Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 10/9/2022
If you have major depressive disorder, another form of depression like bipolar disorder or an anxiety disorder, a mental health professional may recommend you try an antidepressant treatment to alleviate your symptoms.
One common antidepressant is called Paxil. For it to be effective, you’ll want to work closely with a mental health professional to get the dosage right. If your dose is too low, it may not work. If you take too much, your side effects may be pretty rough.
But before you get to dosage, it’s helpful to understand a bit more about this medication.
Paxil, which is the same as the generic paroxetine, is a type of antidepressant called a selective serotonin reuptake inhibitor.
There are a number of mental health conditions that paroxetine is prescribed to treat, including major depressive disorder, bipolar disorder, various anxiety disorders (like generalized anxiety disorder, panic disorder or social anxiety disorder) and premenstrual dysphoric disorder.
Paxil can also be used “off-label” to treat obsessive-compulsive disorder and irritable bowel syndrome in children.
So, how does paroxetine work? To understand, you need to know how SSRIs work. Essentially, they raise serotonin levels in the brain. Serotonin is a neurotransmitter, which is a type of brain chemical that brings messages between neurons. It’s thought that low levels of serotonin are connected to both depression and anxiety.
Before you start a new medication, you should tell your healthcare provider if you are on any other medications so that they can make sure there are no drug interactions with paroxetine. It’s also important to tell them if you’ve had allergic reactions to medications in the past.
Research supports that paroxetine can be an effective treatment for anxiety and depression. One study concluded that it worked better than a placebo in treating acute major depression.
An older randomized trial, published in 2001, also found that paroxetine, along with two other SSRIs called fluoxetine and sertraline, were all equally effective in helping with depressive symptoms.
When it comes to anxiety disorders, there is also research to support the effectiveness of paroxetine. One study found that patients who took between 20mg and 40mg a day for GAD saw an improvement in their symptoms.
A more recent study, published in 2020, looked at adults with social anxiety disorder. It found that paroxetine was effective and well-tolerated by people with this type of anxiety.
Paroxetine comes in tablets and liquid form. The tablets come in 10mg, 20mg, 30mg and 40mg. The liquid form is a 10 mg daily dose.
The best person to determine the correct dosage for you is your healthcare provider. Often, you will be started on a low initial dose. You’ll then work with your healthcare provider to increase the dose over time until you notice the symptoms of whatever you’re trying to address start to subside. Your target dose is whatever dose you are on when symptoms go away.
If you are taking Paxil to treat major depressive disorder (MDD), it’s often recommended that you start with an initial dose of 20mg a day.
From there, your healthcare provider may increase your dosage in 10mg increments, to a maximum dose of 50mg a day.
When Paxil is used to treat GAD, the dosage recommendations are the same as those for MDD. However, it’s thought that 20mg a day is the most effective for GAD.
For OCD, 20mg a day is also the suggested initial dose. And, just like with MDD, it can be increased in increments of 10mg a day — up to a maximum dosage of 60mg a day — until the right dose for you is found.
This same dosage flow is used for social anxiety disorder.
When it comes to treating panic disorder, patients are usually started on 10mg a day. The medication is then incrementally increased by 10mg a day in intervals of at least one week.
The target dosage for treating panic attacks and panic disorder is 40mg a day and the maximum dosage shouldn’t exceed 60mg a day.
Generally, a healthcare provider will help you increase your dosage slowly. If you don’t go slow, you may notice more side effects of paroxetine.
But just because Paxil often works, that doesn’t mean it’s totally without side effects.
Like any medication, some people do notice adverse effects from paroxetine. Some of the common side effects include:
Weight loss or weight gain
If you notice side effects, you should speak with your healthcare provider.
Along with the above mild side effects of paroxetine, there are some more severe side effects. They are rare, but it is helpful to be aware of them, just in case.
These severe adverse effects of paroxetine include chest pain, difficulty breathing, an irregular heart rhythm, fainting and more.
Serotonin syndrome is another potential serious side effect. Its symptoms include fever, seizures, shivering, diarrhea, severe muscle tightness and confusion.
If you notice any of these serious symptoms, reach out to a medical provider as soon as possible. Additionally, if you suspect any allergic reactions, contact a professional immediately.
Paxil does have a Black Box warning from the FDA. This is because antidepressants can, in rare instances, lead to suicidal thoughts and behaviors. This can particularly affect young people when they take antidepressants.
Another thing to know: If you start taking paroxetine and decide you want to stop, don’t quit cold turkey. Instead, you will want to lower your dosage slowly under the supervision of a healthcare provider until you are totally off of the medication. This can help you mitigate withdrawal symptoms.
Some people should probably not take any dosage of Paxil.
Those who Paxil may not be right for include:
People who are allergic to paroxetine
Those who are taking a monoamine oxidase inhibitor (an older type of antidepressant) or have taken this type of medication within two weeks
Individuals on certain antipsychotic medications
If you are pregnant or breastfeeding, you should also speak with a healthcare provider before taking Paxil. This medication does pose an increased risk for birth defects and it could pass through your breast milk.
People who have bipolar disorder, deal with liver or kidney problems, have high blood pressure or glaucoma or deal with other health issues should also speak with a healthcare professional before taking any dosage of Paxil.
Paxil (and the generic version, paroxetine) is an antidepressant medication used to treat major depression and anxiety disorders like generalized anxiety disorder, posttraumatic stress disorder, social anxiety disorder and panic disorder.
It can also be used to treat premenstrual dysphoric disorder, which can cause things like anger, depression and fatigue before your period.
As with any medication, there are some side effects of paroxetine. Most are mild and should subside. Very rarely, people experience more serious adverse effects — like chest pain and serotonin syndrome. If you notice any side effects, you should seek medical advice.
Often, a healthcare professional will start you on a lower daily dose. Then, that daily dose may be increased until the symptoms you are treating subside. This means that your initial dose may not be your target dose. A healthcare provider will also be able to monitor what your maximum dosage should be.
If you’d like to discuss taking a daily dose of paroxetine, want to discuss another type of antidepressant treatment or need medical advice pertaining to psychiatric disorders, schedule a consultation with a healthcare provider.