Paxil Alternatives: Comparing With Zoloft Or Lexapro

Last Updated: December 18, 2019

Authored by Roger Weiss, MD

Paroxetine, generic for Paxil, is an effective antidepressant also used to treat anxiety disorders. It is classified together with alternative drugs such as Prozac, Luvox, Zoloft, and Celexa as selective serotonin reuptake inhibitors (SSRIs).
The good thing about Paroxetine and the alternatives is that they all help in treating depression and anxiety, though at different levels. However, a switch to Paroxetine alternatives is usually occasioned by drug efficacy, side effects, drug interactions, and restrictions to certain age groups, among other factors.

Paxil Alternative Drugs

As mentioned above, some drugs belong to the same family as Paxil. These are often used as alternatives in cases where the drug cannot be administered due to drug interactions or pre-existing patient conditions.

Paxil vs. Zoloft

Both drugs are effective in treating anxiety and depression. They restore the levels of serotonin hormone in the brain to the natural balance. This enhances mood and makes the body relaxed. Paroxetine and Zoloft are prescription-only drugs and can be made available off-label for similar conditions such as trichotillomania, borderline personality disorder, dissociative identity disorder, and dysautonomia.

Unlike Zoloft, Paroxetine should be discontinued more gradually as sudden stops may cause some withdrawal symptoms such as Paxil headache. The difference between Paxil and Zoloft is that Zoloft is less likely to cause drowsiness with monitored continued intake. Though available in both tablet and oral suspension forms, Zoloft dosage is higher in milligrams (100mg) compared to Paxil’s 20 mg.

Zoloft is relatively cheaper per tablet, but when considering the full package (30 tablets each 100 mg) vis-à-vis Paroxetine’s package, 12 paroxetine 10 mg tablets the latter is slightly cheaper. Side effects reported for both drugs are similar and include erectile dysfunction, decreased libido, diarrhea, xerostomia, and others. However, there are differences in Paxil vs. Zoloft weight gain risks with the former much more likely to cause weight gain.

Whether the patient takes Paxil or Zoloft, the efficacy is equivalent in treating anxiety and depression. However, sertraline is much better tolerated and has less significant withdrawal effects than its counterpart.

Paxil vs. Lexapro

Being antidepressants, both drugs are effective in treating anxiety and depression. When taken in the right dosages, they can improve mood and lessen the effects of anxiety and related disorders. They are available in the form of pills and liquid, administered based on the patient’s circumstances. When stopped suddenly, Lexapro and Paxil withdrawal symptoms such as dizziness, poor mood, vivid dreams, nausea, insomnia, and anxiety may begin manifesting.

Lexapro is approved at much lower dosage levels of 10 and 20mg compared to Paroxetine, which is recommended at dosages starting from 12.5 to 50mg. In as much as the same cytochrome P450 isoenzymes metabolize both drugs, Lexapro has much lower drug to drug interaction potential because of its negligible inhibitory action against P-glycoprotein. On the other hand, Paroxetine is more likely to cause drug-drug interactions because of its inhibitory effects against CYP2D6 isoenzyme.

man holding paxil and lexapro pills

In terms of side effects, Lexapro has fewer effects compared to Paroxetine. For instance, the drug is associated with xerostomia, decreased libido, constipation, and asthenia, effects that are not common in Lexapro. Cases of Paxil hallucinations may also manifest in patients taking these drugs. Compared pricing shows Lexapro to be slightly costlier than Paroxetine.

The effectiveness of Lexapro is much higher than that of Paroxetine in the treatment of depression. According to research, this is because of Lexapro’s unique ability to bind onto both orthosteric and allosteric sites of serotonin transporters (SERT). Paroxetine is much weaker in binding to allosteric sites.

Paxil vs. Prozac

Paxil and Prozac are both prescription-only medications that help in treating depression and anxiety disorders. As selective serotonin reuptake inhibitors, these drugs increase the amount of serotonin hormone in the brain.

The primary focus of Paroxetine is in treating depression in adults while Prozac can treat both adults and children starting from 8 years. It takes only 21 hours for the concentration of Paroxetine in the plasma to drop by 50% while Prozac takes 4 to 6 days. Paroxetine must be adjusted if it is to be taken by patients with underlying kidney problems. On the other hand, Prozac dosage must also be lowered for patients with liver problems.

Paroxetine is more expensive than Prozac. Whether one takes Paxil or Prozac, typical side effects such as nausea, diarrhea, shaking, agitation, decreased libido, and fatigue are likely to manifest.

The efficacy of Prozac is much higher compared to that of Paroxetine. Besides, Prozac has more stimulating effects and thus should not be taken before going to bed.

Wellbutrin vs. Paxil

Paxil and Wellbutrin are effective antidepressants. Paroxetine helps in treating obsessive-compulsive disorder, premenstrual dysphoric disorder, and post-traumatic stress disorder while Wellbutrin treats the seasonal affective disorder. Though the two drugs treat the same conditions, their mechanisms of operation are different.

Paroxetine is a selective serotonin reuptake inhibitor (SSRI) while Wellbutrin is classified as norepinephrine and dopamine reuptake inhibitor (NDDI), a class also referred to as aminoketones. Looking at Paxil vs. Wellbutrin comparisons, the latter steers clear of serotonin uptake inhibition and instead targets norepinephrine and dopamine.

Paroxetine is associated with side effects like gastrointestinal disturbances, including nausea. While doctors recommend Paxil for premature ejaculation, there are side effects such as impotence, decreased libido, and organismic disturbance that patients need to be aware of. Wellbutrin, on the other hand, has side effects such as insomnia, agitation, and dizziness in addition to those it shares with Paroxetine such as gastrointestinal disturbances.

While the per tablet cost of Wellbutrin is lower than that of Paroxetine, the whole package of 30 Wellbutrin tablets is more expensive than the standard 12 tablets Paxil package. Compared to Paroxetine, Wellbutrin is much more tolerated, has lower chances of causing weight gain and sexual dysfunction.

Paxil vs. Effexor

These two drugs can help fight off social and panic disorders, among other major depressive disorders. However, both drugs should not be used in children as they can cause suicidal thoughts.

The exciting bit about Effexor vs. Paxil is that Paroxetine only inhibits the reuptake of serotonin while the other (Effexor) has a dual action; inhibiting both the reuptake of serotonin and norepinephrine.

woman choosing between two types of pills

Effexor also found in liquid form is a cheaper alternative. The medications share common side effects, including nausea, weakness, decreased sexual appetite, and difficulty sleeping. A head-to-head comparison shows that Paroxetine has more listed side effects than Effexor.

The fact that Effexor affects two chemicals makes it more effective in treating several conditions related to anxiety and depression.

Paxil vs. Xanax

Xanax is an effective drug for treating anxiety and fears, while its counterpart is primarily used for depression. What is good about Paxil and Xanax is that both medications are available in generic forms which are much cheaper. Apart from the similarities, there are differences in these drugs.

Xanax works for short times and can be habit-forming if used for an extended period. On the other hand, the Paroxetine is a seasoned treatment with doses extending for days without the risk of drug dependency. By design, Paroxetine is not to be used in children, but Xanax can be used to treat anxiety in children.

Is Paxil like Xanax? Well, the effectiveness of Xanax and Paroxetine are a little hard to compare because Xanax is useful in the short-term while Paroxetine works in the medium and long term. However, looking at the side effects, Paxil has more than Xanax though some results are shared. Also, it is much more expensive to purchase paroxetine 20 mg compared to Xanax tablets.

Cymbalta vs. Paxil

These two drugs have featured in many prescriptions for patients suffering from anxiety and depression. Also, Cymbalta can treat fibromyalgia and pain associated with diabetic peripheral neuropathy. Paroxetine is also useful in post-traumatic stress disorder, obsessive-compulsive disorder, and premenstrual syndrome.

They also share in most side effects like nausea, nasal irritation, restlessness, weight changes, and decreased sex drive.

Cymbalta is a selective serotonin-norepinephrine reuptake inhibitor (SNRI) while Paroxetine is purely a selective serotonin reuptake inhibitor (SSRI). This is partly the reason why Cymbalta is more effective than Paxil. It inhibits the reuptake of two mood-boosting chemicals: serotonin and norepinephrine.  In terms of pricing, Cymbalta is a cheaper option.

Reasons to Look for Paxil Alternatives

Paxil is, by all means, effective in treating anxiety and depression. However, medical practitioners may recommend its alternatives due to certain factors, some of which are discussed below:

  • Paroxetine Interactions Paroxetine interacts with drugs such as eliglustat, phenelzine, procarbazine, and many others. This may intensify unwanted nervous system effects like confusion, dizziness, and difficulty concentrating.
  • Side Effects – Paxil causes more and severe side effects than other medications that work like it. Effects such as decreased sleeping and sexual appetite in the first few weeks or months make Paroxetine less desirable to some patients.
  • Pre-existing Conditions – People with bipolar disorders, seizures, or bleeding problems need extra care when taking Paroxetine or should opt for its alternatives. For instance, the drug increases the effects of blood thinners, thus causing further bleeding problems.
  • Target Populations – Teens, expectant, and breastfeeding mothers are highly advised against taking the drug. Cases of complicated deliveries, risk of premature birth in pregnant women, and increased anxiety in teens makes it logical to look for alternatives.

Natural Alternatives to Paxil

Apart from the synthetic pharmaceuticals, there are natural antidepressants that work as well. Most of these are supplements and natural foods.

  • Curcumin Supplements – Curcumin is an active ingredient known for its powerful anti-inflammatory effects and its role as an antidepressant. In a head-to-head study with fluoxetine, it was found that the results of curcumin on severe depression as measured on the Hamilton Rating Scale (HAM-D), fared as well as the prescription drug.
  • Saffron – Clinical trials have established that saffron has antidepressant effects. The safranal and crocin chemical compounds found in stigma and petal extracts of the plant are natural antidepressants. In a double-blind RCT comparison test with fluoxetine, both medications resulted in improved anxiety and depression symptoms based on the Hamilton Rating Scale.
  • B Vitamins – Supplements with B Vitamins have been associated with the production of mood-regulating neurotransmitters. For instance, Vitamin B6 is an essential cofactor for enzymes converting L-tryptophan to serotonin. Vitamin B12 helps in setting the environment for depression treatment.
  • Tryptophan – This amino acid is a precursor to both melatonin and serotonin. It occurs naturally in foods such as fish, eggs, poultry, and meat. Supplements containing this amino acid helps in boosting serotonin levels and thus efficient in treating depression, anxiety, seasonal affective disorder, and ADHD.
  • Arctic Root – Found in the mountainous regions of central China and the arctic circle, Arctic root is effective in reducing depression symptoms. It could take as little as a week for the results to be noticeable.

arctic root plant

Seeking Professional Advice

Depression and anxiety treatment can take different medication alternatives depending on several factors such as drug tolerance, underlying health issues, drug interaction, and the target population. All the same, before getting onto treatment or changing medication, seek professional medical advice and direction. Abuse of this prescription medication may require professional treatment as well. Consult the rehab institution representatives for addictional information.

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Published on: May 23rd, 2019

Updated on: December 18th, 2019

About Author

Roger Weiss, MD

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.


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