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Paxil vs Prozac: Which one should I take?

Paxil vs Prozac: Which one should I take?

Reviewed by:
Divya Khosla, MD
|
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May 6, 2024
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Key takeaways

If you struggle with mental health conditions like anxiety or depression and you’re considering medication, learning about all of the treatment options can be overwhelming. Some of the most commonly prescribed psychiatric medications are antidepressants –– and Paxil and Prozac are two examples of these. Paxil is the brand name for paroxetine, and Prozac is the brand name for fluoxetine. Both of these medications can result in symptom reduction and improvements in quality of life for people struggling with their mental health.

This guide will break down the differences and similarities between these two medications. But remember, your doctor will ultimately decide which is the best choice for you. However, it’s always good to educate yourself on your options.  

Read on to learn more about the conditions that Paxil and Prozac treat, how they work, dosage differences, side effects, and more.  


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What conditions do they treat?

Generally speaking, doctors typically prescribe Paxil and Prozac for conditions like depression, anxiety disorders, and obsessive-compulsive disorder. However, these medications have separate FDA-approved indications and off-label uses. Off-label usage means using a drug for something other than the original use that the FDA has approved it for. Typically, this is based on past scientific research.

Paxil is FDA-approved for the treatment of:

  • Major depressive disorder (MDD)
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Social anxiety disorder
  • Generalized anxiety disorder (GAD)
  • Post-traumatic stress disorder (PTSD)
  • Premenstrual dysphoric disorder PMDD (specifically Paxil CR)
  • Vasomotor symptoms, specifically Brisdelle

Paxil is used off-label for the treatment of:

  • Social anxiety disorder in children and adultsA
  • Body dysmorphic disorder
  • Dysthymia/persistent depressive disorder
  • Postpartum depression
  • Premature ejaculation
  • Separation anxiety

Prozac is FDA-approved for the treatment of:

  • Major depressive disorder (MDD) in children and adults
  • Treatment resistant depression (with olanzapine)
  • OCD in children and adults
  • PMDD  
  • Bipolar depression (with olanzapine)
  • Panic disorder
  • Bulimia nervosa

Prozac is used off-label for the treatment of:

  • Social anxiety disorder
  • Post-traumatic stress disorder
  • Borderline personality disorder
  • Raynaud phenomenon
  • Selective mutism

According to current data, Paxil and Prozac have both been effective to improve depression. Every individual responds to medications differently, and you might find that one works better for you than the other. It all comes down to your unique circumstances.

How do they work?

Paxil and Prozac are both selective serotonin reuptake inhibitors (SSRIs). SSRIs directly affect serotonin, a neurotransmitter that serves as a chemical messenger in the brain. Low levels of serotonin are believed to be linked to mental health conditions like depression and anxiety.

SSRIs work by inhibiting the reuptake of serotonin in the brain. In simpler terms, this means that they block the reabsorption of serotonin in the brain. This leads to more serotonin being available. This additional serotonin can help carry messages and improve communication between your neurons (nerve cells), helping to regulate your mood and lessen symptoms of depression and anxiety.  
Other examples of SSRIs that have this same mechanism of action are:

What are the dosage differences?

The dose you take of Paxil or Prozac will depend on the condition you’re taking it for, as well as how you respond to the medication. The FDA information suggests taking both in the morning, but your psychiatrist might recommend something different for you –– for example, taking it at night if it makes you tired.  

With either medication, you will typically start with a low dose and then increase to a higher dose after a couple weeks if necessary. Your doctor will check in with you to see if your symptoms of depression or anxiety are improving and then adjust the dose as necessary.

The FDA-approved dosing for Paxil is:

Condition Starting dose Maximum dose
Major depressive disorder 20 mg/day 50 mg/day
Obsessive-compulsive disorder 20 mg/day 60 mg/day
Panic disorder 10 mg/day 60 mg/day
Post-traumatic stress disorder 20 mg/day 50 mg/day
Social anxiety disorder 20 mg/day 60 mg/day
Generalized anxiety disorder 20 mg/day 50 mg/day

The FDA-approved dosing for Prozac is:

Conditon Starting dose Maximum dose
Major depressive disorder 20 mg/day 80 mg/day
Obsessive-compulsive disorder 20 mg/day 80 mg/day
Panic disorder 10 mg/day 60 mg/day
Bulimia nervosa 60 mg/day 60 mg/day

These are the guidelines, but your psychiatrist may adjust your dose as necessary. Additionally, if you are taking Paxil or Prozac as an off-label treatment, your psychiatrist will likely dose based on the research that’s available and their past experience treating other patients.  

Additionally, it’s important to note that SSRIs don’t work immediately. It takes time to adjust to them and feel symptom relief. Everyone’s different, but it can take up to 4-6 weeks to really notice a difference.  

Common side effects

Since Paxil and Prozac are both in the same class of drugs, their side effects are very similar. Your doctor will likely discuss these potential side effects with you and consider them when deciding which drug to prescribe you.  

Common side effects of Paxil and Prozac are:

  • Constipation
  • Diarrhea  
  • Dizziness
  • Drowsiness  
  • Dry mouth
  • Loss of appetite
  • Nausea
  • Nervousness
  • Sexual side effects (reduced libido, difficulty reaching orgasm)
  • Shaking/tremors
  • Sweating
  • Trouble sleeping
  • Weakness
  • Weight gain or loss
  • Yawning  

Some side effects more unique to Prozac are hot flashes, rash, flu-like symptoms, and strange dreams. Additionally, Prozac seems to be more “activating,” meaning potentially causing more agitation, anxiety, or restlessness. Paxil is more likely to be sedating and cause dry mouth, constipation, and weight gain.  

These side effects will typically occur in the first few weeks of taking the drug as your body adjusts to it, and then they will subside. However, if your side effects are not going away or you can’t tolerate them, be sure to let your doctor know.  

Additionally, it is possible for antidepressants like Paxil and Prozac to worsen depression symptoms or cause or worsen suicidal thoughts. If you experience this, let your doctor know right away.  

Can you switch from Paxil to Prozac?

You can switch from Paxil to Prozac or Prozac to Paxil—but only if your doctor recommends it. There are multiple reasons why you might want to switch medications. The most common reasons would be if you aren’t experiencing enough relief from your symptoms even when at a therapeutic dose of a drug or if you’re having side effects that you can’t tolerate.  

You should never stop or change medications without consulting your doctor first. It’s very important to work closely with your doctor on a carefully planned and supervised switch between the medications.  

Essentially Prozac stays in your body longer than Paxil, so when you're tapering, you're less likely to experience withdrawal.


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Can you take Paxil and Prozac together?  

Since Paxil and Prozac have the same mechanism of action, they should not be taken together. Taking Paxil and Prozac together can potentially result in dangerous drug interactions, leading to a phenomenon known as serotonin syndrome, which is when the body has dangerously high levels of serotonin. Symptoms of serotonin syndrome can range from mild tremors or restlessness to more severe, like high fever or seizures. This is a medical emergency, and if you experience these symptoms, it’s important to seek medical attention ASAP since serotonin syndrome can possibly be fatal.

The main reason someone would be prescribed both Paxil and Prozac at the same time is if they are tapering down one while starting to take the other, but this would only be a short-term occurrence under the supervision of a doctor.  

Is Paxil or Prozac right for me?

Ultimately, you and your doctor will decide if Paxil or Prozac (or something else) is the right fit for you. Taking your symptoms and history into account, they will discuss your treatment options and determine which SSRI could be more effective for you. They will also take into account any other drugs you take and possible drug interactions.

Every individual is different and responds to medication differently. A medication that works great for a friend might not work as well for you, and vice versa. Finding the right prescription for you takes patience. It can take some trial and error to find out which drug works best for you and what dose results in the best symptom relief with the least amount of side effects.

If you’re looking for a psychiatrist, consider Talkiatry. We’re a national psychiatry practice that treats mental health conditions ranging from anxiety to depression and everything in between. We provide virtual, in-network services so you can get the care you need from home.  

To get started, complete our free online assessment to get matched with a psychiatrist.  

FAQs

Here’s what else to know when comparing Prozac and Paxil.

What are the differences between Paxil and Prozac?

Both drugs are very similar, but there are slight differences in FDA approval. Additionally, due to Prozac’s long half-life and Paxil’s short half-life, there is a greater risk of withdrawal symptoms when taking Paxil. Lastly, Prozac is generally thought to be more “activating,” and Paxil is more “sedating.”  

Related: Paxil vs Lexapro

Does Prozac work better than Paxil?

When it comes down to it, one isn’t necessarily better than the other in general, but everyone’s different, and you may find that one is more effective than the other for you.  

What are other antidepressants medications?

Aside from SSRIs, other types of antidepressants include:

Your psychiatrist will decide which type of antidepressant is best for you based on your symptoms and history.

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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Frequently asked questions

Does Talkiatry take my insurance?

We're in network with major insurers, including:

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The best way to get a detailed estimate of your cost is to contact your insurance company directly, since your cost will depend on the details of your insurance.  

For some, it’s just a co-pay. If you have an unmet deductible it could be more.  

Call the number on your insurance card and ask about your plan’s coverage for outpatient psychiatric services.

How does Talkiatry compare to face-to-face treatment?

For most patients, Talkiatry treatment is just as effective as in-person psychiatry (American Psychiatric Association, 2021), and much more convenient. That said, we don’t currently provide treatment for schizophrenia, primary eating disorder treatment, or Medication Assisted Treatment for substance use disorders.

What kind of treatment does Talkiatry provide?

At Talkiatry, we specialize in psychiatry, meaning the diagnosis and treatment of mental health conditions. Your psychiatrist will meet with you virtually on a schedule you set together, devise a treatment plan tailored to your specific needs and preferences, and work with you to adjust your plan as you meet your goals.

If your treatment plan includes medication, your psychiatrist will prescribe and manage it. If needed, your psychiatrist can also refer you to a Talkiatry therapist.

What's the difference between a therapist and psychiatrist?

Psychiatrists are doctors who have specialized training in diagnosing and treating complex mental health conditions through medication management. If you are experiencing symptoms of a mental health condition such as depression, anxiety, bipolar disorder, PTSD, or similar, a psychiatrist may be a good place to start.  

Other signs that you should see a psychiatrist include:  

  • Your primary care doctor or another doctor thinks you may benefit from the services of a psychiatrist and provides a referral    
  • You are interested in taking medication to treat a mental health condition  
  • Your symptoms are severe enough to regularly interfere with your everyday life

The term “therapist” can apply to a range of professionals including social workers, mental health counselors, psychologists, professional counselors, marriage and family therapists, and psychoanalysts. Working with a therapist generally involves regular talk therapy sessions where you discuss your feelings, problem-solving strategies, and coping mechanisms to help with your condition.

Who can prescribe medication?

All our psychiatrists (and all psychiatrists in general) are medical doctors with additional training in mental health. They can prescribe any medication they think can help their patients. In order to find out which medications might be appropriate, they need to conduct a full evaluation. At Talkiatry, first visits are generally scheduled for 60 minutes or more to give your psychiatrist time to learn about you, work on a treatment plan, and discuss any medications that might be included.

About
Divya Khosla, MD

Dr. Divya Khosla, MD, is a board certified Adult Psychiatrist and board eligible Child and Adolescent Psychiatrist. She received her undergraduate degree from Case Western Reserve University in Cleveland, Ohio, and her medical degree from Ross University, completing all of her clinicals in Maryland, D.C., and NYC. She completed her adult psychiatry residency at The Ohio State University in Columbus, Ohio. Then she returned to the east coast, where she completed her child and adolescent psychiatry fellowship at Nassau University Medical Center in East Meadow, New York.

Dr. Khosla has participated in a variety of innovative academic clinical research, and has presented research at annual national meetings of the American Psychiatric Association. Her robust clinical experience with varying demographics at different clinical sites around the country has allowed her to treat patients in an evidence-based way, tailoring treatment to an individual’s specific needs.

Although Dr. Khosla’s practice focuses on medication management, she also implements supportive therapy and motivational interviewing in sessions to allow for a more comprehensive approach to treatment. Her clinical interests include depression, bipolar disorder, anxiety disorders, post-traumatic stress disorder, panic disorder, and ADHD.

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