Using Paxil for Generalized Anxiety Disorder

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Paxil (paroxetine) is a medication used in the treatment of generalized anxiety disorder (GAD). It belongs to a group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). SSRIs are first-line drugs used for treating anxiety disorders, along with serotonin-norepinephrine reuptake inhibitors (SNRIs).

Paxil is one of only two SSRIs approved by the U.S. Food and Drug Administration (FDA) for treating GAD, the other being Lexapro (escitalopram). While some people may notice a greater improvement in their anxiety symptoms when taking Paxil over other SSRIs, they might also have more side effects.

In addition to GAD, Paxil is also FDA-approved to treat depression, social anxiety disorder (SAD), panic disorder (PD), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), premenstrual dysphoric disorder (PMDD), and menopause-related hot flashes.

How Paxil Works

Even though SSRIs like Paxil have been widely used since the late 1990s, scientists still don't know precisely how they work. At first, they thought that simply increasing serotonin levels reduced symptoms associated with anxiety. 

What Is Serotonin?

Serotonin is a neurotransmitter, meaning that the brain and nervous system use it to communicate. This naturally occurring chemical plays a role in various processes, including mood regulation and memory function. Low levels of serotonin are associated with depression and anxiety.

But SSRIs correct serotonin imbalances within 24 hours. So, if the increased level of serotonin was solely responsible for anxiety, symptoms would disappear as soon as you took the medication. 

Researchers have since learned that higher levels of serotonin boost the brain's ability to rewire and remodel itself in ways that reduce anxiety symptoms. This restructuring takes time. That’s why it usually takes four to six weeks for the full benefit of the drug to kick in.

Paxil and GAD

GAD is characterized by persistent and excessive worry about a number of different topics such as health, money, and work. Quite often, someone with GAD has worries or fears that are out of proportion to the situation. Medications can help ease these anxieties.

SSRIs such as Paxil are typically the first medications tried for treating GAD. If Paxil doesn't provide relief, another SSRI may be tried. If that doesn't work, the next step is an SNRI. If the GAD is not responsive to that, a tricyclic antidepressant or antipsychotic medication may be prescribed.

In contrast to benzodiazepines, antidepressants such as Paxil mainly affect the psychic (psychological distress) symptoms of anxiety—including worry, fear, irritability, and concentration difficulties. Research shows that Paxil is effective for reducing anxiety in people with GAD, regardless of gender and race.

Several studies further suggest that using GAD medications such as Paxil for at least six months after remission can help reduce symptom relapse. Engaging in psychotherapy can also help. Cognitive behavioral therapy (CBT) is one option found to not just reduce GAD symptoms, but it can also improve quality of life.

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Side Effects of Paxil

When compared with other SSRIs, paroxetine tends to have a higher incidence of adverse effects. If you are taking Paxil and have bothersome side effects, talk with your healthcare provider. The dosage may need to be adjusted or you might need to switch to a different medication.

Common side effects when taking Paxil include:

Rare side effects of Paxil include bleeding, teeth grinding, and low blood sodium levels. Serious side effects are seizure and serotonin syndrome, which happens when there is too much serotonin in the body and can lead to death. If any of these are experienced, medical attention is required.

Paxil Black Box Warning

Paxil does have an FDA black box warning indicating that children and young adults may have an increased risk of suicidal thoughts and behaviors when taking antidepressant drugs. This drug is not approved for pediatric patients, but if a young adult appears to have worsening depression symptoms, it is important to seek help immediately.

If you or someone you love is having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Taking Paxil Safely

As with any medication you take, care should be taken to ensure that you use Paxil safely. If you have any questions or concerns about whether this GAD medicine is safe for you, talk with your healthcare provider or pharmacist.

Dosing Information

Your healthcare provider will probably start you on a low dose of Paxil at first, with the recommended starting dose being 20 milligrams (mg) per day. If this doesn't provide symptom relief, the dosage may be increased in 10 mg increments with a maximum dosage of 50 mg daily.

You can take Paxil with or without food, at any time of the day. If you miss a dose, take it when you remember—unless it's close to the time to take it again. You don't want to double your dose.


Paxil is generally considered safe and effective when taken as directed, even with long-term use. However, it should not be taken within 14 days of taking a monoamine oxidase inhibitor (MAOI).

Additionally, individuals who are elderly or have liver or kidney impairment have lower dosage ranges (10 mg to start with a maximum dose of 40 mg per day). Paxil is not approved for use by children, nor should it be used during pregnancy or when breastfeeding.

Avoid alcohol and drugs while taking Paxil, as they may decrease its benefits. If you are taking other prescription drugs, check with your healthcare provider or pharmacist about potential interactions with these medications.

A Word From Verywell

If you have been prescribed Paxil for generalized anxiety disorder, it's important to follow the drug's instructions. It can take some time to figure out the best GAD treatment for you. So, be patient and keep your healthcare provider informed about what is and isn't working for you.

Additionally, be sure to communicate any issues that arise (such as side effects). This enables your healthcare provider to deal with these effects swiftly, potentially changing your dosage amount or switching you to a different medication.

11 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Leonard Holmes, PhD
Leonard Holmes, PhD, is a pioneer of the online therapy field and a clinical psychologist specializing in chronic pain and anxiety.