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Paroxetine / Paxil Withdrawal Symptoms, Timeline, and Treatment

Last Updated on April 30, 2024 by Carol Gillette

Alternative to Meds Editorial Team
Medically Reviewed by Dr Samuel Lee MD

Doctors prescribe paroxetine, better known by its brand name Paxil©, to treat depression and other mental health issues. If you or a loved one has been taking Paxil but would like to stop, you should discuss your options with your healthcare provider.

Paxil withdrawal symptoms can be surprisingly harsh and even dangerous, especially if you stop taking the medication abruptly. To best cope with discontinuing Paxil, seek advice from a medical professional and use this article to learn more about the withdrawal symptoms, timeline, and options for withdrawal treatment.


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What Is Paxil Used For?

Paxil (paroxetine) comes in two forms:  immediate release (IR) and Paxil CR (controlled release). The FDA approved Paxil to treat a wide variety of conditions, including the following: 1,10,

  • what is paxil used forGeneralized anxiety disorders (GAD)
  • Social anxiety disorder (SAD)
  • Panic disorder (PD)
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Major depressive disorder (MDD)

Off-label uses for adults can include:

  • Dysthymia (long lasting mild depression)
  • Premenstrual dysphoric disorder
  • Vasomotor symptoms associated with menopause

It is not uncommon for clinicians to prescribe Paxil “off-label” to treat children and adolescents for conditions described in terms such as separation disorder, body dysmorphic disorder, and many others.

As a selective serotonin reuptake inhibitor (SSRI), Paxil is thought to work by blocking the reabsorption of a neurotransmitter called serotonin in the brain. In doing so, Paxil increases the concentration of serotonin, at least temporarily, which is thought to improve the transmission of messages between neurons in your brain that impact mood and anxiety.2

SSRI drugs such as Paxil have become some of the most widely prescribed medications both in the United States and worldwide. Despite their seeming popularity, a person may wish to discontinue using Paxil because the adverse effects have negatively impacted their quality of life.

Paxil and Suicide

Paxil packaging contains a black box warning for increased rates of suicide in those aged 24 and younger. However, more recent research has revisited the numbers, and has found the same risk is present in the adult population, contrary to earlier findings that preceded the black box warning limiting risk to youth only.22

SSRIs such as Paxil should never be stopped abruptly.3

Paroxetine Side Effects

The most common side effects linked to paroxetine include drowsiness, dry mouth, loss of appetite, sexual side effects, lack of energy, and sleep disturbances. Other adverse effects include headaches, dizziness, tremors, chest pain, rash, constipation, and nervousness.1

In rare cases (especially if taken with other drugs that increase serotonin), paroxetine may cause a serious condition called serotonin syndrome. You should seek medical help if you develop a fast heartbeat, vomiting, twitching muscles, unexplained fever, loss of coordination, hallucinations, diarrhea, or nausea.4

More severe side effects of Paxil use may include birth defects if taken during pregnancy, seizures, and suicidal ideation.1

Common Paroxetine Withdrawal Symptoms

In addition to side effects you may encounter while taking paroxetine, you could experience discontinuation syndrome, causing withdrawal symptoms, especially if you try to discontinue use of Paxil abruptly. To minimize Paxil withdrawal symptoms, experts recommend that you seek Paxil tapering help to reduce your dose of Paxil gradually rather than quitting all at once.

Withdrawal symptoms from SSRIs are likely to emerge when discontinued. Risks of withdrawals may increase if you’ve been taking these drugs for an extended period. Most frequent complaints include flu-like symptoms accompanied by anxiety and agitation, dizziness, and sensory disturbances.2,5

Common Paxil withdrawal symptoms may include:
  • Sleep problems such as insomnia, nightmares, and vivid dreams
  • Mood-related symptoms — confusion, suicidal thoughts and thoughts of self-harm, and panic attacks
  • Brain zaps or a buzzing feeling
  • Electric shock-like sensations
  • Headache
  • Fever
  • Nausea
  • Hallucinations
  • Tremors
  • Lethargy
  • Chills
  • Vomiting
  • Dyskinesia (impaired or abnormal movement)
  • Diarrhea
  • Irritability
  • Paresthesia (a “pins and needles,” tickling, or prickly sensation)

How Long Do Paroxetine Withdrawal Symptoms Last?

Anyone who takes a selective serotonin reuptake inhibitor (SSRI) like Paxil risks going through a discontinuation syndrome and withdrawal symptoms. The duration of withdrawal symptoms from paroxetine can vary, depending on how quickly your body eliminates the drug, how long you’ve been taking Paxil, and the size of your dose.

Typically, symptoms of Paxil withdrawal begin sometime within a day or 2 after the last dose. While some individuals see their symptoms lasting no more than 2 to 3 weeks, others have experienced symptoms lasting 4 to 6 weeks, or a number of months in more severe cases, especially after long-term use.6

A longer-lasting and more severe withdrawal timeline is referred to as post-acute withdrawal syndrome (PAWS or PWS). Those affected by PAWS may see their symptoms anywhere from 1 to 8 weeks, months, a year, or even several years. Studies have shown abrupt discontinuation can result in serious illness, and a lengthy recovery time that can be avoided by gentle, gradual dose reduction over time.7,19

What Happens When You Stop Taking Paroxetine?

As mentioned above, abruptly stopping paroxetine can cause you to experience withdrawal symptoms, and in some cases, those symptoms can be severe and last a very long time. Even missing a dose can trigger withdrawal symptoms and cause your original symptoms to recur.

The half-life point is an approximate predictor of when withdrawal symptoms may appear. Both versions of paroxetine have a very short half-life, compared to other SSRIs.1,20,21

  • Paxil immediate release has a half-life of 21 hours.
  • Paxil controlled release has a half-life of 15-20 hours
  • Prozac (fluoxetine) has a half-life of 2-4 days

An important point to consider is that some Paxil products are time-release, or controlled-release, and you may need your prescriber to transition you to an equivalent dose of another SSRI such as Prozac, to avoid complications with measuring and cutting the dosage. The time-release characteristic of a drug will be lost by simply cutting the tablet. In the case of Paxil controlled-release, the half-life is extremely shortened by cutting the pills. So experts recommend you seek Paxil tapering help from a medical professional who can help with this transition, and who can help you navigate a tolerable, gradual reduction of dosage over time.

It is recommended by researchers to ensure adequate time (several weeks, or longer) between dose reductions to allow symptoms of withdrawal to subside before making subsequent reductions. This is an important point as withdrawal symptoms are often misidentified by prescribers unfamiliar with Paxil withdrawal who may interpret these as “relapse.” The symptoms of relapse and withdrawal are difficult to distinguish because the symptoms commonly overlap, which may result in a misdiagnosis.7,16-18

Ways To Cope With Withdrawal Symptoms

Coping with withdrawal syndrome can be a challenge, especially if you suffer from severe withdrawal symptoms. You should always obtain medical advice and support and discuss all options with your healthcare provider. If your prescriber is not certain or familiar with managing Paxil withdrawal, find one who is confident they can help you. It is not uncommon for prescribers to be unaware of the complexities involved with coming off a drug like Paxil.

In addition to seeking professional medical advice, you can:

  • Reach out to a support network.
  • Follow a healthy diet.
  • Get regular exercise.
  • Monitor your mood and warning signs.

Alternative to Meds Center has developed an arsenal of Paxil alternative treatments that can safely and effectively help a person restore and preserve natural mental health. Along with helping clients complete their paroxetine withdrawal program, we offer a wide range of therapies to address specific health issues relating to sleep, mood, energy level, stress reduction, and much more.

Withdrawal Treatment Options

Withdrawal from Paxil can be mild for some, and severe for others. To ease your withdrawal symptoms, discuss these options with your healthcare provider.

Therapy

CBT is a form of therapy that can be effective when recovering from withdrawal and dependence. With the addition of psychological therapy to your treatment program, you receive an individualized, customized approach to your health and well-being, allowing you to address your mental health challenges as part of a program of recovery. Working with the advice of a medical professional, you can find the right combination of treatments you need.8

Tapering

As a selective serotonin reuptake inhibitor (SSRI) antidepressant medication, paroxetine blocks serotonin reabsorption causing an artificial buildup. As a result, if you stop taking paroxetine abruptly, this shocks the central nervous system. Paxil tapering help can minimize this shock.

Alternative Treatments

When you need to ease your discontinuation symptoms, discuss with your doctor whether any of these alternatives can help:

  • Supplements:  Your healthcare provider can discuss whether any over-the-counter treatments, such as vitamins, minerals, and amino acids can boost the production of naturally occurring neurotransmitters precursors and help ease withdrawal symptoms.
  • Diet:  Discuss with a medical professional how improving the diet such as the Mediterranean diet, can provide your body the raw materials needed for recovery. Another example, cutting out or limiting caffeine and sugar, can help you cope better with withdrawal symptoms.12,15
  • Exercise:  Although all exercise plans should be discussed with your healthcare provider, remember that even a short walk can benefit your recovery.11
  • Learning stress reduction techniques can be extremely profitable for improving mental health symptoms without relying on pharmaceutical products.13
  • Removal of accumulated chemical toxins from the body is an often overlooked strategy in mental health symptoms as the presence of symptoms and toxins in the body are often linked.14

Seeking Support

Paroxetine can interfere with your daily life by creating possible side effects while you are taking the drug and the potential for withdrawal if you decide to stop taking it. If you need Paxil tapering help so that you can discontinue your medication safely or you need help dealing with withdrawal symptoms, discuss all of your alternatives with your healthcare provider.

If you need additional support and want to explore Paxil alternatives, don’t hesitate to reach out to your healthcare provider and contact Alternative to Meds Center.

1 (800) 301-3753 for Paxil Withdrawal Help

Sources:

1. Accessdata.fda.gov. “Paroxetine FDA Label.” [cited Mar. 30, 2022]

2. Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554406/ [cited 2022 July 27]

3. 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; PMCID: PMC5044489. [cited 2022 July 27]

4.; Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013 Winter;13(4):533-40. PMID: 24358002; PMCID: PMC3865832. [cited 2022 July 27]

5. Wilson E, Lader M. A review of the management of antidepressant discontinuation symptoms. Ther Adv Psychopharmacol. 2015 Dec;5(6):357-68. doi: 10.1177/2045125315612334. PMID: 26834969; PMCID: PMC4722507. [cited 2022 July 27]

6. Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry. 2019 Jun;6(6):538-546. doi: 10.1016/S2215-0366(19)30032-X. Epub 2019 Mar 5. PMID: 30850328. [cited 2024 Jan 13]

7. Sage Journals. “Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum” [cited Mar. 3, 2022]

8. Carroll KM, Onken LS. Behavioral therapies for drug abuse. Am J Psychiatry. 2005 Aug;162(8):1452-60. doi: 10.1176/appi.ajp.162.8.1452. PMID: 16055766; PMCID: PMC3633201. [cited 2022 July 27]

9. Young SN. How to increase serotonin in the human brain without drugs. J Psychiatry Neurosci. 2007 Nov;32(6):394-9. PMID: 18043762; PMCID: PMC2077351. [cited 2022 July 27]

10. Shrestha P, Fariba KA, Abdijadid S. Paroxetine. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526022/ [cited 2024 Jan 13]

11. Schuch FB, Vancampfort D. Physical activity, exercise, and mental disorders: it is time to move on. Trends Psychiatry Psychother. 2021 Jul-Sep;43(3):177-184. doi: 10.47626/2237-6089-2021-0237. Epub 2021 Apr 21. PMID: 33890431; PMCID: PMC8638711. [cited 2024 Jan 13]

12. Bremner JD, Moazzami K, Wittbrodt MT, Nye JA, Lima BB, Gillespie CF, Rapaport MH, Pearce BD, Shah AJ, Vaccarino V. Diet, Stress and Mental Health. Nutrients. 2020 Aug 13;12(8):2428. doi: 10.3390/nu12082428. PMID: 32823562; PMCID: PMC7468813. [cited 2024 Jan 13]

13. Franke HA. Toxic Stress: Effects, Prevention and Treatment. Children (Basel). 2014 Nov 3;1(3):390-402. doi: 10.3390/children1030390. PMID: 27417486; PMCID: PMC4928741.[cited 2024 Jan 13]

14. Genuis SJ. Toxic causes of mental illness are overlooked. Neurotoxicology. 2008 Nov;29(6):1147-9. doi: 10.1016/j.neuro.2008.06.005. Epub 2008 Jun 24. PMID: 18621076. [cited 2024 Jan 13]

15. Firth J, Gangwisch JE, Borisini A, Wootton RE, Mayer EA. Food and mood: how do diet and nutrition affect mental wellbeing? BMJ. 2020 Jun 29;369:m2382. doi: 10.1136/bmj.m2382. Erratum in: BMJ. 2020 Nov 9;371:m4269. PMID: 32601102; PMCID: PMC7322666. [cited 2024 Jan 13]

16. Sørensen A, Juhl Jørgensen K, Munkholm K. Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review. Ther Adv Psychopharmacol. 2022 Feb 11;12:20451253211067656. doi: 10.1177/20451253211067656. PMID: 35173954; PMCID: PMC8841913. [cited 2024 Jan 13]

17. Sørensen A, Jørgensen KJ, Munkholm K. Description of antidepressant withdrawal symptoms in clinical practice guidelines on depression: A systematic review. J Affect Disord. 2022 Nov 1;316:177-186. doi: 10.1016/j.jad.2022.08.011. Epub 2022 Aug 12. PMID: 35964766. [cited 2024 Jan 13]

18. Sørensen A, Juhl Jørgensen K, Munkholm K. Clinical practice guideline recommendations on tapering and discontinuing antidepressants for depression: a systematic review. Ther Adv Psychopharmacol. 2022 Feb 11;12:20451253211067656. doi: 10.1177/20451253211067656. PMID: 35173954; PMCID: PMC8841913. [cited 2024 Jan 13]

19. van Geffen EC, Hugtenburg JG, Heerdink ER, van Hulten RP, Egberts AC. Discontinuation symptoms in users of selective serotonin reuptake inhibitors in clinical practice: tapering versus abrupt discontinuation. Eur J Clin Pharmacol. 2005 Jun;61(4):303-7. doi: 10.1007/s00228-005-0921-x. Epub 2005 May 20. PMID: 15906018. [cited 2024 Jan 13]

20. Paroxetine: Dosage, Mechanism/Onset of Action, Half-life [published online Feb. 17, 2020] [cited 2024 Jan 13]

21. Sohel AJ, Shutter MC, Molla M. Fluoxetine. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459223/ [cited 2024 Jan 13]

22.  Hengartner M,  Ploderl M,  Newer-generation Antidepressants and Suicide Risk …. published in the Journal of Psychotherapy Psychosomatics [published June 4, 2019] [cited 2024 April 24]

Originally Published July 28, 2021 by Diane Ridaeus


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

Dr. Samuel Lee

Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente.  He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.

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