Glad to see this thread. I've heard a lot of anecdotal evidence regarding patients experiencing severe side effects on Paxil to the point where I felt I wouldn't prescribe it if I practiced psychiatry but it seemed to be a popular choice amongst the psychiatrists I've worked with. Feels better to know my irrational thoughts are backed by some evidence.
Greenshirt-I don't know if you've picked this up yet in your training. FDA approvals allow for a medication to gain an FDA approved indication so long as in a double blinded, placebo controlled study of at least X people (I forgot the exact amount) the medication shows significantly better response than a placebo.
OK--but when you have multiple SSRIs (or any other medication) then there's the question, which one is the best?
Unfortunately, and you'll see this with almost every single medication in every field of medicine, there is not much data. Thanks to the CATIE trial, we psychiatrists finally got a head to head trial on most of the existing atypicals, and in fact that study dispelled a lot of ideas which were going on at the time--e.g. Geodon was known as the atypical that put patients most at risk for QT prolongation, atypicals would have significantly better efficacy than typicals etc.
Same for SSRIs. Yes there have been some data comparing the SSRIs, but they are sparse, and when the data is presented, it's often not presented to non-psychiatrists.
So most non-psychiatric doctors--who actually are the majority of prescribers of psychotropics, yes they may know that paxil works, but they might not know that it is the most likely to have several uwanted side effects.
Another problem is several prescribers give out medications based on unscientific principles. E.g. I knew one attending in the South NJ area that put everyone on Paxil because that was her "favorite medication." She had no scientific basis for her decision to make it the "favorite." There should be no such thing as a favorite medication. We should give out medications based on that medication being the best for the patient given the amount of data we have.
That requires that we psychiatrists not only keep up to date on the latest data, but also put a lot of thought into the medications we choose, and also make an attempt to educate our patients as to why we recommend the medication.
In the case with that doctor, as is with unfortunately several doctors, it's easier to simply give out a medication without putting a lot of effort into the decision making process. Unfortunately several doctors practice what I call "monkey" or "fast food" medicine. Person has high BP? Give them an antihypertensive, without regard to whether or not a duiretic, B-blocker, ACE-I is the best for their profile. Same with psychiatry. Person's depressed? Give an antidepressant, but place no more thought into which one and why that one is picked.
I call it "monkey" medicine because any monkey can put a ball into a circular shaped hole and a cube into a square shaped hole. Unfortunately you will see some doctors from time to time give out medications in this manner.
As for Paxil, when it came out, it was touted as better than prozac, and several doctors still give it out based on what the drug reps told them at the time. (Same with Neurontin--several doctors still give it out to treat bipolar though the studies are clear that it has not showed significant improvement in double blinded placebo controlled studies. A drug rep told them it worked, they keep prescribing it for bipolar with it even though any doctor worth his salt should know the studies point to it not working for bipolar....)
