Hi CQ - Sorry, I've been out of town or busy running to appointments for the last couple of weeks. I even forget how to turn on my computer. I am about 80 posts behind, so I'll keep my answer short and to the point. I hope that it is understandable.

SSRIs, including Paxilª (paroxetine) have a dose-response curve that flattens out. That means that after a certain dose (which is different for everyone) if you take more of the the drug you will not get any more antidepressant (anti-anxiety, anti-OCD, etc.) response. With Paxil this occurs at about 40mg to 60mg. You are only able to block the serotonin reuptake mechanism so much.

Some of our pdocs up here do use 60mg of Paxil, but not very often. Usually they will add another antidepressant (or other drug) to the mix rather than raising the Paxil dose above 40mg/day. They will usually add Wellbutrin SRª (bupropion) or Remeronª (mirtazapine) or even Effexor XRª (venlafaxine).

As a note, Effexor's dose-response curve is more or less linear to at least 450mg/day. Still, most pdocs will add another medication than raise it's dose above 300mg/day.

I hope that this helps. - Cam

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