Paroxetine (Paxil) has the reputation as a calming (as opposed to energizing) antidepressant. However, there are several reasons to choose a different SSRI. Although paroxetine is FDA-approved for more anxious conditions than other SSRIs, it has performed no better for anxiety in head-to-head trials (Sanchez et al, 2014).
Disadvantages of paroxetine compared to other SSRIs:
► More fatigue
► More weight gain
► More sexual dysfunction
► More likely to cause withdrawal symptoms with missed doses
► More CYP interactions (excluding fluvoxamine)
► More anticholinergic effects
► Risk of dementia (anticholinergic), unlike other SSRIs
► Risk of birth defects
► Less effective than escitalopram, even for anxiety disorders
Axl Rose has short stature. Among antidepressants, Paxil has a relatively short elimination half-life of 21 hours. A missed dose may result in unpleasant serotonin withdrawal symptoms.