Choosing Between Paroxetine and Escitalopram

Introduction to Medication Comparison

• The American Academy of Family Physicians recommends that paroxetine should generally be avoided in elderly patients due to higher rates of adverse effects 1, 2
• The American Academy of Child and Adolescent Psychiatry suggests that paroxetine is associated with a higher risk of suicidal thoughts or behaviors compared to other SSRIs 3, 4

Dosage and Administration

• The American Academy of Family Physicians recommends a dosage of 10-20 mg/day for escitalopram 1, 2
• The American Academy of Family Physicians recommends a dosage of 20-50 mg/day for paroxetine 1, 2

Special Considerations

• The American Academy of Family Physicians considers escitalopram a preferred agent for elderly patients with depression, while paroxetine should generally be avoided due to higher rates of adverse effects in this population 2

Discontinuation Syndrome

• The Journal of the American Academy of Child and Adolescent Psychiatry reports that paroxetine is strongly associated with discontinuation syndrome, characterized by dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 3, 4, 5

Medication Interactions

• The Journal of the American Academy of Child and Adolescent Psychiatry notes that escitalopram has a minimal effect on cytochrome P450 enzymes, resulting in a lower propensity for drug interactions 3, 4

Patient Monitoring

• Pediatrics recommends monitoring for the emergence of adverse events, especially in the first few weeks of treatment 6
• The Journal of the American Academy of Child and Adolescent Psychiatry advises special attention to signs of serotonin syndrome when combining these medications with other serotonergic drugs 3, 4, 5