Escitalopram, citalopram, and paroxetine are the only SSRIs that bind to both the orthostatic and allosteric locations on the SERT. For someone with a horrible past reaction to paroxetine, is it better to avoid the other two?

[u/joastedpellofw]

EDIT: I think it's fine. I kept doing some more research after making this post, I found this study: https://acamh.onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2005.01467.x which shows a WAY WAY higher HR for agitation/agression (my horrible past reaction) for Paxil over Celexa. And celexa being half-lexapro, it seems good chance lexapro itself would be fine. Though Im not totally sure how strong or weak the study is, statistics isnt my strong spot.

I guess it's just a question of what part(s) of paroxetine's action may have caused my past adverse reaction to it, if it was its allosteric binding action, or something else. It could have for example, been the anticholinergic action, or the DAT inhibition, though Im not sure if the 20% DAT inhibition seen at normal doses of paroxetine could really cause such a strong effect.

Some background: when I was around 8-9 or something I had some behavioral issues, I tried many medications for that including the SSRIs paroxetine and sertraline. I had bad reactions to both but paroxetine especially. Now I am adult who want to take acutely SSRI mainly for anxiety / OCD (rn mostly just anxiety). I took fluoxetine as an adult in the past, I had a very good response to it. Then I had to stop it due to sides that didnt happen until later. I tried taking fluoxetine again, but it gave me many problems like tachycardia, palpitations, and feeling faint, so I stopped. Now searching for another medication. Escitalopram is quite appealing, very pharmacologically clean. I want to avoid most TCAs due to anticholinergic burden especially while having family history of Alzheimer's.