Long-Term Effects of Paxil (Paroxetine): Side Effects, Risks, and Withdrawal

Alternative to Meds Editorial Team
Medically Reviewed by Dr John Motl MD

The long-term effects of Paxil (paroxetine) most often include weight gain, sexual side effects, emotional numbness, and withdrawal symptoms when a dose is missed or lowered. Many people take Paxil for years without serious problems, but it has a few risks that set it apart from other SSRIs, and withdrawal is one of them. Here is what the research and the FDA label show, and what your options are.

What is Paxil?

Paxil is the brand name for paroxetine, an SSRI (selective serotonin reuptake inhibitor) antidepressant that came to market in 1992.² It also comes as an extended-release form, Paxil CR. In adults, it is FDA-approved for:¹

• Major depression
• Panic disorder
• Generalized anxiety disorder
• Social anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

Paroxetine binds to the serotonin transporter more strongly than any other antidepressant in common use. It also strongly blocks a liver enzyme (CYP2D6) that clears many other drugs, which gives it more drug interactions than most SSRIs.² Always make sure every prescriber and pharmacist knows you take it.

Long-term side effects of Paxil

These are the long-term effects people raise most often:

• Weight gain. In a 6-to-8-month trial comparing three SSRIs, people on paroxetine gained significantly more weight than people on fluoxetine (Prozac) or sertraline (Zoloft). Significantly more of them gained 7% or more of their body weight.³
• Sexual side effects. Lower sex drive, delayed or absent orgasm, and erectile problems are listed on the label.¹ In a large analysis of antidepressants, paroxetine had one of the highest rates of sexual side effects.⁴
• Sexual problems that persist after stopping. Rarely, sexual problems continue after the drug is stopped. This is called post-SSRI sexual dysfunction (PSSD). One study estimated the risk at about 1 in 216 people treated with serotonergic antidepressants.⁵
• Emotional numbness. Many long-term users describe feeling flat or less able to feel joy or sadness. If you notice this, tell your prescriber. It is a common reason people want to change treatment.

Less common but serious risks

The FDA label lists several risks that are less common but important to know:¹

• Mania or hypomania, especially in people with an undiagnosed bipolar condition. Case reports describe mania brought on by paroxetine.⁸
• Low sodium (hyponatremia), more likely in older adults and people taking diuretics. Signs include headache, confusion, weakness, and unsteadiness.
• Bleeding risk, higher when Paxil is combined with aspirin, NSAIDs like ibuprofen, or blood thinners.
• Bone fractures. Studies link SSRIs with more fractures, though it is not clear how much the drugs themselves are the cause.
• Angle-closure glaucoma in people with narrow eye angles.
• Tamoxifen. Paxil can make the breast cancer drug tamoxifen less effective. If you take tamoxifen, ask about a different antidepressant.
• Pregnancy. Taking paroxetine in the first trimester is linked with a higher rate of heart defects in babies (less than double the usual rate). If you are pregnant or planning to be, talk with your doctor before making any change.
• Suicidal thoughts. All antidepressants carry a boxed warning about suicidal thoughts and behavior in children and young adults. Paxil is not approved for anyone under 18.

Can Paxil cause tardive dyskinesia?

It is possible but rare. Tardive dyskinesia is a movement disorder that causes repeated, involuntary movements, usually of the lips, tongue, and jaw. It is most often caused by antipsychotic medications. Antidepressants, including SSRIs, have been linked to it in a small number of cases.⁹ Movements can begin after long-term use and sometimes continue after the medication stops.

If you notice new facial movements, lip smacking, or tongue movements, tell your prescriber promptly. Read more about tardive dyskinesia.

Paxil dependence and withdrawal

Paxil is not addictive in the way drugs that cause cravings are. But after months or years, the brain adapts to it, and lowering the dose can bring on withdrawal. The FDA label lists these symptoms after stopping:¹

• Dizziness and nausea
• Electric-shock sensations, often called brain zaps
• Anxiety, irritability, and agitation
• Low mood and emotional swings
• Sweating, tremor, and headache
• Insomnia, tiredness, and confusion
• Ringing in the ears
• Rarely, seizures

Paroxetine is known for harder withdrawal than most SSRIs, partly because its half-life is short, about 21 hours.^1,2 In 2002 the FDA warned that withdrawal from paroxetine can be severe.¹⁰

Withdrawal is also more common than older guidelines suggested. A review of 14 studies found an average of 56% of people had withdrawal effects when stopping antidepressants. Nearly half of those described them as severe, and symptoms often lasted more than two weeks, sometimes for months.⁷ Symptoms usually start within a few days of stopping and can happen even with a gradual taper.⁶ They are easy to mistake for depression or anxiety coming back.⁶

Can Paxil withdrawal kill you?

Paxil withdrawal is not usually life-threatening by itself, the way alcohol or benzodiazepine withdrawal can be. But it should be taken seriously, for three reasons:

• Mood can drop sharply. Withdrawal can bring low mood, agitation, and emotional swings.¹ The label’s warning to watch closely for worsening mood and suicidal thoughts applies whenever the dose changes.
• Seizures are possible. They are rare, but they are on the label’s list of withdrawal symptoms.¹
• Symptoms can be disabling. Severe dizziness and confusion can affect driving, work, and safety.

If you or someone you love has thoughts of self-harm, call or text 988 (the Suicide and Crisis Lifeline) or go to the nearest emergency room. Then talk with the prescriber about a slower plan.

Coming off Paxil after 10 or 20 years

Many people reading this have taken Paxil for a decade or more. After that long, the brain has had years to adapt, and it is common for prescribers to plan a slower taper with more time between steps. A plan that works for someone who took Paxil for six months may be too fast after twenty years.

It also helps to look at the whole picture: other medications, sleep, nutrition, and what was going on when Paxil was first prescribed. If the original reason has changed, that is worth discussing too.

Benefits of quitting Paxil

For people whose side effects are caused by the drug, coming off can bring real relief. People often hope for:

• Feeling emotions more fully again
• Improved sexual function
• Easier weight management
• Fewer drug interactions to worry about

Results vary. Some side effects, such as PSSD, can persist after stopping.⁵ And for some people, Paxil is doing important work. Lowering the dose isn’t right for everyone. The goal is a decision you make with good information and your prescriber’s support, not a sudden stop.

Support alongside or instead of medication

Whether you stay on Paxil, lower your dose, or come off, these approaches have research behind them for depression and anxiety:

• Cognitive behavioral therapy (CBT) has strong evidence for both depression and anxiety disorders.¹¹
• Regular exercise improves symptoms of depression and anxiety.¹²
• Mindfulness-based therapy reduces anxiety, depression, and stress.¹³
• Nutrition and lab testing can find physical problems, such as thyroid issues or low vitamin D or B12, that worsen mood. Learn about lab testing at ATMC.

Coming off Paxil at home vs. at ATMC

Helping a loved one who wants to come off Paxil

Many people reading this are worried about a spouse, parent, or adult child.

• Listen first. Weight gain, sexual problems, and emotional numbness can be hard to talk about. Take them seriously.
• Discourage stopping suddenly. Paxil withdrawal can start within days.⁶ Encourage a supervised plan instead.
• Know the warning signs. Watch for worsening mood, agitation, or talk of self-harm, and get help right away if they appear.
• Help gather information. List their medications, doses, and how long they’ve taken Paxil, to bring to a provider.

How ATMC helps

At Alternative to Meds Center, clients taper under medical supervision at our residence in Sedona, Arizona. Our medical and nursing teams monitor each client’s taper and adjust the pace as they respond. Our naturopathic team adds nutrient therapy and wellness therapies to help with symptoms along the way. Clients stay about 60 days on average, and we have specialized in medication tapering for nearly 20 years. Learn more about our published outcomes and inpatient medication tapering.

Watch: Long-term effects of Paxil

Get help

If you’ve tried to lower your Paxil dose and had a hard time, or you’re not sure where to start, our admissions team can talk through your situation.

Paxil long-term effects FAQs

Sources:

1. Apotex Corp. PAXIL (paroxetine) tablets prescribing information. DailyMed, U.S. National Library of Medicine. Revised September 2026. [cited 2026 Oct 19]

2. Nevels RM, Gontkovsky ST, Williams BE. Paroxetine-The Antidepressant from Hell? Probably Not, But Caution Required. Psychopharmacol Bull. 2016 Mar 1;46(1):77-104. PMID: 27738376. [cited 2026 Oct 19]

3. Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000 Nov;61(11):863-7. PMID: 11105740. [cited 2026 Oct 19]

4. Serretti A, Chiesa A. Treatment-emergent sexual dysfunction related to antidepressants: a meta-analysis. J Clin Psychopharmacol. 2009 Jun;29(3):259-66. PMID: 19440080. [cited 2026 Oct 19]

5. Ben-Sheetrit J, Hermon Y, Birkenfeld S, et al. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry. 2023 Apr 21;22(1):15. PMID: 37085865. [cited 2026 Oct 19]

6. Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom. 2015;84(2):72-81. PMID: 25721705. [cited 2026 Oct 19]

7. Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav. 2019 Oct;97:111-121. PMID: 30292574. [cited 2026 Oct 19]

8. Morishita S, Arita S. Induction of mania in depression by paroxetine. Hum Psychopharmacol. 2003 Oct;18(7):565-8. PMID: 14533140. [cited 2026 Oct 19]

9. Cornett EM, Novitch M, Kaye AD, Kata V, Kaye AM. Medication-Induced Tardive Dyskinesia: A Review and Update. Ochsner J. 2017 Summer;17(2):162-174. PMID: 28638290. [cited 2026 Oct 19]

10. Tonks A. Withdrawal from paroxetine can be severe, warns FDA. BMJ. 2002 Feb 2;324(7332):260. [cited 2026 Oct 19]

11. Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognit Ther Res. 2012 Oct 1;36(5):427-440. PMID: 23459093. [cited 2026 Oct 19]

12. Mikkelsen K, Stojanovska L, Polenakovic M, Bosevski M, Apostolopoulos V. Exercise and mental health. Maturitas. 2017 Dec;106:48-56. PMID: 29150166. [cited 2026 Oct 19]

13. Khoury B, Lecomte T, Fortin G, et al. Mindfulness-based therapy: a comprehensive meta-analysis. Clin Psychol Rev. 2013 Aug;33(6):763-71. PMID: 23796855. [cited 2026 Oct 19]

Originally Published November 14, 2022 by Alternative to Meds Editorial Team
Updated October 19, 2026

This content has been reviewed and approved by a licensed physician.

Dr. John Motl, M.D.

Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona.  He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine.  Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.

Social Profile: LinkedIn

View Bio

Lyle Murphy

Lyle Murphy is the founder of the Alternative to Meds Center, a licensed residential program that helps people overcome dependence on psychiatric medication and addiction issues using holistic and psychotherapeutic methods.