e., that after the cessation of medication the anxiety returns. A rebound effect has even been observed, increasing even more the anxiety they suffer when trying to socialize.

Other arguments on which they are based include the lack of knowledge of the long-term effects of the current drugs used for this purpose, as they are used for this purpose, as they are relatively new. In addition, the long list of known side effects generated by paroxetine causes concern.