What We’ve Said

What we’ve said about Paroxetine

8 points from 7 episodes, newest first

Also searched as Paxil, Paxil CR, Pexeva

In short

Paroxetine works quickly and sedates, but we tend not to use it: it is anticholinergic, causes weight gain, has bad withdrawal and is the worst SSRI for pregnancy. For OCD and PTSD we pick sertraline instead, and for sleep it is C tier, with little reason to choose it over mirtazapine.

Where it fits

  1. It has real strengths: it works quickly, it is a sleeper on top of being an antidepressant, it is easy to dose, and it comes in long- and short-acting forms. A lot of bang for your buck in one tablet.

    “its efficacy, it works quickly, you know, and it's a Sleeper on top of being an antidepressant class medication. You get a lot of bang for your buck there. All in one tablet. Easy to dose. There's a long-acting form and a short-acting form”
    28:04Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026

  2. Its reputation for anxiety probably comes from sedation, not from being better than the others. Anxiety and rumination tend to get worse at night, so anything that makes people sleepy helps, and that does not have to be Paxil: a little gabapentin can do it.

    “I don't see it as any better than the others. It's more that anxiety, people with anxiety disorders tend to have worsening anxiety and ruminations at night. So if you give them something that makes them sleepy, they're going to help them with that. And it does not have to be Paxil. It can be a little gabapentin, for example”
    30:35Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025

Side effects and safety

  1. We tend not to use it. It is anticholinergic and makes people sleepy, it causes weight gain, and it is probably the worst SSRI for pregnancy. Even where it helps, as in anxiety, these hold it back.

    “I don't like the anticholinergic effects. I don't like, um, there's weight gain. Uh, it's not good. It's got the worst, I think it's the worst SSRI for pregnancy”
    25:59Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026
    Also said in 2 more episodes
    “venlafaxine has a very severe withdrawal syndrome and paroxetine has plenty of weight gain, some anticholinergic, Even if it has to benefit”
    25:17Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026
    “paroxetine, which makes people a little sleepy because of the anticholinergic. It causes a little weight gain, so I tend to not use it”
    29:37Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025

Compared with others

  1. We like Zoloft or Lexapro because they tend to have fewer med-med interactions, and we avoid Paxil because it tends to cause weight gain.

    “I like to use Zoloft or Lexapro because they tend to have less med-med interactions, but really any SSRI is fine. I avoid Paxil because Paxil tends to cause weight gain”
    16:20Practical OCD Psychopharmacology: Evidence‑Based (& Non Evidence-Based) Medication ApproachAug 2025
    Also said in 1 more episode
    “I do like to use sertraline. I try to avoid Paxil because I don't like to give people weight gain, as you know, with medications”
    4:50PTSD Medications: Integrating Pharmacotherapy, Therapy, and the Treatment Frame | Episode 22Apr 2025

  2. C tier for sleep: the anticholinergic side effects and weight gain push it down, and there is not much reason to use it instead of mirtazapine.

    “Paroxetine is in C tier for different reasons. Again, both anticholinergic with the side effects and weight gain effects are really pushing it down there. There is not a whole lot of reason to be using this one instead of mirtazapine”
    41:42Sleep Medications Treatment Tier List: Best Insomnia Medications RankedAug 2026

Pearls

  1. Paroxetine is anti-muscarinic, and that organizes everything else about it: it is sedating, and it has bad withdrawal, as any anti-muscarinic medication will.

    “paroxetine is anti-muscarinic, and that helps me to organize all the information that you kind of just mentioned. So it is sedating. It does have bad withdrawal because we know any anti-muscarinic medication is going to have bad withdrawal”
    30:08Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026

Pitfalls and myths

  1. Do not use it for sleep in bipolar disorder. It is a potent SSRI with a lot of withdrawal effects.

    “I wouldn't give peroxidine. A lot of people like to use Paxil kind of for sleep, but this is an SSRI. This is a potent SSRI with a lot of withdrawal effects”
    46:06Insomnia and Sleep Medications in PsychiatryDec 2024

  2. The old teaching to pick it for poorly adherent patients, so withdrawal reminds them to take it, is outdated. Set an alarm on the phone and use a pill organizer.

    “I was taught that, hey, this is something you should consider for patients of poor med adherence. They'll know as to withdraw and remember to take medication. I feel like that's very outdated. Set alarm on the phone. Use a pill organizer”
    28:43Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026

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From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.