Been reading through the paroxetine low-dose literature this week, prompted by someone in my network managing chemo-induced menopause on Tamoxifen who’s finding Veozah starting to lose its edge after two years. The EQUILIBRIUM trial is the one worth actually sitting with - it’s the data behind the Brisdelle / low-dose Paxil approval, 7.5mg specifically, which is well below the antidepressant dosing range. The efficacy signal is real but modest: roughly 1.5-2 fewer moderate-to-severe hot flashes per day versus placebo at 12 weeks. Not dramatic, but for someone who’s already cycling through gabapentin (too groggy) and a waning NK3 antagonist, modest gains start to matter. The tolerability profile at 7.5mg looks meaningfully different from standard SSRI doses - discontinuation syndrome is still a consideration though, worth naming before anyone starts. The Tamoxifen interaction is the part I’d want any consultant to address first. CYP2D6 inhibition from paroxetine can reduce tamoxifen conversion to endoxifen, which is the active metabolite doing the actual work. That’s not a theoretical concern - there’s pharmacokinetic data on it. The magnitude of the effect varies by individual CYP2D6 genotype, but it’s enough that most oncologists prefer venlafaxine or citalopram in this population. Tracking symptom frequency daily rather than relying on memory is what would actually make a trial of any of these meaningful - I log mine with a free-text note tied to each entry so the pattern over weeks is visible rather than impressionistic. Without that baseline, it’s hard to know if something’s working or just varying naturally.