Paxil (paroxetine) for anxiety: What you need to know

If you’ve been diagnosed with anxiety, you may be wondering if medication is the right treatment option for you. It’s normal to have questions and concerns about starting a new medication for a mental health condition: Many people wonder how effective the medication will be, and what its potential side effects are, among other things.  

One medication often prescribed for anxiety is Paxil, a common brand name for paroxetine. In the U.S., other brand names of the same paroxetine are Brisdelle and Pexeva. We’ve put together this guide to Paxil that includes everything you need to know about the drug. Read on for information about what Paxil is, how it works, its potential side effects, and more.

What is Paxil and how does it work?

Paxil is an SSRI, or a selective serotonin reuptake inhibitor. In your brain, natural chemicals like serotonin play a role in your well-being, including your mood, emotions, and sleep. The way that Paxil works is by blocking serotonin from being absorbed by your neurons (specialized cells in your brain and spinal cord) so, there’s more of it available where it’s needed. Although depression and related conditions are not technically caused by a mere shortage of serotonin—it’s much more complicated than that—increasing the availability of it has been proven to improve symptoms of anxiety and depression.  

Paxil comes in two forms: Paxil and Paxil CR. Paxil CR is the extended-release form, which means that it delivers its dose slower throughout the course of the day. You should discuss with your doctor which form of Paxil makes the most sense for you.  

What conditions does Paxil treat?

Paxil has been approved by the FDA to treat several depression- and anxiety-related conditions, including:

• Major depressive disorder (MDD)
• Generalized anxiety disorder (GAD)
• Social anxiety disorder
• Panic disorders (PD)
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Premenstrual dysphoric disorder (PMDD)

Paxil has also been approved by the FDA to treat symptoms of menopause, like hot flashes, making it a good alternative for people who cannot treat these symptoms with hormones.

Off-label uses

Additionally, Paxil is sometimes used in ways not specifically approved by the FDA. This is called “off-label” use, because the uses aren’t listed on the insert, or “label,” but medical experts have noticed the medication works for treating these conditions in some people. Some off-label uses for Paxil are:

• Postpartum depression
• Irritable bowel syndrome  
• OCD and social phobia in children
• Separation anxiety
• Body dysmorphic disorder
• Premature ejaculation and compulsive sexual behaviors

Although the phrase “off-label” can sound scary, off-label use of drugs is very common and completely legal. In fact, one in five prescriptions written today are for off-label use. That said, your psychiatrist should of course have good reasons for prescribing Paxil off-label, and be sure to communicate them to you.

How long does it take for Paxil to work?

If you’ve been prescribed Paxil for anxiety and depression, you will probably begin to feel the effects of Paxil within 2-6 weeks after you start taking it. While it can be difficult to continue experiencing symptoms after you’ve started a drug, you should try not to quit taking Paxil just because your symptoms are still present after a week or two. Give the drug a full six weeks to have an effect.

How will you know if Paxil is working? Paxil and other SSRIs impact the psychological symptoms of anxiety (as opposed to the physical ones). After taking Paxil for at least 4-6 weeks, you may begin to experience the following kinds of improvements in your symptoms:

• Reduced worry
• Reduced fear
• Reduced irritability
• Improved concentration
• Improved sleep
• Improved mood

There are also other possible benefits and signs that Paxil is working. For example, if you typically experience panic attacks, you may notice you’re having them less often after starting Paxil. However, if you’ve been taking Paxil for two months and haven’t noticed any improvement in your symptoms, you should bring this up with your healthcare professional. Your dose may be too low, or it’s possible that Paxil is not the right medication for you.  

What happens if I miss a dose of paroxetine?

Sometimes, especially if you are still getting into the habit of taking a new medication, you might miss a dose. You should take the missed dose as soon as you remember, unless it’s closer to the time that you would take your next dose, in which case you should skip it.  

For example, if you usually take Paxil in the morning and you remember before you go to bed that you accidentally skipped a dose, take it then. But if you realize it the next morning, just take your next dose as usual.  

One thing to keep in mind when it comes to missing a dose of Paxil or any other medication is the medication’s “half-life.” Half-life is the time it takes for the amount of the drug in the body to decrease by half. The shorter a drug’s half-life is, the sooner you will begin to feel withdrawal symptoms after you miss a dose or stop taking it. Paxil’s half-life is relatively short at about 24 hours.  

Because Paxil’s half-life is on the shorter side, it’s important to take your missed dose as soon as you remember. However, you’re unlikely to begin experiencing withdrawal symptoms if you only miss one dose. If you’re concerned or not sure what to do about a missed dose, you should contact your healthcare provider.

How long do I have to keep taking Paxil?

If you stop taking your medication too quickly, you might experience symptoms of withdrawal from Paxil. Some of the common withdrawal symptoms are nausea, a depressed or anxious mood, headaches, and trouble sleeping. If you decide you want to stop taking Paxil, it is very important that you work closely with your psychiatrist to figure out a taper plan so that you can reduce the risks of having these or other withdrawal symptoms. Following a taper plan means that you will gradually reduce your dosage of Paxil, rather than completely stopping all at once. Because Paxil has such a short half-life, a longer taper than usual is recommended—about 6-8 weeks, depending on what your starting dosage was.  

Your doctor may recommend that you wait at least 6 months or up to a year to ensure your anxiety symptoms are in remission before starting to taper—otherwise you won’t be sure if Paxil is working for you. Remember your doctor will help create a plan to stop medication once you’re feeling more balanced and stable.

Potential side effects

Like all drugs, Paxil has many potential side effects, some of which are common and mild, and others that are more rare and severe.

Common side effects

The most common mild side effects of Paxil include:

• Constipation
• Decreased appetite
• Diarrhea
• Dizziness
• Drowsiness or sleeping too much
• Dry mouth
• Fatigue
• Increased sweating
• Insomnia
• Occasional headaches
• Nausea
• Nervousness
• Sexual dysfunction
• Sweating
• Tremors
• Weight gain

These mild side effects should go away within a couple of weeks after starting Paxil. If they don’t, or you’re worried about experiencing any of them before taking this drug, you should consult with your psychiatrist. They’ll make it a point to address your concerns and help guide treatment.

Related article: Can antidepressants cause weight loss?

Serious side effects

Paroxetine also sometimes has more adverse effects. These occur in fewer than one in 1,000 people, but if you are taking Paxil and you experience any of the following, you should seek medical attention immediately:

• Constant headaches, or ongoing confusion or weakness, or muscle cramps. All of these could be a sign of low sodium in your blood.
• Coughing up blood or blood in your urine
• Black or red poop, or blood in your vomit (these are signs of internal bleeding)
• Blurred vision
• Bleeding from your gums, or mysterious and growing bruises
• Severe restlessness, where you can’t sit or stand still
• Increased risk of suicide in young adults and adolescents

Serotonin syndrome

All SSRIs carry a risk of serotonin syndrome, which is when too much serotonin builds up in your body. This is more likely if you’re taking more than one medication that raises serotonin levels, such as another SSRI, some back or headache medications, or Saint John’s wort. Serotonin syndrome is very serious, but also rare, and your doctor will help minimize the risk. Although symptoms of it range from mild to severe, you should seek immediate medical help if you suspect you are experiencing it.

Mild symptoms of serotonin syndrome

• Nervousness
• Nausea, vomiting
• Diarrhea
• Dilated pupils
• Tremor

Moderate symptoms of serotonin syndrome

• Restlessness
• Muscle twitching, spasms, or rigidity
• Sweating, shivering
• Abnormal (side-to-side) eye movements

Severe symptoms of serotonin syndrome

• Confusion, disorientation, or delirium
• Very elevated heart rate
• High blood pressure
• High body temperature (higher than 101.3 Fahrenheit)
• Seizures
• Abnormal heartbeat
• Passing out or fainting

Other considerations and precautions

If you have certain medical conditions or take certain medications already, Paxil may not be recommended. Your doctor will ask about your health history to make sure it’s safe for you to take. Some specific conditions to discuss include:

• Heart problems
• Bleeding problems
• Seizures
• Glaucoma
• Low sodium levels in your blood
• Bone problems
• Kidney or liver problems

Also mention to your doctor if you are pregnant or could become pregnant, because taking Paxil could harm a fetus. And, because Paxil can pass into your breast milk, you should let your doctor know if you’re breastfeeding.

Finally, studies have shown that Paxil and other antidepressants increase the risk of suicidal thoughts in younger patients, both children and young adults. If you are a parent considering Paxil for your child, be sure to work with their psychiatrist and other doctors to look out for signs of suicidal thoughts and behaviors.  

Paroxetine vs. other medications

Paroxetine is one of the more serotonergic SSRIs, with more potent reuptake inhibition. Other SSRIs commonly used to treat anxiety include Zoloft (sertraline) and Prozac (fluoxetine) and Celexa (citalopram).

There are also SNRIs (serotonin and norepinephrine reuptake inhibitors), which increase the amount of another mood-regulating neurotransmitter, norepinephrine, in your brain as well as serotonin. One common SNRI that can be used to treat some kinds of anxiety is Effexor (venlafaxine). Since Effexor affects two neurotransmitters instead of just one like Paxil does, it could be effective if Paxil or other SSRIs haven’t worked for you.

Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are another family of antidepressants that can be used to treat anxiety. However, they tend to have more side effects and interactions with both diet and other medications, so they are less commonly prescribed than SSRIs and SNRIs.

Is Paxil good for depression and anxiety?

Paxil is an SSRI that is FDA-approved to treat both depression and anxiety. Although Paxil is usually described as an antidepressant medication, the way it works—by increasing the availability of serotonin in your brain—can also help improve the symptoms of anxiety. If you’d like to see if Paxil can help you, the first step is to get a diagnosis from a mental health professional. Once you get a diagnosis, they can talk you through your treatment options, including what anxiety or depression medications might work in your situation.  

If you’re looking for a psychiatrist, consider Talkiatry. We offer in-network psychiatry that is 100% online. Our psychiatrists will work with you to find the best treatment plan for your needs. Get started with a short online assessment.

The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.