Licensed providers on Klarity provide personalized treatment. Find a provider that matches your needs and preferences.
Depression
26 min read
Written by Klarity Editorial Team
Published: Oct 31, 2022
Medically Reviewed by Dr. Zoe Russell
Both Paxil and Effexor are effective at treating anxiety and depression, but they are different classes of drugs. Learning how each medication works is the first step toward understanding which one might be best for you.
This post will explore Paxil and Effexor in detail to help you have an informed discussion with your healthcare provider.
We’ll discuss—
Ready to discover how the providers on Klarity can help you? All you have to do is schedule an initial visit and see a board-certified mental health professional within 48 hours.
This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the Suicide Prevention Lifeline immediately at 800-273-8255.
Paxil | Effexor XR | |
Drug Class | Selective serotonin reuptake inhibitor (SSRI) | Selective serotonin and norepinephrine reuptake inhibitor (SNRI) |
Brand / Generic Status | Brand name for paroxetine | Brand name for venlafaxine (extended-release formula) |
Form(s) of the Drug | • Color-coded tablets • Time-release tablets • Orange-colored and flavored liquid suspension | • Extended-release capsules |
Standard Dosage | Time-release tablets: • 37.5mg of paroxetine Color-coded tablets: • Yellow: 10 mg • Pink: 20 mg • Blue: 30 mg • Green: 40 mg Liquid suspension: • 5mg of suspension contains 10mg of paroxetine | Extended-release capsules: • 37.5mg • 75mg • 150 mg |
Conditions Treated | FDA-approved uses: • Major depression Off-label uses: • Anxiety • Panic disorder • Insomnia | FDA-approved uses: • Major depressive disorder • Panic disorder • Social anxiety disorder • Generalized anxiety disorder Off-label uses: • Post-traumatic stress disorder (PTSD) • Obsessive compulsive disorder (OCD) • Diabetic neuropathy • Hot flashes • Migraine prevention • Complex pain syndromes • Premenstrual dysphoric disorder (PMDD) • Attention deficit hyperactivity disorder (ADHD) • Fibromyalgia |
Cost | Generic form (paroxetine): • $4 to $25 for a 30-day supply Brand-name: • $280 for a 30-day supply | Generic form (venalfaxine): • $13 to $48 for a 30-day supply Brand-name: • $580 to $640 for a 30-day supply |
Side-Effects | Common side effects: • Changes in vision • Weakness, drowsiness, or dizziness • Sweating or shaking • Anxiety • Insomnia • Loss of appetite, nausea, and vomiting • Diarrhea or constipation • Dry mouth • Infections • Headaches • Decreased sex drive or impotence • Abnormal ejaculation or difficulty orgasming Serious side effects: • Racing thoughts • Decreased need for sleep • Unusual risk-taking behaviors • Extreme feelings of happiness or sadness • Being more talkative than usual • Blurred vision or tunnel vision • Eye pain, swelling, or seeing halos around lights • Bone pain, tenderness, swelling, or bruising • Changes in weight or appetite • Coughing up blood or bleeding from your nose, mouth, or rectum • Unusual vaginal bleeding • Stiff or rigid muscles • High fever, sweating, tremors, or fainting • Fast, uneven heartbeat • Headaches • Confusion or slurred speech • Severe weakness, lost coordination, or feeling unsteady | Common side effects: • Headache, dizziness, drowsiness, tiredness • Anxiety, nervousness, restlessness • Sleep disturbances • Strange dreams • Changes in weight or appetite • Dry mouth, increased yawning • Increased sweating • Sexual dysfunction • Tremors • Heart racing • Blurred vision • Nausea and vomiting • Diarrhea or constipation Serious side effects: • Seizures • Blurred vision/seeing halos around lights • Difficulty breathing/chest tightness • Abnormal bleeding • Unnaturally stiff muscles • Low blood sodium—confusion, headaches and memory problems |
Warnings For Use | Contraindicated conditions: • Bipolar disorder • History of suicide attempts • Liver or kidney problems • Bleeding problems • Low sodium in the blood • Peptic ulcer disease • Seizure disorders • Thyroid disease • Angle-closure type glaucoma • Pregnancy or breastfeeding Adverse drug interactions: • Thioridazine • Clopidogrel • NSAIDs • Warfarin • Aspirin • Atomoxetine • Phenothiazines • Pimozide, • Risperidone • Tamoxifen • Tetrabenazine • Antiarrhythmic medications • TCA antidepressants • Antihistamines • Sleep aids • Muscle relaxants • Opiate-based pain relievers or cough suppressants • Water pills (may cause salt imbalance) • MAOIs may cause a fatal reaction • Alcohol • Marijuana | Contraindicated conditions: • Hypertension • Interstitial lung disease • Glaucoma • Hyponatremia, or SIADH • Seizure disorder • Liver disease • Kidney disease • Bipolar disorder Adverse drug interactions: • MAOIs • Blood thinners • Other antidepressants • Cimetidine • Tramadol • St. John’s Wort • Tryptophan • Weight-loss medicine • Mood disorder medication • Migraine medication |
SSRIs and SNRIs treat anxiety and depression in different ways. Paxil is an SSRI or selective serotonin reuptake inhibitor, and Effexor is an SNRI or selective norepinephrine reuptake inhibitor. Paxil increases the level of serotonin and dopamine in the synapses of the brain, whereas Effexor increases serotonin and norepinephrine.
Low levels of serotonin and norepinephrine are associated with symptoms of depression and anxiety. Both antidepressants help alleviate symptoms by increasing one or both neurotransmitters, reducing symptoms of depression and anxiety.
To better understand the differences between Paxil and Effexor, it’s important to look at what each neurotransmitter affects.
Serotonin affects the following bodily functions:
Dopamine affects the following bodily functions:
Norepinephrine affects the following bodily functions:
Though these neurotransmitters all have a hand in regulating mood, they also affect other systems in the body. This leads to the main side effect differences between Paxil and Effexor, which we’ll address in the following sections.
Paxil (paroxetine hydrochloride) helps increase the amount of available serotonin in the synapses of the brain—the regions where brain cells (called neurons) communicate with one another.
Normally, after the serotonin is used, the neuron reabsorbs it in a process known as “reuptake.” When a person has chronically low serotonin levels, reuptake can deplete what little serotonin is left. SSRIs work by blocking the reuptake channels, keeping serotonin in circulation. Over time, SSRIs can restore serotonin levels in patients.
Paxil comes in capsule, tablet, and liquid form. Additionally, there are controlled-release (Paxil CR) capsules available. Depending on the condition being treated, starting doses of immediate-release Paxil may vary.
Dosages range from 20 mg—a typical starting dose—to 60 mg, which is the maximum dosage. For extended-release Paxil, doses range between 12.5 and 62.5 mg per day.
Paxil is taken once daily with or without food, usually in the mornings. If you experience drowsiness as a side effect, talk to your doctor about possibly taking Paxil in the evening.
In addition to major depressive disorder (MDD), Paxil is used to treat:
Paxil can help treat the following symptoms of depression:
Paxil can help reduce the following symptoms of chronic anxiety:
For 30 tablets of 20 mg Paxil, the cost ranges from $4.00 to $30.00. Prices vary due to location, insurance, and pharmacy deals or coupons. Liquid suspensions of Paxil cost more—ranging from $120 to $310.
Taking Paxil comes with a risk of possible side effects (like any antidepressant). For many, noticeable side effects subside over time. It’s important to remember that your medical provider believes the potential benefits of taking Paxil outweigh any side effects you may experience. Still, it’s crucial to fully understand the risks before taking any antidepressants, including Paxil.
For many users of Paxil, side effects subside with time. Here are commonly reported side effects of Paxil. Talk with your doctor or medical provider if specific side effects do not go away.
It’s vitally important to take Paxil as prescribed. Stopping the medication or missing too many doses can lead to the development of withdrawal symptoms, including:
There is a risk of developing severe side effects when using Paxil and other SSRI antidepressants. Though rare, it’s essential to understand the risks of taking any medication. If you experience severe side effects, contact your psychiatric care provider.
Using any antidepressant, whether an SSRI or SNRI, comes with the risk of developing suicidal thoughts or thoughts of self-harm. In short-term studies, a small number of patients had suicidal thoughts worsen or developed suicidal thoughts for the first time. You must monitor yourself for increased suicidal thoughts or thoughts of self-harm when taking an SSRI.
If you have thoughts of suicide or of harming yourself, call the Suicide and Crisis Lifeline at 988.
There is also a risk of developing a rare condition called serotonin syndrome, which happens when there is too much serotonin in the brain. Certain medications that increase serotonin can lead to this condition, which usually develops within a few hours of ingesting the medication. In rare cases, serotonin syndrome can be fatal.
Be on the lookout for the following symptoms directly after taking any medication that increases serotonin levels:
Contact your health provider immediately if you experience any of these severe symptoms.
Paxil may interact with other medications or supplements and cause adverse effects in the body. Paxil, when taken along with other medications, can increase the risk of side effects or cause other conditions.
Avoid taking monoamine oxidase inhibitors (MAOIs) while taking Paxil. Doctors recommend stopping MAOIs at least two weeks before starting Paxil. Common MAOIs include
Taking Paxil alongside blood thinners or other medications that thin the blood can increase the risk of bleeding. Common drugs that thin the blood are:
Paxil may reduce your body’s ability to metabolize certain drugs, meaning they stay active in your system for longer. Paxil may affect how the following medicines work in your body:
Tell your doctor about any medications, vitamins, or supplements you are taking before starting Paxil to avoid adverse drug interactions.
Effexor (venlafaxine hydrochloride) is an SNRI, a class of antidepressants that block the reuptake of both serotonin and norepinephrine in the brain’s synapses. Unlike Paxil, which increases serotonin, Effexor works on an additional neurotransmitter—norepinephrine.
Because Effexor works on both serotonin and norepinephrine, it has different effects on the brain than Paxil. As a result, specific side effects and treatment options vary. People who don’t respond well to treatment with Paxil might respond better to Effexor because it affects a different chemical channel in the brain.
Effexor comes in capsules and tablets with immediate-release and extended-release (XR) options. For immediate-release pills, the standard dose is 150 mg per day, but Effexor also comes in 17mg, 25 mg, 37.5 mg, and 100 mg doses. Effexor XR capsules come in a standard dose of 75 mg, but 37.5 and 150 mg XR capsules are available.
Make sure you use the medication as prescribed. Usually, patients are directed to take Effexor once a day at the same time each day, with or without food.
Effexor is FDA-approved to treat various mental health conditions and disorders including major depressive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder. Additionally, it is used off-label to treat other conditions.
Effexor has been shown to reduce certain symptoms of anxiety:
Prescribed use of Effexor has also been shown to reduce symptoms of depression as well, including
Psychiatric care providers sometimes prescribe Effexor as an off-label treatment for other related mental health conditions, including
150 mg of generic Effexor, called venlafaxine, generally ranges between $13 and $48 dollars. However, the cost depends on several factors, including the region you are purchasing the medication, your access to health insurance, and which pharmacy you use.
Like SSRIs, SNRIs come with the risk of side effects. It’s important you discuss these with your psychiatric healthcare provider before starting treatment. Medical professionals prescribe Effexor when they determine that the benefits of the medication outweigh any potential risks.
Effexor’s most common side effects appear in the first few weeks of treatment. Usually, they decrease or disappear entirely after a few months. Talk with your doctor if certain side effects persist and interfere with your daily life.
Common side effects include:
There is a risk of experiencing more severe side effects, which Effexor users need to be aware of:
If you experience severe side effects, contact your health care provider immediately.
If your symptoms improve or you don’t notice any effects while taking Effexor, it’s vitally important that you still use the medication as prescribed. If you and your medical provider decide Effexor isn’t right for you, you need to gradually wean off the drug to prevent the risk of developing withdrawal symptoms, which include:
Effexor might not be the right medication for people with certain preexisting medical conditions:
Like with SSRIs, SNRIs increase the levels of serotonin in the brain, which can lead to a severe but rare condition called serotonin syndrome. This condition usually develops within the first few hours of taking medication that elevates serotonin levels. Monitor for symptoms if you are using Effexor and are already taking medication that affects serotonin levels.
If you’re experiencing severe side effects from taking Effexor, contact your healthcare provider as soon as possible.
As with Paxil and many other SSRIs and SNRIs, there is a chance that Effexor users will experience an increase in suicidal thoughts. This is more common in teens and younger adults, however, it can still occur in older adults.
It’s important that Effexor users monitor themselves for increased thoughts of self-harm and suicide. Also, ask others to monitor you for unusual changes in behavior, such as acting withdrawn or more depressed.
If you have thoughts of suicide or self-harm, immediately contact the Suicide and Crisis Lifeline at 988.
People who have previously used MAOIs or monoamine oxidase inhibitors must wait at least two weeks after stopping that medication before starting Effexor, as there is a risk of severe drug interactions. Common MAOIs include:
Effexor increases the risk of bleeding. Patients on blood thinners or other drugs that thin the blood as a side effect need to monitor for an increased risk of bleeding. Common medications that thin the blood are:
Paxil and Effexor are both approved by the FDA to treat symptoms of anxiety, major depressive disorder, and related mental health disorders. However, your body chemistry may respond differently to SSRIs and SNRIs.
This fact, when taken into consideration with your medical history, means that one might work better for you than the other. Or, there may be a better third option for treating your anxiety and/or major depressive disorder. It’s crucial to talk with your healthcare provider about which medication is best for you.
If you aren’t happy with your current antidepressant medication, consider switching over to a different medication that has less severe or fewer side effects. Always consult with your doctor before stopping or switching medication.
Here are some common questions Klarity receives about Paxil and Effexor:
When first starting Paxil or Effexor, it’s important to monitor for any side effects like dizziness, nausea, confusion, or tiredness, which might impact your ability to drive. If you do not experience these symptoms, or if they go away in the first couple of weeks, then you are clear to drive while taking Paxil or Effexor.
Discuss possible side effects of Paxil or Effexor with your doctor and how they may impact your daily life.
Potentially. Both SSRIs and SNRIs can make anxiety symptoms worse depending on the patient. If you experience worsening anxiety symptoms, talk to your medical provider right away. Remember, it’s important to take Paxil or Effexor as directed.
Stopping abruptly can make symptoms worse. Your psychiatric healthcare provider can develop a plan to wean you off the medication if indicated.
Generally, Paxil and Effexor are considered safe to take while pregnant. However, be sure to discuss your pregnancy with your medical provider, who will decide which medication is safest for you to take.
Both Paxil and Effexor are equally effective at treating chronic depression and its symptoms.
It is not recommended that patients drink any amount of alcohol while using Paxil or Effexor. The presence of alcohol can increase the risk of experiencing adverse side effects and can make the effects of alcohol stronger. In addition, alcohol is a depressant that can increase some symptoms of depression.
Generally, it doesn’t matter which time of day you take Effexor or Paxil; however, doctors recommend you take it at the same time every day. If you experience side effects like drowsiness or sleepiness, then it may be best to take the medication at night.
Your healthcare provider will determine which time of day you should take your medication.
Paxil is FDA-approved to treat more anxiety-related conditions than Effexor, but Effexor is often prescribed “off-label” for many of the same conditions. Both can be effective in treating symptoms of anxiety. Your psychiatric healthcare provider will determine the best medication for you based on your medical history and anxiety symptoms.
Klarity has already helped 30,000 people connect with depression and anxiety-trained mental health specialists and get online treatment for their anxiety or depression. If you are weighing the pros and cons of SSRIs vs SNRIs, a board-certified medical provider on Klarity can help you figure out which medication treatment, if any, is right for you.
Schedule an appointment and discover how Klarity can help you.
Sources
“Dopamine.” Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22581-dopamine
“Effexor XR.” drugs.com. https://www.drugs.com/paxil.html
John Cunha. “Paxil vs. Effexor.” RxList. https://www.rxlist.com/paxil_vs_effexor/drugs-condition.htm
“Norepinephrine (Noradrenaline).” Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22610-norepinephrine-noradrenaline
“Paxil.” Drugs.com. https://www.drugs.com/paxil.html
“Serotonin.” Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22572-serotonin
Get free, credible health and wellness tips from Klarity
Subscribe to our blog for the latest insights and advice—totally free! No spam, and you can unsubscribe at any time.