Paroxetine

Speaking from experience as a prescriber: Unfortunately almost all antidepressants are associated with sexual dysfunction. Mirtazapine is not, but this is one of the worst for weight gain and sedation. Vortioxetine also has a bit less sexual dysfunction but is not a first line pick and not licensed for anxiety. Also less evidence in breastfeeding simply as its newer. Paroxetine being an SSRI is a first line choice, although a slightly unusual one (usually sertraline is picked first but not necessarily because it's any better). There's also decent safety evidence for the SSRIs in breastfeeding. At a low dose, any SSRI is usually tolerated quite well and I'd suggest it's worth a try (for at least four weeks to see any positive effects). What newer less potent options did you have in mind?

Thanks so much for taking time to reply, this is really helpful. Honestly I thought sertraline is usually first choice when b/f and then when I looked into seroxat (exact product I've been prescribed) I've read the side effects mentioned are much more likely and also that is has been discontinued as of last month. So I'm just a bit confused by the choice. Thanks for your reassurance x 🙏

Yes you're not wrong! GSK manufacture that brand of paroxetine and are discontinuing purely for commercial reasons. The pharmacy are probably getting rid of their stock 😅 it's completely equivalent to other brands though so don't worry about that side of things.