Paroxetine is a potent and selective inhibitor of the neuronal reuptake of 
serotonin (5-hydroxytryptamine; 5-HT), which was previously reviewed as an 
antidepressant in Drugs in 1991. Since then, more comparative trials with other 
antidepressants have become available, and its use in the elderly and as long 
term maintenance therapy has been investigated. Paroxetine has also been studied 
in several other disorders with a presumed serotonergic component, primarily 
obsessive compulsive disorder (OCD) and panic disorder. In short term clinical 
trials in patients with depression, paroxetine produced clinical improvements 
that were significantly greater than those with placebo and similar to those 
achieved with other agents including tricyclic antidepressants (TCAs), 
maprotiline, nefazodone and the selective serotonin reuptake inhibitors (SSRIs) 
fluoxetine, fluvoxamine and sertraline. Long term data suggest that paroxetine 
is effective in preventing relapse or recurrence of depression in patients 
treated for up to 1 year. In the elderly, the overall efficacy of paroxetine was 
at least as good as that of comparator agents. In short term clinical trials 
involving patients with OCD or panic disorder, paroxetine was significantly more 
effective than placebo and of similar efficacy to clomipramine. Limited long 
term data show that paroxetine is effective in maintaining a therapeutic 
response over periods of 1 year (OCD) and up to 6 months (panic disorder). 
Preliminary data suggest that paroxetine has potential in the treatment of 
social phobia, premenstrual dysphoric disorder and chronic headache. Like the 
other SSRIs, paroxetine is better tolerated than the TCAs, causing few 
anticholinergic adverse effects. The most commonly reported adverse event 
associated with paroxetine treatment is nausea, although this is generally mild 
and subsides with continued use. Fewer withdrawals from treatment due to adverse 
effects occurred with paroxetine treatment than with TCAs. The adverse events 
profile of paroxetine appears to be broadly similar to that of other SSRIs, 
although data from comparative trials are limited. Serious adverse effects 
associated with paroxetine are very rare. In conclusion, paroxetine is effective 
and well tolerated, and suitable as first-line therapy for depression. It also 
appears to be a useful alternative to other available agents for the treatment 
of patients with OCD or panic disorder.