Paroxetine, brand name Paxil, is an SSRI (Selective Serotonin Reuptake Inhibitor) that is prescribed to treat anxiety disorders, panic disorders, PTSD, depression, and OCD. Those with these disorders are theorized to have issues producing enough serotonin on their own. Thus, according to the pharmaceutical companies, the purpose of Paxil is to force the brain to retain serotonin by blocking its reuptake to alleviate this deficit.
However hopeful such a hypothesis is, chronic use of SSRIs has been shown to deplete serotonin and its availability rather than improve it, and this is especially true where there was a deficiency to begin with.9 With at least 66% of Americans using prescription drugs, it is vital to consider the long-term effects of Paxil, as it is prescribed to treat common mental health disorders.1
What Are SSRIs and What Do They Do?
SSRIs are most frequently prescribed to treat depression, but have also been prescribed for other psychiatric disorders, including but not limited to, generalized anxiety disorder (GAD), bipolar depression, panic disorder, and post-traumatic stress disorder (PTSD).15 It is also used off-label to treat several other disorders, including body dysmorphic disorder, paraphilias, and fibromyalgia.2
The proposed mechanism by which SSRIs operate is to influence the brain to retain serotonin in those who are assumed deficient, with the stated purpose of treating disorders that may be caused by serotonin deficiency. Serotonin is one of the many neurotransmitters, or chemical messengers, used by neurons to calm, excite, or relay messages to other neurons. Serotonin is thought to calm neurons and positively affect emotion, mood, and sleep.
SSRIs block neurons from naturally absorbing the serotonin, making more serotonin accessible to the brain. While, in theory, higher serotonin availability would help regulate emotions, mood, and sleep, in reality, such effects that do occur are short-lived. In fact, artificially raised serotonin levels can cause negative side-effects.
These can include:
Loss of appetite
Side effects of Paxil in males may also include erectile dysfunction. SSRIs may also cause abnormal heart rhythms that can become dangerous. Worse, too much serotonin may cause the symptoms that SSRIs are prescribed to treat, such as anxiety, confusion, restlessness, and rapid heart rate, to elevate. SSRIs also come with a warning of worsened depression and increased suicidal thoughts.10
Paxil Side Effects
Paroxetine entered the drug market in 1992 with brand names like Aropax, Seroxat, and Paxil.3 Paroxetine was being linked to severe drug interactions by the late 1990s, most notably a 620% increase in the instance of breast cancer for women who had been taking the drug during a four-year time period. This was reinvestigated and found to be largely circumstantial; however, other side effects were discovered during this investigation.
Paxil is frequently prescribed for those with anxiety due to its assumed sedating and calming effects.4 However, if one suddenly stops using Paxil, it has been known to cause a severe withdrawal reaction. Drinking alcohol while taking Paxil is not recommended. In some cases, combining Paxil and alcohol can be lethal in some persons, inducing serotonin syndrome, agitation, disorientation, and other undesirable reactions.11
Paxil side effects include sexual dysfunction side effects, including erectile dysfunction in men, lowered arousal in women, delayed ejaculation, and lowered sexual desire in both men and women.
Unfortunately, when the efficacy and risks of drugs are studied, the length of the majority of these studies is only short term. However, many Americans who have been prescribed SSRIs have been taking them for 10 years or more. This is troubling, as there have been some severe risks associated with long term use of antidepressants, such as a 14% increased risk of cardiovascular events, including heart attack and stroke. Worse, long-term Paxil use is associated with a 33% increased risk of death.5
Serotonin plays vital roles in immune function, digestion, and growth. Continuous disruption of these levels may have wide-ranging negative effects, especially for certain populations. The side effects of Paxil in elderly patients can include negative effects on cognitive function, as there is strong evidence that the long-term usage of Paxil may lead to an increased risk of dementia.6 Also, between 1-8% of patients taking Paxil in various clinical trials developed hypomania and mania symptoms.20 Paxil has been used to treat hot flashes associated with menopause.
While Paxil may decrease incidents of hot flashes, the side effects of Paxil for hot flashes are most commonly fatigue and dizziness. Few studies have been carried out on 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
Serious side effects of long-term Paxil use include:
Loss of coordination
Eye pain, redness or swelling
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, Paxil withdrawal symptoms can be severe and “treatable only by restarting the drug.” 13 Withdrawal symptoms occur when the drug is stopped after drug dependency has developed.
Symptoms of Paxil withdrawal include:
High blood pressure
What Are the Worst Side Effects of Paxil?
Many people taking Paxil experience severe side effects, whether from ceasing use or with continued use of Paxil.
Tapering off of Paxil or any SSRI should be done with the guidance of a medical professional. While many people may be able to stop taking Paxil after several months of use, a number of people may encounter a disorder called tardive dyskinesia. Tardive dyskinesia is an involuntary neurological movement disorder that can be caused by using particular drugs prescribed to treat gastrointestinal and psychiatric conditions.
Tardive dyskinesia occurs when prescribed drugs are taken over a long period of time, and they yield biochemical abnormalities in one area of the brain, called the striatum. 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 withdrawal from the medications.7 The possibility of acquiring this condition increases the longer these drugs are taken.
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
High blood pressure
Loss of muscle coordination or twitching muscles
Rapid heart rate coupled with high blood pressure
Life-threatening symptoms include:
WARNING: The treatment of serotonin syndrome must be done in a hospital or emergency setting to save the life of the patient.
Discontinuation syndrome is a common occurrence when ceasing the use of drugs used to treat depression. Due to health risks, suddenly halting use of Paxil is not recommended. Withdrawal symptoms, also called discontinuation syndrome, are a possibility even if you’re tapering off Paxil, but 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 adverse side effects
Anxiety, confusion, mood swings, or irritability
Dizziness, lightheadedness, or vertigo
Digestive issues, such as nausea, vomiting, diarrhea, decreased appetite, and cramps
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 up to three weeks. The peak of symptom severity commonly occurs around day five. So, how long the side effects of Paxil last can vary from a few days to several weeks.
Withdrawal symptoms are often more severe with Paxil than other SSRIs and more common 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, and this is when withdrawals typically begin to emerge. 15
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. 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 more constructive lifestyle and other strategic choices.
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, instances of depression and rumination are lower, while there is 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 may be prescribed to treat both anxiety and depression, however the side effects and long-term implications of Paxil usage are disturbing and severe. In some cases, the symptoms of anxiety and depression are made worse by using Paxil and other SSRIs. Natural alternatives to Paxil avoid the negative and dangerous side effects while treating underlying anxiety and depression in safer, more constructive ways.
1. Health Policy Institute (2003). Prescription Drugs | Health Policy Institute | Georgetown University. (n.d.). Georgetown University Health Policy Institute Profile. Retrieved May 8, 2022
2. Chu A, Wadhwa R. (2022). Selective Serotonin Reuptake Inhibitors. Treasure Island (FL): StatPearls Publishing. Retrieved May 8, 2022
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.
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.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.