Welcome to the most exasperated column yet in the ever-expanding Frontier Psychiatrists’ pharmacopeia of the gosh-darned. This is a daily health-related newsletter, and there is a lot behind the paywall (most writing past 5 weeks old)—consider subscribing and buying coffee makers I like from Amazon to support the work.

Other Include Risperidone, Depakote, Geodon, Ambien, Prozac, Xanax, Klonopin, Lurasidone, Olanzapine, Zulranolone, Benzos, Caffeine, Semeglutide, Lamotrigine, Cocaine, Xylazine, Lithium, dextromethorphan/bupropion and Adderall, etc.

TL;DR?

The world doesn't need Paxil.

Paroxetine is another SSRI. I have never prescribed it. If I had ever needed it to exist, I probably would have. Like Xanax, they got it over the line with panic disorder as an indication. This alone should have been a red flag.

It’s got a viciously short half-life. It’s got tons of awful adverse effects…

paroxetine was associated with a 620 percent increase in the rate of breast cancer in women who had taken it over a four-year period

Following this thread, which lands amid “eh-I-don’t-know-ville,” then takes you down a fiendishly complex rabbit hole of human biology. The genetics for why Paxil sucks are complex:

As many of these genes lie in the major histocompatibility complex (MHC), paroxetine may have downstream disruptive effects on synaptic pruning and over-editing of brain connections as well as polymorphic gene induction resulting in single nucleotide polymorphisms (SNPs) or even tri-nucleotide repeat polymorphisms (TNPs). This is speculation, but theoretically consistent with what is known about these phenomena.

This is complicated but probably not true of other oral antidepressants. I am a “smart doctor,” probably. Even I have precious little idea what the hell the authors are trying to say in the above paper other than “it’s complicated.”—like a Facebook relationship status in the late 2000s (h/t ) or an SBF explanation (h/t ) of the “where the money went.” (h/t ).

Paxil: It is to SSRIs what the FTT token was to cash money. It is conceptually related. BUT…didn't need to exist.

I was going to do a big long thing, like I do. I might still. In the case of Paxil, much like the brutal withdrawal phenomena, less is more. The following is the actual title of an academic review paper:

Paroxetine—The Antidepressant from Hell? Probably Not, But Caution Required

Paxil. I. Just. Can’t.

—Owen Muir, M.D.

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