Maximum dosage for Seroxat (paroxetine)

If you are stopping taking medication it is advisable to reduce the dose gradually, as it is difficult to predict who will have problems withdrawing. It is worth getting as much information and support as you can, and involving your doctor wherever possible.

Committee of Safety of Medicines Guidance from MHRA

Recommended maximum dosages
The Committee on Safety of Medicines has issued guidance that the recommended dose of Seroxat for depression is 20mg/day, and there is no benefit in increasing the dose above this.

The recommended maximum dose is also 20mg for social anxiety disorder, generalised anxiety disorder and post traumatic stress disorder. The recommended maximum dose for obsessive compulsive disorder and for panic disorder is 40mg/day. Before this new recommendation the maximum dose was 50mg for depression, and 60mg for panic disorder.

Why has this new guidance come out?
This guidance has been issued because the working group who have been looking at the research results on Seroxat have found that there is no evidence that higher doses are more effective against depression, but it is clear that adverse effects increase and are more serious with higher doses.

What should I do if I am taking more than 20mg for depression?
If you are taking Seroxat at a higher dose than 20mg/day, and it is not causing you any problems, you can continue to take it until you next see your doctor. If you feel that it is not helping you, or the adverse effects are troublesome, you should go to your doctor as soon as you can to talk about reducing your dose to 20mg, and the best way of doing this.

Will I get withdrawal problems if I reduce the dose?
Seroxat is known to cause unpleasant and troublesome withdrawal effects in many people. You should not reduce your dose suddenly, but by small steps over a period of weeks. You may like to refer to David Healy's SSRI withdrawal plan for advice on this. (The withdrawal plan is for coming off the drugs completely, but may be used as a guideline for simply reducing the dose.)

If you find withdrawal very unpleasant and difficult, and need to reduce your dose by very small steps, you could ask your doctor if you could take the liquid form of Seroxat rather than the tablets. This can be diluted very gradually. (See David Healy's guidelines for more information.) Not everyone is troubled by withdrawal effects, and you may know from past experience that reducing your dose will not be a problem for you.

What if I have just started taking Seroxat?
You should not be started on a dosage higher than 20mg. The research evidence suggests that higher doses are not more effective, but may cause significant adverse effects some of which may be the same as the symptoms of depression. If you are taking it for depression, social anxiety disorder (also called social phobia), generalised anxiety disorder, or post traumatic stress disorder, the dosage should not normally be increased above 20mg.

Can doctors still prescribe a higher dose?
The dosage should not normally be increased above 20mg for depression unless this seems to be ineffective, and you and your doctor feel that an increased dose might help you, perhaps based on your previous experience.

If you are taking Seroxat for panic disorder or obsessive compulsive disorder rather than depression (or the other conditions listed above), you should be started on a dosage of 20mg, and this may be increased gradually in weekly steps of 10mg to a maximum of 40mg. You should not be started on the higher doses, as this can cause serious adverse effects. It is important to increase gradually, just as it is important to decrease gradually when you are withdrawing.

I am taking a different SSRI. Does this guidance affect my medication?
This advice applies only to Seroxat. There is at present no similar advice about other SSRI antidepressants. The research evidence about other SSRIs will also be reviewed, and guidance about them will be issued in the future if appropriate.

If you are stopping taking medication it is advisable to reduce the dose gradually, as it is difficult to predict who will have problems withdrawing. It is worth getting as much information and support as you can, and involving your doctor wherever possible.