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130-402: Paroxetine , sold under the brand name Paxil among others, is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is used to treat major depressive disorder , obsessive-compulsive disorder , panic disorder , social anxiety disorder , post-traumatic stress disorder , generalized anxiety disorder , and premenstrual dysphoric disorder . It has also been used in

260-452: A second-line treatment for adult obsessive–compulsive disorder (OCD) with mild functional impairment, and a first-line treatment for those with moderate or severe impairment. In children, SSRIs are considered as a second-line therapy in those with moderate-to-severe impairment, with close monitoring for psychiatric adverse effects. Sertraline and fluoxetine are effective in treating OCD for children and adolescents. Clomipramine ,

390-467: A 'hepatoxic agent' and has been associated with hepatoxicity and jaundice. Like other antidepressants, paroxetine may increase the risk of suicidal thinking and behaviour in people under the age of 25. The FDA conducted a statistical analysis of paroxetine clinical trials in children and adolescents in 2004 and found an increase in suicidality and ideation as compared to placebo, which was observed in trials for both depression and anxiety disorders. In 2015

520-538: A Glaxo spokesperson's statement that withdrawal reactions occur only in 0.2% of patients and are "mild and short-lived", the International Federation of Pharmaceutical Manufacturers Associations said GSK had breached two of the federation's codes of practice. Paroxetine prescribing information posted at GlaxoSmithKline has been updated related to the occurrence of a discontinuation syndrome, including serious discontinuation symptoms. Acute overdosage

650-436: A TCA drug, is considered effective and useful for OCD. However, it is used as a second-line treatment because it is less well-tolerated than SSRIs. Despite this, it has not shown superiority to fluvoxamine in trials. All SSRIs can be used effectively for OCD. SNRI use may also be attempted, though no SNRIs have been approved for the treatment of OCD. Despite these treatment options, many patients remain symptomatic after initiating

780-420: A few of these have ever been the object of empirical research. Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction , and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by

910-567: A lower incidence of diarrhea, but a higher incidence of anticholinergic effects (e.g., dry mouth, constipation, blurred vision, etc.), sedation/somnolence/drowsiness, sexual side effects, and weight gain. Due to reports of adverse withdrawal reactions upon terminating treatment, the Committee for Medicinal Products for Human Use at the European Medicines Agency recommends gradually reducing over several weeks or months if

1040-404: A mental health professional in the previous year. Several strategies are used in clinical practice to try to overcome these limits and variations. They include switching medication, augmentation, and combination. There is controversy amongst researchers regarding the efficacy and risk-benefit ratio of antidepressants. Although antidepressants consistently out-perform a placebo in meta-analyses,

1170-536: A new drug and staying on the old medication: although 34% of treatment-resistant people responded when switched to the new drug, 40% responded without being switched. For a partial response, the American Psychiatric Association (APA) guidelines suggest augmentation or adding a drug from a different class. These include lithium and thyroid augmentation, dopamine agonists , sex steroids , NRIs , glucocorticoid -specific agents, or

1300-489: A number of other SSRIs. Paroxetine is used in the treatment of obsessive-compulsive disorder. Comparative efficacy of paroxetine is equivalent to that of clomipramine and venlafaxine . Paroxetine is also effective for children with obsessive-compulsive disorder. Paroxetine is approved for treatment of PTSD in the United States, Japan, and Europe. In the United States, it is approved for short-term use. Paroxetine

1430-513: A paper published in The BMJ that reanalysed the original case notes argued that in Study 329 , assessing paroxetine and imipramine against placebo in adolescents with depression, the incidence of suicidal behavior had been under-reported and the efficacy exaggerated for paroxetine. Sexual dysfunction, including loss of libido , anorgasmia , lack of vaginal lubrication, and erectile dysfunction,

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1560-448: A pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH, but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment. Dhat syndrome is another condition which occurs in men: it

1690-612: A person suffering from loss of energy and enjoyment of life would take a norepinephrine–dopamine reuptake inhibitor . The UK National Institute for Health and Care Excellence (NICE)'s 2022 guidelines indicate that antidepressants should not be routinely used for the initial treatment of mild depression, "unless that is the person's preference". The guidelines recommended that antidepressant treatment be considered: The guidelines further note that in most cases, antidepressants should be used in combination with psychosocial interventions and should be continued for at least six months to reduce

1820-547: A phenomenon called publication bias or selective publication. Although this issue has diminished with time, it remains an obstacle to accurately assessing the efficacy of antidepressants. Misreporting of clinical trial outcomes and of serious adverse events, such as suicide, is common. Ghostwriting of antidepressant trials is widespread, a practice in which prominent researchers, or so-called key opinion leaders, attach their names to studies actually written by pharmaceutical company employees or consultants. A particular concern

1950-433: A placebo, while the other SNRIs are not considered particularly useful for this disorder as many of them did not undergo testing for it. As of 2008 , it is unclear if duloxetine and desvenlafaxine can provide benefits for people with social anxiety. However, another class of antidepressants called MAOIs are considered effective for social anxiety, but they come with many unwanted side effects and are rarely used. Phenelzine

2080-513: A potentially lethal hypertensive crisis . At lower doses, the person may only experience a headache due to an increase in blood pressure. In response to these adverse effects, a different type of MAOI, the class of reversible inhibitor of monoamine oxidase A (RIMA), has been developed. The primary advantage of RIMAs is that they do not require the person to follow a special diet while being purportedly effective as SSRIs and tricyclics in treating depressive disorders. Tricyclics and SSRI can cause

2210-671: A short follow up after termination of treatment; non-systematic recording of adverse effects; very strict exclusion criteria in samples of patients; studies being paid for by the industry; selective publication of results. This means that the small beneficial effects that are found may not be statistically significant. Among the 21 most commonly prescribed antidepressants, the most effective and well-tolerated are escitalopram , paroxetine , sertraline , agomelatine , and mirtazapine . For children and adolescents with moderate to severe depressive disorder, some evidence suggests fluoxetine (either with or without cognitive behavioral therapy )

2340-524: A statement that efficacy [in children] had not been demonstrated, as this would undermine the profile of paroxetine". In 2012, the United States Department of Justice fined GlaxoSmithKline $ 3 billion for withholding data, unlawfully promoting use in those under 18, and preparing an article that misleadingly reported the effects of paroxetine in adolescents with depression following its clinical trial study 329 . In February 2016,

2470-437: A tool that allows people to rate their concern about common side effects of antidepressants. The tool ranks potential treatment options in a visual display that highlights the drugs with side effects of least concern to an individual. SSRI use in pregnancy has been associated with a variety of risks with varying degrees of proof of causation. As depression is independently associated with negative pregnancy outcomes, determining

2600-441: A treatment for social anxiety disorder , but their efficacy is not entirely convincing, as only a small proportion of antidepressants showed some effectiveness for this condition. Paroxetine was the first drug to be FDA-approved for this disorder. Its efficacy is considered beneficial, although not everyone responds favorably to the drug. Sertraline and fluvoxamine extended-release were later approved for it as well, while escitalopram

2730-425: A type of physical therapy designed to restore the health and function of the pelvic floor and surrounding areas. Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include: the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis: The prevalence of sexual dysfunction in women

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2860-682: A vicious cycle that often leads to female sexual dysfunction. According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become "an illness that needs treatment" instead of viewing it as a natural part of the aging process. Not all cultures seek treatment; for example, a population of men living in Mexico often accept ED as a normal part of their maturing sexuality. Sexual problems are common with SSRIs, which can cause anorgasmia , erectile dysfunction , diminished libido , genital numbness, and sexual anhedonia (pleasureless orgasm). Poor sexual function

2990-723: Is a culture-bound syndrome which causes anxious and dysphoric mood after sex. It is distinct from the low-mood and concentration problems (acute aphasia) seen in POIS. Sexual pain disorders in women include dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by vaginal dryness . Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause , pregnancy , or breastfeeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex. It

3120-479: Is a common disorder in which the central feature is excessively worrying about numerous events. Key symptoms include excessive anxiety about events and issues going on around them and difficulty controlling worrisome thoughts that persists for at least 6 months. Antidepressants provide a modest to moderate reduction in anxiety in GAD. The efficacy of different antidepressants is similar. Some antidepressants are used as

3250-490: Is a common finding in waste water. It is highly toxic to the alga Pseudokirchneriella subcapitata (syn. Raphidocelis subcapitata ). Antidepressant Antidepressants are a class of medications used to treat major depressive disorder , anxiety disorders , chronic pain , and addiction . Common side effects of antidepressants include dry mouth , weight gain , dizziness , headaches , akathisia , sexual dysfunction , and emotional blunting . There

3380-405: Is a feeling of melancholy and anxiety after sexual intercourse that lasts for up to two hours. Sexual headaches occur in the skull and neck during sexual activity, including masturbation , arousal or orgasm. In men, POIS causes severe muscle pain throughout the body and other symptoms immediately following ejaculation . These symptoms last for up to a week. Some doctors speculate that

3510-529: Is a high treatment response heterogeneity. Some patients, that differ strongly in their response to antidepressants, could influence the average response, while the heterogeneity could itself be obscured by the averaging. Studies have not supported this hypothesis, but it is very difficult to measure treatment effect heterogeneity. Poor and complex clinical trial design might also account for the small effects seen for antidepressants. The randomized controlled trials used to approve drugs are short, and may not capture

3640-474: Is a relatively rare cause of erectile dysfunction. In individuals with testicular failure, as in Klinefelter syndrome , or those who have had radiation therapy , chemotherapy , or childhood exposure to the mumps virus , the testes may fail to produce testosterone. Other hormonal causes of erectile failure include brain tumors, hyperthyroidism , hypothyroidism , or adrenal gland disorders. Anorgasmia

3770-404: Is a reversible non-selective MAOI), or within 14 days of discontinuing treatment with an MAOI", and should not be used in combination with pimozide , thioridazine , tryptophan , or warfarin . Paroxetine interacts with the following cytochrome P450 enzymes: Paroxetine has been shown to be an inhibitor of G protein-coupled receptor kinase 2 (GRK2). Paroxetine is the most potent and one of

3900-501: Is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis . There are various underlying causes of ED, including damage to anatomical structures, psychological causes, medical disease, and drug use. Many of these causes are medically treatable. Psychological ED can often be treated by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage can be more difficult to treat. One leading physical cause of ED

4030-502: Is also FDA-approved for generalized anxiety disorder. In 2013, low-dose paroxetine was approved in the US for the treatment of moderate-to-severe vasomotor symptoms such as hot flashes and night sweats associated with menopause. At the low dose used for menopausal hot flashes, side effects are similar to placebo and dose tapering is not required for discontinuation. Studies have also shown paroxetine "appears to be well-tolerated and improve

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4160-406: Is also one of the most common reasons people stop the medication. In some cases, symptoms of sexual dysfunction may persist after discontinuation of SSRIs. This combination of symptoms is sometimes referred to as post-SSRI sexual dysfunction . Pelvic floor dysfunction can be an underlying cause of sexual dysfunction in both women and men, and is treatable by pelvic floor physical therapy ,

4290-464: Is an increased risk of suicidal thinking and behavior when taken by children, adolescents, and young adults. Discontinuation syndrome , which resembles recurrent depression in the case of the SSRI class, may occur after stopping the intake of any antidepressant, having effects which may be permanent and irreversible. Research regarding the effectiveness of antidepressants for depression in adults

4420-517: Is arbitrary, and that antidepressants consistently result in significantly raised scores on the mood item of the scale. Assessments of antidepressants using alternative, more sensitive scales, such as the MADRS , do not result in marked difference from the HDRS and likewise only find a marginal clinical benefit. Another hypothesis proposed to explain the poor performance of antidepressants in clinical trials

4550-510: Is classified as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75% of sexual encounters. The disorder can have physical, psychological, or pharmacological origins. SSRI antidepressants are a common pharmaceutical culprit, as they can delay orgasm or eliminate it entirely. A common physiological cause of anorgasmia is menopause ; one in three women report problems obtaining an orgasm during sexual stimulation following menopause. Premature ejaculation

4680-582: Is continual or severe damage taken to the nervi erigentes , which can prevent or delay erection. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries . Diseases are also common causes of erectile dysfunction. Diseases such as cardiovascular disease , multiple sclerosis , kidney failure , vascular disease , and spinal cord injury can cause erectile dysfunction. Cardiovascular disease can decrease blood flow to penile tissues, making it difficult to develop or maintain an erection. Due to

4810-483: Is controversial and has found both benefits and drawbacks. Meanwhile, evidence of benefit in children and adolescents is unclear, even though antidepressant use has considerably increased in children and adolescents in the 2000s. While a 2018 study found that the 21 most commonly prescribed antidepressant medications were slightly more effective than placebos for the short-term (acute) treatments of adults with major depressive disorder , other research has found that

4940-579: Is currently unclear which factors predict partial remission. However, it is clear that residual symptoms are powerful predictors of relapse, with relapse rates three to six times higher in people with residual symptoms than in those, who experience full remission. In addition, antidepressant drugs tend to lose efficacy throughout long-term maintenance therapy . According to data from the Centers for Disease Control and Prevention , less than one-third of Americans taking one antidepressant medication have seen

5070-428: Is especially common among people who have anxiety disorders . Ordinary anxiety can cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as panic disorder commonly cause avoidance of intercourse and premature ejaculation. Pain during intercourse is often a comorbidity of anxiety disorders among women. Physical factors that can lead to sexual dysfunctions include

5200-625: Is excreted in urine unchanged. Paroxetine is a mechanism-based inhibitor of CYP2D6 . Paroxetine was approved for medical use in the United States in 1992 and initially sold by GlaxoSmithKline . It is available as a generic medication . In 2022, it was the 92nd most commonly prescribed medication in the United States, with more than 7   million prescriptions. It is on the World Health Organization's List of Essential Medicines . GlaxoSmithKline has paid substantial fines, paid settlements in class-action lawsuits, and become

5330-418: Is important to normal sexual function in men and women. Dihydrotestosterone is the most prevalent androgen in both men and women. Testosterone levels in women at age 60 are on average about half of what they were before the women were 40. Although this decline is gradual for most women, those who have undergone bilateral oophorectomy experience a sudden drop in testosterone levels, as the ovaries produce 40% of

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5460-436: Is less clear. The hormonal changes that take place during the menopausal transition have been suggested to affect women's sexual response through several mechanisms, some more conclusive than others. Whether or not aging directly affects women's sexual functioning during menopause is controversial. However, many studies have demonstrated that aging has a powerful impact on sexual function and dysfunction in women, specifically in

5590-475: Is most common in young men and children. Individuals with sickle-cell disease and those who use certain medications can often develop this disorder. There are many factors which may result in a person experiencing a sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which include depression , sexual fears or guilt, past sexual trauma, and sexual disorders. Sexual dysfunction

5720-486: Is not recommended, while use during breastfeeding is relatively safe. Paroxetine shares many of the common adverse effects of SSRIs, including (with the corresponding rates seen in people treated with placebo in parentheses): Most of these adverse effects are transient and go away with continued treatment. Central and peripheral 5-HT 3 receptor stimulation is believed to result in the gastrointestinal effects observed with SSRI treatment. Compared to other SSRIs, it has

5850-414: Is not recommended, while use during breastfeeding is relatively safe. It is believed to work by blocking the reuptake of the chemical serotonin by neurons in the brain. Paroxetine was approved for medical use in the United States in 1992 and initially sold by GlaxoSmithKline . It is on the World Health Organization's List of Essential Medicines . It is available as a generic medication . In 2022, it

5980-403: Is not well known due to a paucity of epidemiological studies, inconsistent criteria for sexual dysfunction across different studies and incomplete recruitment, with studies often excluding women who were without a partner or who were sexually inactive. However, based on incomplete population based studies from the United States, Europe and Australia, unspecified arousal dysfunction (in which a woman

6110-581: Is often manifested by emesis , lethargy , ataxia , tachycardia , and seizures . Plasma, serum, or blood concentrations of paroxetine may be measured to monitor therapeutic administration, confirm a diagnosis of poisoning in hospitalized patients or to aid in the medicolegal investigation of fatalities. Plasma paroxetine concentrations are generally in a range of 40–400 μg/L in persons receiving daily therapeutic doses and 200–2,000 μg/L in poisoned patients. Postmortem blood levels have ranged from 1–4 mg/L in acute lethal overdose situations. Along with

6240-457: Is often selectively reported in trials of antidepressants. For children and adolescents, fluvoxamine is effective in treating a range of anxiety disorders. Fluoxetine, sertraline, and paroxetine can also help with managing various forms of anxiety in children and adolescents. Meta-analyses of published and unpublished trials have found that antidepressants have a placebo -subtracted effect size ( standardized mean difference or SMD) in

6370-419: Is one of the most commonly encountered adverse effects of treatment with paroxetine and other SSRIs. While early clinical trials suggested a relatively low rate of sexual dysfunction, more recent studies in which the investigator actively inquires about sexual problems suggest that the incidence is higher than 70%. Symptoms of sexual dysfunction have been reported to persist after discontinuing SSRIs, although this

6500-411: Is planned. Reviews of antidepressants generally find that they benefit adults with depression. On the other hand, some contend that most studies on antidepressant medication are confounded by several biases: the lack of an active placebo , which means that many people in the placebo arm of a double-blind study may deduce that they are not getting any true treatment, thus destroying double-blindness;

6630-652: Is significantly higher than what paroxetine and sertraline achieved. However, it did not address as many symptoms of PTSD as paroxetine and sertraline, in part due to the fact that venlafaxine is an SNRI . This class of drugs inhibits the reuptake of norepinephrine, which may cause anxiety in some patients. Fluvoxamine, escitalopram, and citalopram were not well-tested for this disorder. MAOIs , while some of them may be helpful, are not used much because of their unwanted side effects. This leaves paroxetine and sertraline as acceptable treatment options for some people, although more effective antidepressants are needed. Panic disorder

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6760-524: Is that the psychoactive effects of antidepressants may lead to the unblinding of participants or researchers, enhancing the placebo effect and biasing results. Some have therefore maintained that antidepressants may only be active placebos. When these and other flaws in the research literature are not taken into account, meta-analyses may find inflated results on the basis of poor evidence. Critics contend that antidepressants have not been proven sufficiently effective by RCTs or in clinical practice and that

6890-622: Is the best treatment, but more research is needed to be certain. Sertraline, escitalopram, and duloxetine may also help reduce symptoms. A 2023 systematic review and meta-analysis of randomized controlled trials of antidepressants for major depressive disorder found that the medications provided only small or doubtful benefits in terms of quality of life . Likewise, a 2022 systematic review and meta-analysis of randomized controlled trials of antidepressants for major depressive disorder in children and adolescents found small improvements in quality of life. Quality of life as an outcome measure

7020-486: Is the result of pharmaceutical advertising, research manipulation, and misinformation. Current mainstream psychiatric opinion recognizes the limitations of antidepressants but recommends their use in adults with more severe depression as a first-line treatment. The American Psychiatric Association 2000 Practice Guideline advises that where no response is achieved within the following six to eight weeks of treatment with an antidepressant, switch to an antidepressant in

7150-568: Is thought to be occasional. Antidepressant exposure (including paroxetine) is associated with shorter duration of pregnancy (by three days), increased risk of preterm delivery (by 55%), lower birth weight (by 75 g or 2.6 oz), and lower Apgar scores (by <0.4 points). The American College of Obstetricians and Gynecologists recommends that for pregnant women and women planning to become pregnant, paroxetine "be avoided, if possible", as it may be associated with increased risk of birth defects . Babies born to women who used paroxetine during

7280-420: Is to temporarily switch to fluoxetine , which has a longer half-life and thus decreases the severity of discontinuation syndrome. In 2002, the U.S. FDA published a warning regarding "severe" discontinuation symptoms among those terminating paroxetine treatment, including paraesthesia, nightmares, and dizziness. The agency also warned of case reports describing agitation, sweating, and nausea. In connection with

7410-551: Is treated relatively well with medications compared to other disorders. Several classes of antidepressants have shown efficacy for this disorder, with SSRIs and SNRIs used first-line. Paroxetine, sertraline, and fluoxetine are FDA-approved for panic disorder, while fluvoxamine, escitalopram, and citalopram are also considered effective for them. SNRI venlafaxine is also approved for this condition. Unlike social anxiety and PTSD , some TCAs antidepressants , like clomipramine and imipramine, have shown efficacy for panic disorder. Moreover,

7540-416: Is unable to achieve desirable genital or non-genital sexual arousal despite adequate stimulation and desire) was present in 3-9% of women aged 18-44, 5-7.5% aged 45-64 and 3-6% in women older than 65. Anorgasmia with distress (in which women were unable to achieve an orgasm) was present in 7-8% of women younger than 40, 5-7% aged 40-64 and 3-6% of those older than 65. Poor sexual self image leading to distress

7670-405: Is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse ) may play a role. Another female sexual pain disorder is vulvodynia , or vulvar vestibulitis when localized to the vulval vestibule . In this condition, women experience burning pain during sex, which seems to be related to problems with the skin in the vulvar and vaginal areas. Its cause

7800-470: Is unknown. In men, structural abnormalities of the penis like Peyronie's disease can make sexual intercourse difficult and/or painful. The disease is characterized by thick fibrous bands in the penis that lead to excessive curvature during erection. It has an incidence estimated at 0.4–3% or more, is most common in men 40–70, and has no certain cause. Risk factors include genetics, minor trauma (potentially during cystoscopy or transurethral resection of

7930-511: Is unknown; however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the National Institute of Health , but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and may be incorrectly diagnosed as such. There is no known cure or treatment. Erectile dysfunction (ED), or impotence,

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8060-435: Is used off-label with acceptable efficiency. However, there is not enough evidence to support Citalopram for treating social anxiety disorder, and fluoxetine was no better than a placebo in clinical trials. SSRIs are used as a first-line treatment for social anxiety, but they do not work for everyone. One alternative would be venlafaxine , an SNRI , which has shown benefits for social phobia in five clinical trials against

8190-643: Is usually correlated with other psychiatric issues, such as mood disorders, eating and anxiety disorders, and schizophrenia. Assessing performance anxiety, guilt , stress , and worry are integral to the optimal management of sexual dysfunction. Many of the sexual dysfunctions that are defined are based on the human sexual response cycle proposed by William H. Masters and Virginia E. Johnson , and modified by Helen Singer Kaplan . Sexual dysfunction can be classified into four categories: sexual desire disorders , arousal disorders , orgasm disorders , and pain disorders . Dysfunction among men and women are studied in

8320-456: Is when ejaculation occurs before the partner achieves orgasm, or a mutually satisfactory length of time has passed during intercourse. There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in under two minutes from the time of the insertion of the penis. For a diagnosis, the patient must have a chronic history of premature ejaculation, poor ejaculatory control, and

8450-684: The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders : lack of desire, lack of arousal, pain during intercourse, and lack of orgasm. For both men and women, these conditions can manifest themselves as an aversion to and avoidance of sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity. There may be physiological origins to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease and

8580-612: The MAOI phenelzine is also considered useful. Panic disorder has many drugs for its treatment. However, the starting dose must be lower than the one used for major depressive disorder because people have reported an increase in anxiety as a result of starting the medication. In conclusion, while panic disorder's treatment options seem acceptable and useful for this condition, many people are still symptomatic after treatment with residual symptoms. Antidepressants are recommended as an alternative or additional first step to self-help programs in

8710-512: The prefrontal cortex . Paroxetine is a phenylpiperidine and might have some affinity for opioid receptors. Paroxetine is well-absorbed following oral administration. It has an absolute bioavailability of about 50%, with evidence of a saturable first pass effect . When taken orally, it achieves maximum concentration in about 6–10 hours and reaches steady-state in 7–14 days. Paroxetine exhibits significant interindividual variations in volume of distribution and clearance. Less than 2% of an oral dose

8840-457: The 1990s and 2000s. Commercials also aired for the CR version of the drug beginning in 2003. In 2007, paroxetine was ranked 94th on the list of bestselling drugs , with over $ 1 billion in sales. In 2006, paroxetine was the fifth-most prescribed antidepressant in the U.S. retail market, with more than 19.7 million prescriptions. In 2007, sales had dropped slightly to 18.1 million but paroxetine remained

8970-627: The UK Competition and Markets Authority imposed record fines of £45 million on companies which were found to have infringed European Union and UK Competition law by entering into agreements to delay the market entry of generic versions of the drug in the UK. GlaxoSmithKline received the bulk of the fines, being fined £37,600,757. Other companies, which produce generics, were issued fines which collectively total £7,384,146. UK public health services are likely to claim damages for being overcharged in

9100-399: The United States for the treatment of panic disorder. Several studies have concluded that paroxetine is superior to placebo in the treatment of panic disorder. Paroxetine has demonstrated efficacy for the treatment of social anxiety disorder in adults and children. It is also beneficial for people with co-occurring social anxiety disorder and alcohol use disorder . It appears to be similar to

9230-495: The activity of the beta adrenergic receptor , which becomes desensitized in cases of heart failure , paroxetine (or a paroxetine derivative) could be used as a heart failure treatment in the future. Paroxetine has been identified as a potential disease-modifying osteoarthritis drug . Paroxetine may be useful in the treatment of canine or feline behavioral diagnoses and is effective in the treatment of social anxiety, depression, and agitation associated with depression. Paroxetine

9360-519: The areas of desire, sexual interest, and frequency of orgasm. The primary predictor of sexual response throughout menopause is prior sexual functioning, which means that it is important to understand how the physiological changes in men and women can affect sexual desire. Despite the apparent negative impact that menopause can have on sexuality and sexual functioning, sexual confidence and well-being can improve with age and menopausal status. Testosterone, along with its metabolite dihydrotestosterone ,

9490-478: The benefit of antidepressants for anxiety disorders is attributable to placebo responses rather than to the effects of the antidepressants themselves. Antidepressants are recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of generalized anxiety disorder (GAD) that has failed to respond to conservative measures such as education and self-help activities. GAD

9620-571: The condition is serious, it is not particularly common, generally only appearing at high doses or while on other medications. Assuming proper medical intervention has been taken (within about 24 hours) it is rarely fatal. Antidepressants appear to increase the risk of diabetes by about 1.3-fold. MAOIs tend to have pronounced (sometimes fatal) interactions with a wide variety of medications and over-the-counter drugs . If taken with foods that contain very high levels of tyramine (e.g., mature cheese, cured meats, or yeast extracts), they may cause

9750-399: The decision to withdraw is made. See also Discontinuation syndrome (withdrawal) . Mania or hypomania may occur in 1% of patients with depression and up to 12% of patients with bipolar disorder . This side effect can occur in individuals with no history of mania, but it may be more likely to occur in those with bipolar disorder or with a family history of mania. Paroxetine is described as

9880-474: The difference is modest and it is not clear that their statistical superiority results in clinical efficacy. The aggregate effect of antidepressants typically results in changes below the threshold of clinical significance on depression rating scales. Proponents of antidepressants counter that the most common scale, the HDRS , is not suitable for assessing drug action, that the threshold for clinical significance

10010-549: The effects of serotonergic psychedelics like psilocybin and lysergic acid diethylamide (LSD). Among individuals treated with a given antidepressant, between 30% and 50% do not show a response. Approximately one-third of people achieve a full remission , one-third experience a response, and one-third are non-responders. Partial remission is characterized by the presence of poorly defined residual symptoms. These symptoms typically include depressed mood, anxiety, sleep disturbance, fatigue, and diminished interest or pleasure. It

10140-424: The efficacy of combining modafinil for treatment-resistant people. It has been used to help combat SSRI-associated fatigue. The effects of antidepressants typically do not continue once the course of medication ends. This results in a high rate of relapse . In 2003, a meta-analysis found that 18% of people who had responded to an antidepressant relapsed while still taking it, compared to 41% whose antidepressant

10270-402: The efficacy of paroxetine in depression. They have variously concluded that paroxetine is superior or equivalent to placebo and that it is equivalent to other antidepressants. Despite this, there was no clear evidence that paroxetine was better or worse compared with other antidepressants at increasing response to treatment at any point in time. Paroxetine was the first antidepressant approved in

10400-816: The environment where sex occurs being uncomfortable, or an inability to concentrate on the sexual activity due to a bad mood or burdens from work. Other factors include physical discomfort or difficulty in achieving arousal, which could be caused by aging or changes in the body's condition. Sexual assault has been associated with excessive menstrual bleeding, genital burning, and painful intercourse (attributable to disease, injury, or otherwise), medically unexplained dysmenorrhea, menstrual irregularity, and lack of sexual pleasure. Physically violent assaults and those committed by strangers were most strongly related to reproductive symptoms. Multiple assaults, assaults accomplished by persuasion, spousal assault, and completed intercourse were most strongly related to sexual symptoms. Assault

10530-829: The evidence supporting this association is of low quality. Bupropion is used to help people stop smoking . Antidepressants are also used to control some symptoms of narcolepsy . Antidepressants may be used to relieve pain in people with active rheumatoid arthritis . However, further research is required. Antidepressants have been shown to be superior to placebo in treating depression in individuals with physical illness, although reporting bias may have exaggerated this finding. Antidepressants have been shown to improve some parts of cognitive functioning for depressed users, such as memory, attention, and processing speed. Certain antidepressants acting as serotonin 5-HT 2A receptor antagonists, such as trazodone and mirtazapine , have been used as hallucinogen antidotes or "trip killers" to block

10660-449: The extent to which observed associations between antidepressant use and specific adverse outcomes reflect a causative relationship has been difficult in some cases. In other cases, the attribution of adverse outcomes to antidepressant exposure seems fairly clear. Sexual dysfunction A thorough sexual history and assessment of general health and other sexual problems (if any) are important when assessing sexual dysfunction, because it

10790-463: The failure of various organ systems (such as the heart and lungs), endocrine disorders ( thyroid , pituitary , or adrenal gland problems), hormonal deficiencies (low testosterone , other androgens , or estrogen ), and some birth defects . In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for

10920-406: The fields of andrology and gynecology respectively. Sexual desire disorders or decreased libido are characterized by a lack of sexual desire , libido for sexual activity , or sexual fantasies for some time. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may start after a period of normal sexual functioning, or

11050-407: The fifth-most prescribed antidepressant in the U.S. Brand names include Aropax, Paretin, Brisdelle, Deroxat, Paxil, Pexeva, Paxtine, Paxetin, Paroxat, Paraxyl, Sereupin, Daparox and Seroxat. Several studies have suggested that paroxetine can be used in the treatment of premature ejaculation . In particular, intravaginal ejaculation latency time (IELT) was found to increase with 6- to 13-fold, which

11180-595: The first trimester have an increased risk of cardiovascular malformations, primarily ventricular and atrial septal defects. Unless the benefits of paroxetine justify continuing treatment, consideration should be given to stopping or switching to another antidepressant. Paroxetine use during pregnancy is associated with about 1.5– to 1.7-fold increase in congenital birth defects, in particular, heart defects, cleft lip and palate, clubbed feet, or any birth defects. Many psychoactive medications can cause withdrawal symptoms upon discontinuation from administration. Paroxetine has among

11310-413: The frequency of POIS "in the population may be greater than has been reported in the academic literature", and that many with POIS are undiagnosed. POIS may involve adrenergic symptoms: rapid breathing, paresthesia , palpitations , headaches , aphasia , nausea , itchy eyes, fever , muscle pain and weakness , and fatigue . The etiology of this condition is unknown; however, it is believed to be

11440-537: The full effect of antidepressants. Additionally, the placebo effect might be inflated in these trials by frequent clinical consultation, lowering the comparative performance of antidepressants. Critics agree that current clinical trials are poorly-designed, which limits the knowledge on antidepressants. More naturalistic studies, such as STAR*D , have produced results, which suggest that antidepressants may be less effective in clinical practice than in randomized controlled trials. Critics of antidepressants maintain that

11570-475: The highest incidence rates and severity of withdrawal syndrome of any medication of its class. Common withdrawal symptoms for paroxetine include nausea, dizziness, lightheadedness and vertigo; insomnia, nightmares and vivid dreams; feelings of electricity in the body, as well as rebound depression and anxiety. Liquid formulation of paroxetine is available and allows a very gradual decrease of the dose, which may prevent discontinuation syndrome. Another recommendation

11700-434: The idea that low serotonin levels cause depression is not supported by scientific evidence. Proponents of the monoamine hypothesis of depression recommend choosing an antidepressant which impacts the most prominent symptoms. Under this practice, for example, a person with MDD who is also anxious or irritable would be treated with selective serotonin reuptake inhibitors (SSRIs) or norepinephrine reuptake inhibitors , while

11830-456: The male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and atrophy . If a woman does not participate in sexual activity regularly (in particular, activities involving vaginal penetration), she will not be able to immediately accommodate a penis without risking pain or injury if she decides to engage in penetrative intercourse. This can turn into

11960-501: The medication, and less than half achieve remission . Placebo responses are a large component of the benefit of antidepressants in the treatment of depression and anxiety. However, placebo responses with antidepressants are lower in magnitude in the treatment of OCD compared to depression and anxiety. A 2019 meta-analysis found placebo improvement effect sizes (SMD) of about 1.2 for depression, 1.0 for anxiety disorders, and 0.6 for OCD with antidepressants. Antidepressants are one of

12090-481: The most effective class, with moderate effects on pain and sleep, and small effects on fatigue and health-related quality of life. The fraction of people experiencing a 30% pain reduction on tricyclics was 48%, versus 28% on placebo. For SSRIs and SNRIs, the fractions of people experiencing a 30% pain reduction were 36% (20% in the placebo comparator arms) and 42% (32% in the corresponding placebo comparator arms) respectively. Discontinuation of treatment due to side effects

12220-564: The most optimistic about menopausal life; Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic. Since these women have sexual problems, their sexual lives with their partners can become a burden without pleasure, and may eventually lose complete interest in sexual activity. Some of the women found it hard to be aroused mentally, while others had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners,

12350-492: The most specific selective serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitors (SSRIs). It also binds to the allosteric site of the serotonin transporter, similarly to escitalopram , though less potently so. Paroxetine also inhibits the reuptake of norepinephrine to a lesser extent (<50 nmol/L). Based on evidence from four weeks of administration in rats, the equivalent of 20 mg paroxetine taken once daily occupies approximately 88% of serotonin transporters in

12480-405: The newer anticonvulsants . A combination strategy involves adding another antidepressant, usually from a different class to affect other mechanisms. Although this may be used in clinical practice, there is little evidence for the relative efficacy or adverse effects of this strategy. Other tests conducted include the use of psychostimulants as an augmentation therapy. Several studies have shown

12610-414: The newsworthiness of stories about it and heavy advertising . It is estimated that around 30 million men in the United States and 152 million men worldwide have erectile dysfunction. However, social stigma , low health literacy , and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine. The Latin term impotentia coeundi describes the inability to insert

12740-641: The other SSRIs, sertraline and fluoxetine , paroxetine is considered a low-risk drug in cases of overdose. Interactions with other drugs acting on the serotonin system or impairing the metabolism of serotonin may increase the risk of serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reaction. Such reactions have been observed with SNRIs and SSRIs alone, but particularly with concurrent use of triptans , MAO inhibitors , antipsychotics, or other dopamine antagonists. The prescribing information states that paroxetine should "not be used in combination with an MAOI (including linezolid, an antibiotic which

12870-497: The overall symptomatology in patients with fibromyalgia", but is less robust in helping with the pain involved. Common side effects include drowsiness, dry mouth, loss of appetite, sweating, insomnia, and sexual dysfunction . Serious side effects may include suicide in those under the age of 25, serotonin syndrome , and mania . While the rate of side effects appears similar compared to other SSRIs and SNRIs, antidepressant discontinuation syndromes may occur more often. Use in pregnancy

13000-434: The partners' relationship can also contribute to dysfunction. Additionally, postorgasmic illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation: rapid breathing, paresthesia , palpitations, headaches, aphasia , nausea, itchy eyes, fever, muscle pain and weakness, and fatigue. From the onset of arousal, symptoms can persist for up to a week in patients. The cause of this condition

13130-633: The penis into the vagina , and has been mostly replaced by more precise terms. ED from vascular disease is seen mainly amongst older individuals who have atherosclerosis . Vascular disease is common in individuals who smoke or have diabetes , peripheral vascular disease , or hypertension . Any time blood flow to the penis is impaired, ED can occur. Drugs are also a cause of erectile dysfunction. Individuals who take drugs that lower blood pressure , antipsychotics , antidepressants , sedatives, narcotics, antacids, or alcohol can have problems with sexual function and loss of libido. Hormone deficiency

13260-522: The period where the generic versions of the drug were illegally blocked from the market, as the generics are over 70% less expensive. GlaxoSmithKline may also face actions from other generics manufacturers who incurred loss as a result of the anticompetitive conduct. In April 2016, appeals were lodged with the Competition Appeal Tribunal by the companies which were fined. GSK marketed paroxetine through television advertisements in

13390-421: The person may always have had an absence or a lesser intensity of sexual desire. The causes vary considerably but include a decrease in the production of normal estrogen in women, or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs ), or psychiatric conditions, such as depression and anxiety . While many causes of low sexual desire are cited, only

13520-664: The placebo effect may account for most or all of the drugs' observed efficacy. Research on the effectiveness of antidepressants is generally done on people who have severe symptoms, a population that exhibits much weaker placebo responses, meaning that the results may not be extrapolated to the general population that has not (or has not yet) been diagnosed with anxiety or depression. Antidepressants are prescribed to treat major depressive disorder (MDD), anxiety disorders , chronic pain , and some addictions. Antidepressants are often used in combination with one another. Despite its longstanding prominence in pharmaceutical advertising,

13650-440: The problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both. Premature ejaculation has historically been attributed to psychological causes, but newer theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation. Post-orgasmic disorders cause symptoms shortly after orgasm or ejaculation . Post-coital tristesse (PCT)

13780-412: The prostate ), chronic systemic vascular diseases, smoking, and alcohol consumption. Priapism is a painful erection that occurs for several hours and occurs in the absence of sexual stimulation . This condition develops when blood is trapped in the penis and is unable to drain. If the condition is not promptly treated, it can lead to severe scarring and permanent loss of erectile function. The disorder

13910-433: The risk for relapse . Antidepressants can cause various adverse effects , depending on the individual and the drug in question. Almost any medication involved with serotonin regulation has the potential to cause serotonin toxicity (also known as serotonin syndrome ) – an excess of serotonin that can induce mania, restlessness, agitation, emotional lability , insomnia, and confusion as its primary symptoms. Although

14040-709: The risk of relapse and that SSRIs are typically better tolerated than other antidepressants. American Psychiatric Association (APA) treatment guidelines recommend that initial treatment be individually tailored based on factors including the severity of symptoms, co-existing disorders, prior treatment experience, and the person's preference. Options may include antidepressants, psychotherapy , electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or light therapy . The APA recommends antidepressant medication as an initial treatment choice in people with mild, moderate, or severe major depression, and that should be given to all people with severe depression unless ECT

14170-459: The same class, and then to a different class. A 2006 meta-analysis review found wide variation in the findings of prior studies: for people who had failed to respond to an SSRI antidepressant, between 12% and 86% showed a response to a new drug. However, the more antidepressants an individual had previously tried, the less likely they were to benefit from a new antidepressant trial. However, a later meta-analysis found no difference between switching to

14300-431: The shame and embarrassment felt by some with erectile dysfunction, the subject was taboo for a long time and is the focus of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by

14430-446: The so-called drug-induced QT prolongation , especially in older adults; this condition can degenerate into a specific type of abnormal heart rhythm called Torsades de points , which can potentially lead to sudden cardiac arrest . Some antidepressants are also believed to increase thoughts of suicidal ideation . Antidepressants have been associated with an increased risk of dementia in older adults. Researchers have developed

14560-636: The subject of several highly critical books about its marketing of paroxetine, in particular the off-label marketing of paroxetine for children, the suppression of negative research results relating to its use in children, and allegations that it failed to warn consumers of substantial withdrawal effects associated with use of the drug. In 2004, GSK agreed to settle charges of consumer fraud for $ 2.5 million. The legal discovery process also uncovered evidence of deliberate, systematic suppression of unfavorable Paxil research results. One of GSK's internal documents read, "It would be commercially unacceptable to include

14690-591: The superiority of antidepressants over placebo is the result of systemic flaws in clinical trials and the research literature. Trials conducted with industry involvement tend to produce more favorable results, and accordingly many of the trials included in meta-analyses are at high risk of bias. Additionally, meta-analyses co-authored by industry employees find more favorable results for antidepressants. The results of antidepressant trials are significantly more likely to be published if they are favorable, and unfavorable results are very often left unpublished or misreported,

14820-610: The treatment of bulimia nervosa . SSRIs (fluoxetine in particular) are preferred over other antidepressants due to their acceptability, tolerability, and superior reduction of symptoms in short-term trials. Long-term efficacy remains poorly characterized. Bupropion is not recommended for the treatment of eating disorders, due to an increased risk of seizure. Similar recommendations apply to binge eating disorder . SSRIs provide short-term reductions in binge eating behavior, but have not been associated with significant weight loss. Clinical trials have generated mostly negative results for

14950-519: The treatment of compulsive gambling and hot flashes . Benefits of paroxetine prescription for diabetic neuropathy or chronic tension headache are uncertain. Although the evidence is conflicting, paroxetine may be effective for the treatment of dysthymia , a chronic disorder involving depressive symptoms for most days of the year. There is evidence to support that paroxetine selectively binds to and inhibits G protein-coupled receptor kinase 2 (GRK2) in mice with heart failure. Since GRK2 regulates

15080-605: The treatment of neuropathic pain and found limited useful randomized clinical trial data. They concluded that the long history of successful use in the community for the treatment of fibromyalgia and neuropathic pain justified its continued use. The group was concerned about the potential overestimation of the amount of pain relief provided by amitriptyline, and highlighted that only a small number of people will experience significant pain relief by taking this medication. Antidepressants may be modestly helpful for treating people who have both depression and alcohol dependence , however,

15210-519: The treatment of premature ejaculation and hot flashes due to menopause . It is taken orally (by mouth). Common side effects include drowsiness, dry mouth, loss of appetite, sweating, trouble sleeping , and sexual dysfunction . Serious side effects may include suicidal thoughts in those under the age of 25, serotonin syndrome , and mania . While the rate of side effects appears similar compared to other SSRIs and SNRIs, antidepressant discontinuation syndromes may occur more often. Use in pregnancy

15340-407: The treatment of anxiety disorders of around 0.3, which equates to a small improvement and is roughly the same magnitude of benefit as their effectiveness in the treatment of depression. The effect size (SMD) for improvement with placebo in trials of antidepressants for anxiety disorders is approximately 1.0, which is a large improvement in terms of effect size definitions. In relation to this, most of

15470-485: The treatment options for PTSD . However, their efficacy is not well established. Paroxetine and sertraline have been FDA approved for the treatment of PTSD. Paroxetine has slightly higher response and remission rates than sertraline for this condition. However, neither drug is considered very helpful for a broad patient demographic. Fluoxetine and venlafaxine are used off-label. Fluoxetine has produced unsatisfactory mixed results. Venlafaxine showed response rates of 78%, which

15600-613: The use of SSRIs in the treatment of anorexia nervosa . Treatment guidelines from the National Institute of Health and Care Excellence (NICE) recommend against the use of SSRIs in this disorder. Those from the American Psychiatric Association (APA) note that SSRIs confer no advantage regarding weight gain, but may be used for the treatment of co-existing depressive, anxiety, or obsessive–compulsive disorders. A 2012 meta-analysis concluded that antidepressant treatment favorably affects pain, health-related quality of life, depression, and sleep in fibromyalgia syndrome. Tricyclics appear to be

15730-675: The use of drugs, such as alcohol, nicotine , narcotics , stimulants, antihypertensives , antihistamines , and some psychotherapeutic drugs. For women, almost any physiological change that affects the reproductive system— premenstrual syndrome , pregnancy and the postpartum period, and menopause—can have an adverse effect on libido. Back injuries may also impact sexual activity, as can problems with an enlarged prostate gland, problems with blood supply, or nerve damage (as in sexual dysfunction after spinal cord injuries ). Diseases such as diabetic neuropathy , multiple sclerosis , tumors , and, rarely, tertiary syphilis may also impact activity, as can

15860-450: The widespread use of antidepressants is not evidence-based. They also note that adverse effects, including withdrawal difficulties, are likely underreported, skewing clinicians' ability to make risk-benefit judgements. Accordingly, they believe antidepressants are overused, particularly for non-severe depression and conditions in which they are not indicated. Critics charge that the widespread use and public acceptance of antidepressants

15990-405: Was associated with sexual indifference only among Latinas. The most prevalent of female sexual dysfunctions that have been linked to menopause include lack of desire and libido; these are predominantly associated with hormonal physiology. Specifically, the decline in serum estrogens causes these changes in sexual functioning. Androgen depletion may also play a role, but current knowledge about this

16120-645: Was common. Antidepressants including amitriptyline , fluoxetine, duloxetine, milnacipran , moclobemide , and pirlindole are recommended by the European League Against Rheumatism (EULAR) for the treatment of fibromyalgia based on "limited evidence". A 2014 meta-analysis from the Cochrane Collaboration found the antidepressant duloxetine to be effective for the treatment of pain resulting from diabetic neuropathy . The same group reviewed data for amitriptyline in

16250-399: Was occasionally associated more strongly with reproductive symptoms among women with lower income or less education, possibly because of economic stress or differences in assault circumstances. Associations with unexplained menstrual irregularity were strongest among African American women; ethnic differences in reported circumstances of assault appeared to account for these differences. Assault

16380-756: Was seen in 13.4% of women younger than 40 in an Australian population based study. The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity. Several factors influence a women's perception of her sexual life. These can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion. Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study found that African American women are

16510-510: Was shown to be a good treatment option, but its use is limited by dietary restrictions. Moclobemide is a RIMA and showed mixed results, but still received approval in some European countries for social anxiety disorder. TCA antidepressants , such as clomipramine and imipramine , are not considered effective for this anxiety disorder in particular. This leaves out SSRIs such as paroxetine, sertraline, and fluvoxamine CR as acceptable and tolerated treatment options for this disorder. SSRIs are

16640-435: Was somewhat longer than the delay achieved by the treatment with other SSRIs (fluvoxamine, fluoxetine, sertraline, and citalopram). However, paroxetine taken acutely ("on demand") 3–10 hours before coitus resulted only in a "clinically irrelevant and sexually unsatisfactory" 1.5-fold delay of ejaculation and was inferior to clomipramine , which induced a fourfold delay. There is also evidence that paroxetine may be effective in

16770-536: Was switched for a placebo . A gradual loss of therapeutic benefit occurs in a minority of people during the course of treatment. A strategy involving the use of pharmacotherapy in the treatment of the acute episode, followed by psychotherapy in its residual phase, has been suggested by some studies. For patients who wish to stop their antidepressants, engaging in brief psychological interventions such as Preventive Cognitive Therapy or mindfulness-based cognitive therapy while tapering down has been found to diminish

16900-597: Was the 92nd most commonly prescribed medication in the United States, with more than 7   million prescriptions. In 2018, it was in the top 10 of most prescribed antidepressants in the United States. Paroxetine is primarily used to treat major depressive disorder , obsessive-compulsive disorder , post-traumatic stress disorder , social anxiety disorder , and panic disorder . It is also occasionally used for agoraphobia , generalized anxiety disorder , premenstrual dysphoric disorder , and menopausal hot flashes . A variety of meta-analyses have been conducted to evaluate

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