Dr. I hope you can shed some light on something for me. I have been HIV+ with an Aids diagnosis for the past 8 years. I have had my share of ups and downs. I have also used some of this time to get some mental health therapy. I feel it has been of great benefit to me. I am presently taking 40mg of Paxil a day to help with depression. It seems to be helping. A friend suggested I ask my Dr about trying Remeron instead. My friend suggested this as my appetite sometimes can be poor. I have also heard it has less sexual side-effects than Paxil. Any input you can give would be appreciated. (pro and cons for one med vs. the other)



Paxil [paroxetine] is one of several antidepressants in a class of drugs known as selective serotonin reuptake inhibitors (SSRI's ). The other members of this class are fluoxetine[Prozac], sertraline [Zoloft], citalopram [Celexa], and escitalopram [Lexapro]. All of these medications are quite effective in treating depression and are very well tolerated. This means that, compared to most other antidepressants, they have relatively few side effects and are quite safe.

Unfortunately, decreased sexual interest, delayed ejaculation, anorgasmia, and other sexual problems are common side effects of these medications. Some people also experience decreased appetite (especially with Prozac) when they start these medications, but this is usually transient. In my experience, it is just as likely to experience increased appetite and weight gain with these medicines. Depressed persons often experience an improved appetite when their depression improves.

Persons with AIDS may have decreased appetites for a variety of reasons other than an antidepressants. Other causes of anorexia are HIV infection itself, nausea, and side effects of other medications.

Other antidepressants, including Remeron (mirtazapine), also have numerous side effects. In fact, antidepressants such as Remeron [mirtazapine], Effexor [venlafaxine], and Serzone [nefazadone] sometimes have more troublesome side effects than the SSRI's. In particular, Remeron is associated with orthostatic hypotension (drops in blood pressure), somnolence, dry mouth, increased cholesterol and triglycerides, constipation, dizziness, tremor, and urinary frequency.

Although Remeron may be an alternative to Paxil, you should realize that the likelihood of new, and potentially more troublesome, side effects does exist.

Some people with decreased sexual interest on SSRI's benefit from the addition of a small dose of Wellbutrin [bupropion]. You may want to discuss this with your psychiatrist.