Selective serotonin reuptake inhibitor (SSRI)
ATC code: N06AB05 (Paroxetine)
Brand names
Paxil, Seroxat, Motivan
The most serotonin-selective SSRI with mild additional anticholinergic action. Also a strong CYP2D6 inhibitor – significantly raises metoprolol, codeine (blocks morphine conversion), tramadol, tamoxifen levels (breast cancer recurrence risk). Short 21-hour half-life and active metabolite without accumulation – the worst discontinuation syndrome among SSRIs.
First line
First-line for generalized anxiety disorder. Effect at 4–6 weeks. Dose 20–50 mg daily.
Second line
Second-line for major depressive disorder per NG222 (2022) after sertraline and escitalopram. Dose 20–50 mg once daily in the morning. Worse tolerability than other SSRIs due to severe discontinuation syndrome, weight gain, and sexual dysfunction. Cipriani 2018 showed efficacy comparable to other SSRIs but worse tolerability.
First line
First-line for obsessive-compulsive disorder at high doses 40–60 mg once daily. Effect at 8–12 weeks.
First line
First-line for panic disorder. Dose 20–60 mg once daily. Low start dose (10 mg) with slow titration – anxiety worsening possible in first weeks.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Paroxetine is an SSRI antidepressant. It is prescribed for depression, generalized anxiety disorder, panic disorder, social anxiety, and post-traumatic stress disorder ( 2022 and NG222 guidelines). For emotional regulation or workplace stress, paroxetine does not work: no clinical studies of such use exist. Paroxetine has the most severe discontinuation syndrome among SSRIs: abrupt stopping causes dizziness, brain-zaps, nausea, and anxiety, sometimes lasting weeks. Other risks: sexual dysfunction, weight gain, teratogenicity ( category D, risk of fetal cardiac defects), and increased suicide risk in young adults (FDA boxed warning). If paroxetine was prescribed for emotional regulation, consider seeking a second opinion.
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Boxed warning
FDA boxed warning: antidepressants increase suicidal ideation and behavior risk in children, adolescents, and young adults under 24 during the first weeks.
FDA category D since 2005. T1 raises cardiac defect risk 1.5–2-fold. T3 risks persistent pulmonary hypertension of the newborn and neonatal adaptation. Sertraline is preferred in pregnant depression.
Low milk concentrations. Compatible with breastfeeding.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Paroxetine is evaluated for the following indications with varying evidence strength: Generalized anxiety disorder (evidence tier A), Panic disorder (evidence tier A), Obsessive-compulsive disorder (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Paroxetine (≥ 1 in 100): Nausea, Drowsiness, Dry mouth, Weight gain, Sexual dysfunction (more marked than other SSRIs), Constipation. See the Safety section for uncommon and serious reactions.
FDA category D. FDA category D since 2005. T1 raises cardiac defect risk 1.5–2-fold. T3 risks persistent pulmonary hypertension of the newborn and neonatal adaptation. Sertraline is preferred in pregnant depression.
Low milk concentrations. Compatible with breastfeeding.
Paroxetine is contraindicated in: Paroxetine hypersensitivity; Concurrent MAO inhibitors or within 14 days of stopping; Concurrent thioridazine, pimozide (QT prolongation risk); Concurrent tamoxifen (reduced breast cancer efficacy); Pregnancy (category D). Full list in the Safety section.
FDA boxed warning: antidepressants increase suicidal ideation and behavior risk in children, adolescents, and young adults under 24 during the first weeks.