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Long-Term Effects of Paxil

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Medically Reviewed Fact Checked

Last Updated on November 15, 2022 by Diane Ridaeus

Long Term Effects of Paxil

Alternative to Meds Editorial Team
Medically Reviewed by Dr Michael Loes MD

What is Paxil and Why is it Prescribed?

Paxil© (generic paroxetine) entered the drug market in 1992. Other brand names include Aropax© and Seroxat©.3 Paxil is available in immediate-release and extended-release (Paxil CR) forms. This medication is classed as an SSRI type of antidepressant. SSRIs are primarily discussed as serotonergic, that is, targeting the transmitter serotonin. However, chronic or long-term Paxil use also targets many other neurotransmitters including acetylcholine, histamine, dopamine, GABA, noradrenaline, and glutamate as examples.27,33 Paxil is FDA-approved to treat a wide variety of disorders, including MDD (major depressive disorder), OCD (obsessive-compulsive disorder), PD (panic disorder), SAD (social anxiety disorder), GAD (generalized anxiety disorder, and PTSD (posttraumatic stress disorder).15 It is also prescribed off-label to treat numerous other disorders, including binge eating, hot flashes associated with menopause, paraphilias (examples are sexual interest in children, exhibitionism, sexual sadism, voyeurism), Raynaud phenomenon (fingers turning blue when triggered by cold or stress), fibromyalgia, and others.2

Paxil is frequently prescribed for anxiety due to its sedating and calming effects. There can be dangerous drug-drug interactions if taking other medications at the same time as Paxil. Always ensure your healthcare provider knows exactly what other drugs you are taking.21

Drinking alcohol while taking Paxil is not recommended. In some cases, combining Paxil and alcohol can be lethal and can induce serotonin syndrome, agitation, disorientation, and other risks.11

How Long is Paxil Prescribed?

Guidelines for physicians, psychologists, and psychiatrists treating depression speak in terms of months and years of medication-based treatment, yet long-term clinical trials are few. The entire round of Paxil drug trials lasted 8, 10, or 12 weeks, and one study did follow-ups for “up to one year,” (no other specifics provided) before commercial approvals were granted.15 Apart from pre-marketing trials, some medical authorities have given guidelines. But guidelines that are authored by recipients of grants or other monies from the drugmakers, the question of bias must come into play.21

Of further concern, a plan to accelerate drug approvals WITHOUT requiring safety confirmation studies was put in place in 1992, the year that Paxil came to market, allowing drug companies to sell new drugs in the US without knowing whether they are safe or not. There was a requirement to complete post-market safety and efficacy trials to retain approval status, but according to a 2022 article in The Lancet, these were often ignored. In 2022 new legislation was passed to begin to enforce these confirmation trials more stringently.

Given the paucity of long-term trials and the aforementioned laxness of the drug approval process, it is not surprising that SSRIs have been prescribed for the last 30 years without any truly rigorous oversight. These factors make it impossible to provide authentically reliable guidelines on how long one should take Paxil. But statistics show that the overarching trend has been to prescribe antidepressants for an indefinite time horizon, typically years or for life.22

The “Science” of SSRIs

The mechanism by which SSRIs like Paxil operate is unknown, according to drugmakers and the FDA.15 You can correctly say that is “the science” of SSRIs.15 The clever advertising angle that has been overlaid on the matter suggests that a deficiency of serotonin causes depression, panic attacks, hot flashes, and the many other things they are prescribed for. And the idea passed along to consumers is that SSRIs improve that deficiency and that’s what you do — take an SSRI to fix the symptom.23

Serotonin is one of the body’s many neurotransmitters, or chemical messengers, that relay messages to and from the neurons that make up the central nervous system. No drug can create serotonin. Serotonin is a natural hormone that regulates thousands of functions in the body such as mood, energy, and sleep.

SSRIs block serotonin, making it accumulate at the synaptic cleft, instead of continuing on through its natural course throughout the body. While in theory, higher serotonin availability would improve mood, energy, and sleep, such improvements that do occur are short-lived. In fact, artificially concentrated serotonin levels will soon degrade and become waste products, resulting in a deficiency. Whether one had or did not have a serotonin deficiency prior to SSRI treatment, one will surely develop one as a long-term effect of Paxil or similar drugs. This phenomenon has been clearly demonstrated in clinical studies.24,25

Common Long-term Effects of Paxil

A broad set of data has accumulated over the last 30 years on the most common long-term effects of Paxil. Not everyone reacts in the same way. There can also arise more serious, rare long-term effects that can, unfortunately, become chronic and debilitating, A common outcome is for a depressed person to become manic or some other undesirable manifestation after medication, and their diagnosis may be changed to Bipolar, for example. This can introduce further complexities and errors in treatment. It is advisable to understand as much as possible what can occur after being on an SSRI for a significant period of time. Paxil affects more than serotonin and these long-term effects may be better understood by relating them to the various neurotransmitters the drug affects. A more expanded description follows this list.

Common long-term effects of Paxil can include:
  • Acetylcholinergic effects
  • Serotonergic effects
  • Dopaminergic effects
  • Histaminergic effects
  • GABA-ergic effects
  • Noradrenalinergic effects
  • Glutaminergic effects
  • Paradoxical effects


  • Anticholinergic effects — This set of symptoms may arise from disruption of the acetylcholine neurotransmitters and can include slowed gastrointestinal motility, (constipation, urinary retention), increased heart rate, sedation, delirium, heat intolerance, fever, blurred or impaired vision, and others.28
  • Serotonergic effects — Serotonin is a major transmitter in the body affecting thousands of functions and behaviors. The reactions to increased serotonin vary widely and include cardiovascular effects like high blood pressure or racing heart rate. Physical manifestations may include developing glaucoma, dermatitis, seizures, tremors, migraines, decreased bone density, and nausea, Psychiatric-type symptoms can include akathisia, increased energy and impulsivity leading to taking action on suicidal thoughts, delirium, mania, hallucination, insomnia, agitation, irritability, and others. Serotonin dysfunction is also associated with memory, anxiety, apathy, crying spells, and emotionally triggered asthma.29.30
  • Dopaminergic effects — Dopamine is the “reward” chemical. A state of dopamine dysfunction is associated with decreased executive functions, lowered impulse control, mania, elevated heart rate, and increased blood pressure in the brain which can lead to stroke or other injuries.31
  • Histaminergic effects — Paroxetine also affects the histamine neurotransmitters. Disruption of this hormone can negatively affect the airway and respiration, the mucous membranes (throughout the body) which may present as allergic symptoms or rashes, can affect the heart and circulation of blood, vascular dilation or constriction, and many other manifestations. 32
  • GABA-ergic effects — GABA is a primary inhibitory transmitter that affects a multitude of spinal cord, neurologic and psychiatric conditions. Dysfunctional GABA can present in significant ways that include seizures, liver dysfunction, and muscle movement disorders.34
  • Noradreanalinergic effects — When noradrenaline (basically adrenaline) becomes dysregulated the manifestations can include agitation, arousal, fear response, panic, and the fight or flight response.35
  • Glutaminergic effects — Glutamate comprises the most abundant amino acid in the brain. It functions as an excitatory hormone, but in a tightly-coordinated fashion with other neurotransmitters that regulate how much glutamate needs to be active along the nerves in the brain. When glutamate becomes dysregulated the results can include over-excited responses such as fear, panic, dread, movement disorders, and anxiety. Also found troubling is the paradoxical reversals of such symptoms, such as low mood or muscle paralysis and stiffness, associated with chronic use of GABAergic medications.36
  • Paradoxical effects — SSRIs are prescribed to quell anxiety and stop panic attacks. However, paradoxical effects which are poorly understood can also occur. Increased frequency of panic attacks, anxiety, and brain zaps or “shivers” are such paradoxical effects that can occur with short-term and long-term use in some persons. These manifestations can also occur when attempting to discontinue SSRI treatment. Without proper treatment, these manifestations may linger for a very long time.38-40
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Serious and Rare Long-Term Paxil Effects

Many have been prescribed SSRIs for 10 years or more. This is troubling, as there have been some severe risks associated with the long-term use of antidepressants. Watch the video to learn more.

Serious long-term Paxil effects can include:
  • Cardiovascular events, stroke, heart attack
  • Tardive dyskinesia 26
  • Increased risk of death 5
  • Loss of coordination leading to falls
  • Restlessness
  • Muscle weakness, tremors
  • Increased risk of dementia 6
  • Clotting or bleeding
  • Seizures
  • Mania 20
  • Bipolar disorder
  • Liver disease
  • Kidney disease
  • Heart disease

SSRIs and Pregnancy Risks

Few studies have been carried out on the use of SSRIs during pregnancy, but the ones that are published show increased risk to the infant including premature term, smaller head growth, and the potential for numerous other birth defects, for which the drug maker has been fined over $1 billion in damages to 800 cases reported up to 2010. No data for later lawsuits concerning birth defects has been published on extensive search.12

Paxil and Dependency

While most SSRIs aren’t a primary concern for recreational use, dependency is a possibility with any drug. According to the FDA, coming off Paxil can cause severe reactions, “treatable only by restarting the drug.” 13 These symptoms occur when the drug is stopped after drug dependency has developed.

Once dependency has developed, stopping the drug can cause:
  • Brain zaps
  • Panic attacks
  • Agitation
  • Aggression
  • Diarrhea
  • Forgetfulness
  • Headaches
  • High blood pressure
  • Insomnia
  • Sexual dysfunction
  • Sweating
  • Weight gain

Tardive Dyskinesia

Tardive dyskinesia is an involuntary neurological movement disorder that is medication-induced. Sometimes it persists despite stopping the medication. Often once it develops, the condition is difficult to reverse.

Tardive dyskinesia is typified by involuntary movements of the lips, tongue, and jaw. These movements appear abnormal. Movements such as grimacing, fish-like mouth movements, or sticking out the tongue are typical.

SSRIs may increase incidences of tardive dyskinesia. Symptoms of tardive dyskinesia have been reported to occur up to one year after stopping the medications.7 The possibility of acquiring this condition increases the longer these drugs are taken.

Serotonin Syndrome

Serotonin Syndrome

Both short and long-term use of SSRIs may cause what is called serotonin syndrome, or an undesirable drug-induced increase of serotonin levels. This life-threatening condition can occur as a result of SSRIs or the use of multiple drugs that cause a synergistic increase in levels of serotonin.11,14

This serious drug reaction can cause mild to severe symptoms, the worst of which is death. These symptoms typically occur within a few hours of increasing a drug dosage or taking a new drug that increases levels of serotonin. Milder symptoms may include:

  • Agitation or restlessness
  • Confusion
  • Dilated pupils
  • Diarrhea
  • Goosebumps
  • Headache
  • High blood pressure
  • Heavy sweating
  • Insomnia
  • Loss of muscle coordination or twitching muscles
  • Muscle rigidity
  • Rapid heart rate coupled with high blood pressure
  • Shivering
Life-threatening symptoms include:
  • High fever
  • Irregular heartbeat
  • Seizures
  • Tremor
  • Unconsciousness
WARNING:  The treatment of serotonin syndrome must be done in a hospital or emergency setting to save the life of the patient.

Discontinuation Syndrome

Discontinuation syndrome is a common occurrence when ceasing the use of drugs used to treat depression. Due to health risks, suddenly halting the use of Paxil is not recommended. Discontinuation syndrome is a possibility even if you’re in the process of reducing the dosage, which should always be done with medical supervision. Discontinuation reactions can be much more severe if you stop cold turkey.

Because Paxil specifically affects levels of serotonin in the body, stopping it rapidly can cause some very troubling adverse effects.

Common adverse effects of Paxil discontinuation may include:
  • Suicidal thoughts
    Anxiety, confusion, mood swings, or irritability
  • Dizziness, lightheadedness, or vertigo
  • Digestive issues, such as nausea, vomiting, diarrhea, decreased appetite, and cramps
  • Flu-like symptoms
  • Headache
  • Loss of coordination
  • Ringing noises in the ears
  • Sleep issues, including insomnia, excessive dreaming, or nightmares
  • Tremors, restless legs, or mumbling

Stopping Paxil, even slowly, may result in physical or mental symptoms. Another possible disturbing symptom is what’s often described as being ‘zapped,’ or feeling an electric shock in the brain. Unfortunately, this sensation is something that can happen several times a day and may be activated by rapid eye movement.

Typically, discontinuation symptoms will begin within one to two days of ceasing Paxil use and may last for weeks, months, or even years in rare cases.  So, how long the reactions and changes last can vary from person to person. 

Symptoms experienced when coming off Paxil are often more severe than other SSRIs and appear to occur more commonly than the drugmakers originally stated. This is likely due to its short half-life. The half-life of a drug is the amount of time for half of the drug to be metabolized, and become inactive. Paxil’s half-life is about 21 hours, the second shortest half-life of any SSRI on the market today. The half-life point is typically when you can estimate discontinuation symptoms can begin to emerge.15

Alternatives to Paxil

Alternatives to Paxil

Often, patients are prescribed these drugs long before any in-depth alternative treatments are conducted or considered. If you’re taking SSRIs like Paxil or have been prescribed Paxil but have not yet started your medication, there are several alternatives to the pharmaceutical approach.

Microbiome Health in the Gut

Restoring the gut microbiome is one such approach. Antibiotics and SSRIs can wreak havoc on the good gut bacteria present in our bodies and can severely impact our health. Attention to the microbiome via supplements and adjusting your diet can help you address this imbalance and improve cognitive function. Daily consumption of probiotics, prebiotics, fermented foods, omega-3 fatty acids, fresh fruits and vegetables are excellent choices for supporting mental wellness.16


Cognitive behavioral therapy, or CBT, is another approach that has been well-documented as highly efficacious for many conditions, and with longer-lasting results than pharmaceutical treatments. CBT is a common type of talk therapy that has shown positive efficacy for the treatment of conditions like depression and anxiety. CBT helps a patient become conscious of negative self-talk and negative thinking in order to respond better to situations and provides an opportunity to create a more constructive lifestyle and other strategic choices for change.37


Exercise is one of the most effective ways to treat the symptoms of anxiety and depression. Whether practicing Bikram yoga, or committing to aerobic exercise, the benefits are clear. Studies found that Instances of depression and rumination were lower, while there was an increase in positive improvements in mood. 8,17

Mindfulness and Relaxation

Relaxation techniques, such as mindfulness-based therapy, acupuncture and massage therapy, have been shown to relieve feelings of stress and other symptoms of anxiety and depression. The popularity of these techniques has been growing in Western settings. Overall, the goal is relaxation and relief of mental distress without drugs.18,19

There’s an Alternative

Paxil is FDA-approved to treat both anxiety and depression and myriad other unwanted symptoms. However, the long-term effects of Paxil usage for many persons become disturbing and severe. In some cases, the symptoms of anxiety and depression are made worse by using Paxil and other SSRIs. Natural drug-free approaches avoid the negative and dangerous adverse effects while treating underlying anxiety and depression in safer, more constructive ways. Please contact us to find out more about treatment options for the long-term effects of Paxil or other medications that have failed to achieve your personal goals for natural mental health. 

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

Dr. Michael Loes, M.D.


Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.

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Long-Term Effects of Paxil
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