Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM:
Paroxetine is an oral drug that is used for treating depression. It is in a
class of drugs called selective serotonin reuptake inhibitors (SSRIs), a class
that also contains fluoxetine (Prozac),
citalopram (Celexa), and sertraline
(Zoloft). Paroxetine affects neurotransmitters, the chemicals that nerves within
the brain use to communicate
with each other. Neurotransmitters are manufactured and released by nerves and
then travel and attach to nearby nerves. Thus, neurotransmitters can be thought
of as the communication system of the brain. Serotonin is one neurotransmitter
that is released by nerves in the brain. The serotonin either travels across the
space that lies between nerves and attaches to receptors on the surface of
nearby nerves or it attaches to receptors on the surface of the nerve that
produced it, to be taken up by the nerve and released again (a process referred
to as re-uptake).
Many experts believe that an imbalance among
neurotransmitters is the cause of depression. Paroxetine works by preventing the
reuptake of one neurotransmitter, serotonin, by nerve cells after it has been
released. Since reuptake is an important mechanism for removing released
neurotransmitters and terminating their actions on adjacent nerves, the reduced
uptake caused by paroxetine increases free serotonin that stimulates nerve cells
in the brain. The FDA approved paroxetine in December 1992.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 10, 20, 30, and 40 mg; Paxil CR Tablets: 12.5,
25, and 37.5 mg; Suspension: 10 mg/5ml
STORAGE: Tablets should be kept at room temperature, 59-86 F (15- 30 C). The suspension and controlled release tablets should be stored at or
below 77 F (25 C).
DOSING: The recommended dose
is 20-60 mg daily of immediate release tablets or 12.5-75 mg daily using
controlled release tablets. Paroxetine is given as a single daily dose, usually
in the morning. As with all anti-depressants, the full effect may not occur
until after a few weeks of therapy. Doses for obsessive-compulsive disorders and panic disorders are often
higher than those for depression. Doses often are adjusted to find the optimal
dose. Elderly patients, debilitated persons, and patients with certain kidney or
liver diseases may need lower doses because they metabolize and eliminate
paroxetine more slowly and, therefore, are prone to develop high blood levels
and toxicity.
DRUG INTERACTIONS: All
SSRIs, including paroxetine, should not be taken with any of the monoamine
oxidase inhibitor (MAOI) class of antidepressants, for example, isocarboxazid
(Marplan), phenelzine (Nardil), tranylcypromine (Parnate),
selegiline
(Eldepryl, Carbex), and procarbazine (Matulane) or other drugs that inhibit monoamine
oxidase, for example, linezolid (Zyvox). Such combinations may lead to confusion,
high
blood pressure, tremor, hyperactivity, coma,
and death. (A period of 14 days without treatment should lapse when switching
between paroxetine and MAOIs.) Similar reactions occur when paroxetine is
combined with other drugs [for example,
tryptophan,
St. John's wort,
meperidine (Demerol),
tramadol (Ultram) that increase serotonin in the brain.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizzyness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Obsessive compulsive disorder (OCD) is an anxiety disorder that causes a person to suffer repeated obsessions and compulsions. Symptoms include irresistible impulses despite a person's realization that the thoughts are irrational, excessive hand washing, skin picking, lock checking, or repeatedly rearranging items. People with OCD are more likely to develop trichotillomania, muscle or vocal tics, or an eating disorder. Treatment for OCD includes psychotherapy, behavioral therapy, and medication.
Premenstrual syndrome (PMS) is a combination of physical and emotional disturbances that occur after a woman ovulates and ends with menstruation. Common PMS symptoms include depression, irritability, crying, oversensitivity, and mood swings. For some women PMS symptoms can be controlled with medications and lifestyle changes such as exercise, nutrition, and a family and friend support system.
Agoraphobia is a fear of being outside or of being in a situation from which escape would be impossible. Symptoms include anxiety, fear, disorientation, rapid heartbeat, diarrhea, or dizziness. Treatment may incorporate psychotherapy, self-exposure to the anxiety-causing situation, and medications such as SSRIs, benzodiazepines, and beta blockers.
Seasonal affective disorder is a type of depression that tends to occur as the days grow shorter in the fall and winter. Symptoms of seasonal affective disorder include tiredness, fatigue, depression, irritability, body aches, poor sleep and overeating.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Separation anxiety disorder is a common childhood anxiety disorder that has many causes. Infants, children, older kids and adults can suffer from symptoms of separation anxiety disorder. Common treatment methods include therapy and medications.
Premenstrual dysphoric disorder (PMDD) is considered to be a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include: mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, hot flashes and more. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Narcolepsy, a chronic disease of the central nervous system causes have not been fully determined. Some theories include abnormalities in hypocretin neurons in the brain or an autoimmune disorder. Symptoms of narcolepsy include excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, sleep paralysis, disturbed nocturnal sleep, and automatic behavior. Diagnosis of narcolepsy is based on a clinical evaluation, specific questionnaires, sleep logs or diaries, and the results of sleep laboratory tests. Treatments of narcolepsy symptoms include medication and lifestyle changes.
Dysthymia is a less severe form of chronic depression. Symptoms and signs include insomnia, suicidal thoughts, guilt, empty feeling, loss of energy, helplessness, sluggishness, and persistent aches and pains. Treatment may involve psychotherapy, electroconvulsive therapy, and antidepressants.
Though the holidays are a fun time for most, for others, they're a sad, lonely and anxiety-filled time. Get tips on how to avoid depression and stress during the holiday season.
Body dysmorphic disorder (BDD) is an illness where a person is overly preoccupied with some minor or imaginary flaw. People with BDD tend to have cosmetic surgery. BDD can be treated with SSRIs and cognitive behavioral therapy.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Bipolar disorder, also called manic depression, is a mental illness that is characterized by severe mood swings, repeated episodes of depression, and at least one episode of mania. Bipolar disorder is one kind of mood disorder that afflicts more than
1% of adults in the United States, up to as many as 4 million people. Here are
some additional statistics about bipolar disorder:
Bipolar disorder is the fifth leading cause of disability worldwide.
Bipolar disorder is the ninth leading cause of years lost to death or disability worldwide.
The number of individuals with bipolar disorder who commit suicide is 60 times higher than that of the general population.
People who have bipolar disorder are at a higher risk of also suffering from substance abuse and other mental health problems.
Males may develop bipolar disorder earlier in life compared to females.