Should I switch my child from Paxil to Zoloft for selective mustism and anxiety?

[Janay]

My daughter is twelve years old and has selective mutism and some generalized anxiety.  About a year ago she was put on Paxil and has done very well as far as her socializing and anxiety goes.  She is on 30mg a day.  She also has cardiomyopathy due to a rare genetic disorder known as Friedreich's Ataxia.
We were getting the Paxil from a psychiatrist who is not covered by our insurance.  We have switched to a psychologist who is not recommending Paxil--although he is not entirely against it.  The pediatrician is really giving me a hassle about prescribing Paxil due to the dosage amount and her cardiomyopathy.
Would switching her to Zoloft as her psychologist recommends be OK?  Is there a risk in switching?  Any known cardiac effects of Paxil greater than Zoloft?  Is Zoloft as effective in treating the anxiety and selective mutism?  She has been on Prozac in the past with minimal success.

[Kevin Kennedy, Ph.D.]

In a general sense, Paxil use is not correlated with serious cardiovascular side effects. In the clinical trial which resulted in FDA approval of Paxil, palpitations occurred in 3% of the Paxil subjects vs 1% of the placebo subjects, and vasodilation occurred in 3% of the Paxil subjects vs 1% of the placebo subjects. The important question to ask of your daughter's doctors is if there are particulars about her condition that make it unwise to use Paxil. Also, ask the psychologist if there is a particular reason why he is recommending she stop using Paxil. In the recent past the FDA issued a warning about pediatric use of Paxil due to the possibility of suicidal behavior. This warning pertained to patients who were prescribed Paxil for depression, not for patients who are prescribed Paxil for anxiety. It sounds like your daughter has done well with Paxil, and she might do equally well on another SSRI (like Zoloft), but not necessarily. If there's no particular reason why Paxil would pose any risk to her it's hard to discern why you would switch her. It will also be important to locate another child psychiatrist. The prescribing of antidepressants like Paxil should generally not be in the hands of a pediatrician. They don't have the range of experience and the expertise to be doing this (though there are certainly exceptions). Finally, if you decide to switch your daughter off Paxil, be sure to taper her slowly. Abrupt discontinuation of Paxil can be dangerous.

[andi67]

My daughter will be 12 in Dec. She is suffering from separation anxiety. Last year I put her on Paxil. We ended up adding Buspirone as well. She did really well on it. She even went to camp for a month. Then in Aug. the FDA issued a warning to take all children off Paxil. I was debating. Her dad (we're divorced) insisted she not be on that drug. He's against most medication. He and I do not get along. I ended up taking her off Paxil and I put her on Zoloft, which did nothing. Her anxiety increased to the point of temper tantrums that were out of control (only at home). I then switched her to Luvox. She has been on it now for a week and it has given her really bad headaches. She  now has become agoraphobic. I can't get her to go anywhere with out me. She sleeps in my bed. I don't know what to do.  She also has periodic bedwetting.It's hard to treat because there is no pattern and she can sometimes go for months and then she'll have it twice in a week. It's odd.  The big problem though is her anxiety. She did complain that the Paxil made her nauseous. I don't know what to do for her. She said she wants to go back on Paxil even though it made her a little sick. These drugs take so many weeks to start working. Any advice?? Andi

[Kevin Kennedy, Ph.D.]

The warning about Paxil did not advise removing all chikldren from the medication. It pertained specifically to children who had been diagnosed with depression and who were prescribed the medication for the purpose of treating depression. From what you are describing, your daughter was prescribed the medication for anxiety. Discuss this with the prescribing clinician. Children and teens who had been prescribed the medication for anxiety and who were dpoing well on the medication typically can remain on it. "If it's not broken, don't fix it!"

[Nana114]

A related discussion, OCD Zoloft was started.