Antidepressant medications belong to a number of different subclasses of drugs that have the primary use of addressing the symptoms of major depressive disorder. A number of these medications also have other uses, such as being prescribed along with other medications to treat issues with anxiety, chronic pain, eating disorders, obsessive-compulsive disorders, personality disorders, and other disorders. In addition, a number of other medications may be used in the treatment of depressive symptoms, such as mild stimulants, benzodiazepines, pain relievers, etc., but these drugs are not considered to be part of the class of antidepressant medications because their primary function is not designed to address major depressive disorder.
Antidepressant medications are not a singular class of medications. The major classes of antidepressant medications include:
- Monoamine oxidase inhibitors
- Tricyclic antidepressants
- Selective serotonin reuptake inhibitors
- Atypical antidepressants
All of these classes of drugs are primarily designed to treat major depressive disorder, and each class has a different mechanism of action. This mechanism of action is designed to increase the availability of one or more neurotransmitters in the central nervous system (the brain and spinal cord).
One of the most prescribed classes of drugs in the world is the class of selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications that is believed to indirectly increase the amount of serotonin in the central nervous system (and actually in other areas of the body). This is accomplished by the SSRIs’ ability to block the reabsorption of serotonin in the brain (commonly referred to as the “reuptake” of serotonin). This makes serotonin more available in the central nervous system, and this is believed to result in attenuation of the symptoms of depression. Serotonin is also increased in other areas of the body where serotonin is used, such as in the digestive tract.
SSRIs do not have an immediate effect because the individual’s system typically adjusts to the blockage of the reuptake of serotonin and stops or reduces its release for a period of time. Once the system readjusts and becomes habituated, it begins releasing serotonin at its regular rate, and serotonin is allowed to accumulate. Thus, individuals taking SSRIs do not immediately experience their benefits, but they immediately experience many of the side effects of these drugs, such as agitation, irritability, nausea, weight gain, etc.
Paxil (paroxetine) is a commonly prescribed SSRI. SSRIs may have some utility in recovery; however, the use of Paxil and other SRRIs are not approved by the Food and Drug Administration (FDA) for this purpose.
Do These Drugs Work?
A number of early research studies have suggested that the development of a depressive disorder is associated with a decrease in certain neurotransmitters in the brain, and serotonin became a major neurotransmitter of interest according to this approach. However, despite quite a bit of marketing by pharmaceutical companies, there is no direct clinical evidence that a lack of serotonin actually causes depression in people, and a number of researchers have seriously questioned the effects of these drugs regarding their treatment utility for depression.
There is also research to suggest that these antidepressant medications are no more effective than active placebos in addressing the symptoms of depression; this clashes with a number of other studies. For a full discussion of this issue, see The Emperor’s New Drugs.
In addition, while SSRIs remain the most commonly prescribed class of antidepressants, they do not address the symptoms of depression significantly better than other antidepressant drugs. Instead, they are associated with fewer side effects.
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The Utility of Paxil in the Treatment of Substance Use Disorders
Paxil and other SSRIs are not frontline treatments for substance use disorders. Part of the issue with using SSRIs in the treatment of substance use disorders is a lack of immediate efficacy associated with the mechanism of action of these drugs. Individuals with substance use disorders often will not wait 3-6 weeks to experience the benefits of the medication. However, there might be some utility in using these drugs as adjunctive treatments for a number of issues that can occur in substance use disorders.
These issues include:
- Co-occurring disorders: Individuals who have any type of substance use disorder are at an increased risk to also have a diagnosable co-occurring mental health disorder, such as major depressive disorder, an anxiety disorder, a trauma- and stressor-related disorder, an eating disorder, etc. Treatment of any substance use disorder should also include treatment of any co-occurring mental health disorders. Simply trying to address one of these disorders and ignoring the other will not be successful. Paxil may often be prescribed for the purpose of treating a co-occurring disorder in an individual who is in recovery from any type of substance use disorder.
- Withdrawal symptoms: A number of different studies have suggested that Paxil may have some utility in addressing the symptoms of withdrawal from a number of different drugs that include:
In all of these situations, the use of Paxil is primarily as an adjunctive medication, and its efficacy is questionable at best. In contrast, there is research that suggests that selective serotonin reuptake inhibitors, including Paxil, are not effective for treating issues with tobacco abuse as primary approaches or as adjunctive medications.
Because continued use of antidepressant medications is now recognized to result in the potential to develop an antidepressant discontinuation syndrome(a specialized term that simply means the development of physical dependence on an antidepressant), Paxil is also useful in recovery from this syndrome. Typically, individuals who have been taking Paxil for lengthy periods of time and are about to discontinue its use for any reason would be administered the medication on a tapering schedule to slowly adjust to decreasing amounts of the medication in their system. Eventually, the drug can be discontinued without any effects. Paxil could conceivably also be used on a tapering basis to assist with the withdrawal symptoms of other SSRIs.
Paxil may have some limited utility as an adjunctive medication in the treatment of substance use disorders. Its primary utility appears to be its effectiveness in treating co-occurring disorders that may be present in individuals with substance use disorders.
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