My doctor wants to switch me from sertraline to paroxetine. What is the difference between them? And how can she tell in advance whether one medication will be more effective than another?

Also, are there any risks in switching medications, and if so, what are they?

Answered by: Ramin Parsey

Sertraline and paroxetine are medications in a class referred to as the selective serotonin reuptake inhibitors (SSRIs). At typical doses, these medications block the reuptake of serotonin, a chemical in the brain thought to be associated with depression and other disorders.

There are many different medications in the SSRI class. Most of the literature suggests that there is no difference in efficacy between the SSRIs; they differ mainly in their side effect profiles. Interestingly, if you do not respond to one SSRI, you have a fairly good likelihood of responding to a second SSRI.

While several research groups are actively pursuing markers that would help identify which medication would be best for an individual, we currently do not have a universally accepted and proven method to address this very important problem. Our group has been exploring the use of brain imaging techniques to address this issue.

If medications are cross-tapered (one is lowered as the other is raised) there are usually no complications with switching. There may be side effects associated with the second medication that were not present with the first. On the other hand, side effects of the first medication may not be present with the second.

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Ramin Parsey, M.D./PH.D.
Director of the Brain Imaging Division, Department of Molecular Imaging and Neuropathology 

Ramin V. Parsey M.D. Ph.D. is a Professor of Psychiatry at Columbia University and the Director of the Brain Imaging Core of the Silvio O. Conte Center for the Neurobiology of Mental Disorders, at the New York State Psychiatric Institute, Department of Molecular Imaging and Neuropathology. His areas of expertise include magnetic resonance imaging and positron emission tomography (PET) studies in mood disorders.

Dr. Parsey graduated from the University of Maryland with a Bachelor of Science in Biochemistry. He received his M.D. and Ph.D. degrees from the University of Maryland. His Ph.D....
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