The selective serotonin reuptake inhibitor paroxetine has been extensively studied and is now an established therapy for the treatment of depressive disorders. Paroxetine has demonstrated efficacy in major depression in both young and elderly patients, with an improved tolerability profile over conventional antidepressants. Paroxetine is effective across a continuum of anxiety and depressive disorders, including severe depression, depression with anxiety, comorbid depression and obsessive-compulsive disorder. The first agent of its class licensed for use in panic disorder, paroxetine has been shown to be effective in reducing the number of panic attacks and preventing relapse. A worldwide clinical database has established that paroxetine has a benign adverse event profile. Paroxetine therefore offers an effective and well tolerated treatment for a broad spectrum of psychiatric disorders.

SummaryThe effect of paroxetine on symptoms of anxiety associated with depression were assessed by meta-analysis of data on the use of paroxetine (n = 2963), active control (n = 1151), and placebo (n = 554) in six-week clinical trials. Paroxetine significantly reduced psychic anxiety by comparison with placebo from week 1 and was more effective than active control from week 2. Paroxetine improved somatic anxiety from week 4 of treatment. There was no association between antidepressant therapy and the emergence of anxiety symptoms in patients with little or no baseline anxiety. Paroxetine resolved baseline symptoms of agitation from week 1 of treatment, and both paroxetine and active control prevented the emergence of agitation. There was no difference between placebo and antidepressant therapy in the frequency of adverse events indicative of increased arousal. The results indicate the utility of paroxetine in depressed patients presenting with associated anxiety symptoms.

In two studies using the dexamethasone suppression test (DST) to evaluate the efficacy of newer antidepressants in depressed outpatients, the authors found a DST nonsuppression rate of 13% (11 of 86 patients). Thirty-three of the DST suppressors received an antidepressant and 42 received placebo; the drug-treated group showed a significant therapeutic response. The low rate of DST nonsuppression in these depressed outpatients, a finding consistent with that of other investigators, does not confirm or refute reports that these patients are relatively resistant to placebo in comparison with active medication. The authors recommend that DST results not be used as selection criteria in studies assessing newer therapies for depressed outpatients.

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