Paxil vs. Escitalopram
See how Paxil and Escitalopram compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Paxil and escitalopram are both SSRIs, but Paxil is FDA-approved for OCD, panic disorder, social anxiety disorder, and PTSD, while escitalopram's approval is limited to depression and generalized anxiety disorder.
Paxil's short half-life makes withdrawal symptoms more likely if a dose is missed or stopped, while escitalopram tends to cause milder discontinuation effects.
Escitalopram typically costs far less than Paxil because generic versions have been widely available for years.
Paxil vs. Escitalopram Drug Summary
Paxil
Paxil (paroxetine) is a selective serotonin reuptake inhibitor used for depression, OCD, panic disorder, social anxiety disorder, generalized anxiety disorder, and PTSD. It comes as an immediate-release tablet taken once daily, with extended-release and liquid options also available.
Escitalopram
Escitalopram is a selective serotonin reuptake inhibitor approved for major depressive disorder in adults and adolescents and for generalized anxiety disorder in adults. It is taken once daily as a tablet or oral solution, usually starting at 10 mg before increasing to 20 mg.
Paxil vs. Escitalopram Side Effects
Paxil
Escitalopram
Paxil vs. Escitalopram Dosage
Paxil
Escitalopram
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 20 mg once daily | Week 2 onward |
| Dose changes | 1 increase | Every week |
Paxil
| STAGE | DOSE | WHEN |
| Starting dose | 20 mg once daily | At the start |
| Maximum dose | 50 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Escitalopram
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | Week 1 |
| Maximum dose | 20 mg once daily | Week 2 onward |
| Dose changes | 1 increase | Every week |
Paxil vs. Escitalopram Indications
Paxil
Paxil is FDA-approved for a wide range of conditions, including major depressive disorder, OCD, panic disorder, social anxiety disorder, and PTSD. It works by increasing serotonin availability in the brain across all of these conditions.
Major depressive disorder
Obsessive-compulsive disorder
Panic disorder
Escitalopram
Escitalopram is FDA-approved for major depressive disorder in both adults and adolescents ages 12 to 17, as well as for generalized anxiety disorder in adults. Its approval list is narrower than Paxil's, focusing on these two core conditions.
Major depressive disorder in adults
Major depressive disorder in adolescents 12-17
Generalized anxiety disorder in adults
Paxil vs. Escitalopram Pros and Cons
Paxil
Paxil covers more FDA-approved indications than escitalopram, making it useful for patients with OCD, panic disorder, social anxiety, or PTSD alongside depression. It requires more careful management due to strong drug interactions and a higher chance of withdrawal symptoms when doses are missed.
Pros
FDA-approved for OCD, panic disorder, social anxiety, and PTSD
Available in extended-release and liquid forms
Long track record of use since 1992
Cons
Significant CYP2D6 interactions requiring dose adjustments
Higher rates of nausea, somnolence, and dry mouth
Short half-life increases risk of withdrawal symptoms
Escitalopram
Escitalopram is approved for fewer conditions than Paxil but is generally easier to dose, with a single titration step and lower cost due to widespread generic availability. It carries fewer drug interaction concerns, though it still requires caution with other serotonergic medications.
Pros
Simple once-daily dosing with only one titration step
Approved for adolescents 12 to 17 with depression
Fewer significant drug interactions than Paxil
Cons
Narrower FDA-approved use, limited to depression and anxiety
Sexual side effects such as ejaculation disorder are common
Not approved for OCD, panic disorder, or PTSD
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.