Paxil Withdrawal & Tapering Guide
paroxetine
Boxed Warning
Suicidality risk in children, adolescents, and young adults under 25 during initial treatment.
In short
Paxil (paroxetine) is an SSRI with a half-life of 21 hours. Short half-life for an SSRI. Withdrawal symptoms, when they occur, usually begin 12-24 hours after missed dose (shortest onset of all SSRIs) and settle within 2-6 weeks for most symptoms. It is also sold as Seroxat, Pexeva.
- Class
- SSRI
- Half-life
- 21 hours
- Common doses
- 10mg, 20mg, 30mg, 40mg
- Withdrawal onset
- 12-24 hours after missed dose (shortest onset of all SSRIs)
- Typical resolution
- 2-6 weeks for most symptoms
Educational reference only. Dose changes are decided with the prescriber who knows your history.
Overview
Paroxetine is an SSRI with notable anticholinergic activity, approved for major depressive disorder, OCD, panic disorder, social anxiety disorder, GAD, and PTSD. It is widely recognized as one of the more difficult SSRIs to discontinue.
10mg, 20mg, 30mg, 40mg
Tablets: 10mg, 20mg, 30mg, 40mg; Oral suspension: 10mg/5mL; Controlled-release (CR) tablets: 12.5mg, 25mg, 37.5mg
Category D (positive evidence of risk — cardiac malformations)
Mechanism of Action
Potent and selective inhibitor of serotonin reuptake (SERT). Also has significant anticholinergic (muscarinic) activity and weak norepinephrine reuptake inhibition, which contribute to its withdrawal profile.
Taper Notes
Short half-life for an SSRI. Liquid formulation available. Often considered one of the harder SSRIs to taper.
Hyperbolic Tapering Guidance
Particularly difficult to stop due to short half-life and anticholinergic withdrawal. Very slow final taper essential.
Summary written by TaperCommunity, informed by the Maudsley Deprescribing Guidelines (Horowitz & Taylor) and related literature — see Sources & References below. Not affiliated with or endorsed by the Maudsley.
Tapering Protocol
Evidence-based phased reduction schedule. Always taper under medical supervision.
| Phase | Duration | Notes |
|---|---|---|
| Initial reductions | 4-6 weeks | Use available tablet strengths. Anticholinergic rebound may begin in this phase. |
| Middle reductions | 6-8 weeks | Ask your prescriber about liquid suspension or CR tablets for smoother transitions. |
| Lower dose reductions | 6-8 weeks | Paroxetine's non-linear kinetics mean even small changes can have an outsized effect. Go slow. |
| Final reductions | 8-16 weeks | Liquid formulation is often necessary for precise adjustments. Work closely with your prescriber. |
Withdrawal Timeline
12-24 hours after missed dose (shortest onset of all SSRIs)
2-5 days
2-6 weeks for most symptoms
Electric shock sensations, emotional lability, and derealization can persist 2-6 months. Paxil has the highest rate of protracted withdrawal among SSRIs.
Community Tips
Practical insights shared by members tapering Paxil. Not medical advice — always consult your prescriber.
- 1Ask your prescriber about Paxil liquid suspension — tablets crumble unevenly at lower doses.
- 2Paroxetine inhibits its own metabolism, so dose reductions at lower doses can feel larger than expected. Discuss this with your prescriber.
- 3Anticholinergic rebound (sweating, GI cramping, vivid dreams) is unique to Paxil among SSRIs. These symptoms resolve but can be alarming.
- 4If considering switching formulations (CR to IR), discuss equivalent dosing with your prescriber — they are not 1:1.
- 5Many members report Paxil as the hardest SSRI to stop. A fluoxetine cross-taper is an option but should be carefully considered with your prescriber given its complexity.
Common Withdrawal Symptoms
Interactions & Safety
Drug Interactions
- MAOIs — contraindicated (serotonin syndrome risk)
- Thioridazine — contraindicated (QT prolongation via CYP2D6 inhibition)
- Pimozide — contraindicated
Food Interactions
- No significant food effect on absorption
- Avoid alcohol during treatment
Contraindications
- MAOIs within 14 days
- Thioridazine
- Pimozide
Toxicity
Serotonin syndrome risk. Anticholinergic toxicity at high doses. Associated with higher rates of discontinuation syndrome than other SSRIs.
Pharmacokinetics
ADME Profile
Completely absorbed after oral dosing but extensive first-pass metabolism reduces bioavailability to ~50%. Tmax ~5 hours. Food does not significantly affect absorption.
~8.7 L/kg
Extensively metabolized hepatically via CYP2D6 (primary) with CYP3A4 contribution. Paroxetine inhibits its own metabolism (CYP2D6 saturation), leading to non-linear pharmacokinetics.
Renal (~64% as metabolites, ~2% unchanged) and fecal (~36%).
~93–95%
Non-linear; clearance decreases at higher doses due to CYP2D6 saturation.
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Other Drug Profiles
The arithmetic of a proportional reduction
The Maudsley Deprescribing Guidelines and NICE NG222 describe reducing SSRI medications by a proportion of the previous dose rather than by a fixed amount, so each cut is smaller than the last. The table shows what that arithmetic produces at 10% per step, using 20 mg only as a worked example. How large each step is, how long it is held, and whether this pattern applies at all are decisions for the person and their prescriber.
| Step | % of starting dose | Worked example (20 mg start) |
|---|---|---|
| Start | 100% | 20 mg |
| Step 1 | 90% | 18 mg |
| Step 2 | 81% | 16.2 mg |
| Step 3 | 73% | 14.6 mg |
| Step 4 | 66% | 13.1 mg |
| Step 5 | 59% | 11.8 mg |
| Step 6 | 53% | 10.6 mg |
| Step 7 | 48% | 9.57 mg |
| Step 8 | 43% | 8.61 mg |
This is an illustration of a published method, not a schedule for anyone. It does not account for how long you have taken Paxil, your current dose, formulation, or history. TaperCommunity does not recommend doses or dose changes; those are agreed with your prescriber.
Frequently asked questions about Paxil
What are the withdrawal symptoms of Paxil (paroxetine)?
Common withdrawal symptoms of Paxil (paroxetine) include: brain zaps, dizziness, electric shocks, crying spells, flu-like symptoms. Symptom severity varies by individual, dose, and duration of use.
How should I taper off Paxil (paroxetine)?
Short half-life for an SSRI. Liquid formulation available. Often considered one of the harder SSRIs to taper. Particularly difficult to stop due to short half-life and anticholinergic withdrawal. Very slow final taper essential.
How long does Paxil withdrawal last?
Paxil withdrawal typically begins 12-24 hours after missed dose (shortest onset of all SSRIs), peaks around 2-5 days, and resolves within 2-6 weeks for most symptoms. Electric shock sensations, emotional lability, and derealization can persist 2-6 months. Paxil has the highest rate of protracted withdrawal among SSRIs.
Can I stop Paxil cold turkey?
Stopping Paxil abruptly is not recommended. Its half-life is 21 hours, and the receptor adaptations built up during treatment do not reverse at that speed, so a sudden stop tends to produce the sharpest withdrawal. Prescribing guidance favours gradual, proportional reductions agreed with your prescriber.
How long does Paxil stay in your system?
Paxil (paroxetine) has a half-life of 21 hours. A drug is mostly cleared after about five half-lives, so Paxil is largely out of the body about 4 days after the last dose, longer in older adults or with liver or kidney impairment. Withdrawal symptoms often begin before the drug has fully cleared and continue after it has, because the adaptations the brain made during treatment reverse more slowly than the drug leaves the blood.
What tips do others have for tapering Paxil?
Ask your prescriber about Paxil liquid suspension — tablets crumble unevenly at lower doses. Paroxetine inhibits its own metabolism, so dose reductions at lower doses can feel larger than expected. Discuss this with your prescriber. Anticholinergic rebound (sweating, GI cramping, vivid dreams) is unique to Paxil among SSRIs. These symptoms resolve but can be alarming. If considering switching formulations (CR to IR), discuss equivalent dosing with your prescriber — they are not 1:1.
Recent discussions about Paxil
What members tapering Paxil are asking and reporting right now. Personal experience, not medical advice.
- Paxil Tapering ThreadThis is the forum for everyone tapering Paxil. When you log a check-in in My Taper, it will appear here. That way you can see how others on the same medication are…Based · 8 months ago
- NewHi, Im Ness, 42, ex paramedic with PTSD. Ive been on Paroxetine and previously a different ssri for about 5 ton6 years. Im on Agomelatine, for 4 years. I found this…Ness · today · 1 reply
- Hello 👋Hi, Im Ness, 42, ex paramedic with PTSD. Ive been on Paroxetine and previously a different ssri for about 5 ton6 years. Im on Agomelatine, for 4 years. I found this…Ness · yesterday · 1 reply
- What are the things you track daily to help you see the overall picture or how you’re doing?Hey beautiful people I bought a new journal and I was wondering what do you guys track daily ? I used to track my periods (cause it was involved with my anxiety) anxiety…Nessi · 3 days ago · 9 replies
- Paxil switch Zoloft, taper flu-like symptomsHello, I have been on Paroxetine for 12 years at low doses (usually <20mg). One year ago, despite cautious 3-month tapering steps & custom made Paxil pills (down to…Thom42 · 3 days ago · 6 replies
Sources & References
Paxil (paroxetine) information on this page is sourced from peer-reviewed research, regulatory bodies, clinical guidelines, and patient-advocacy organizations.
Encyclopedic & chemical databases
Neutral, high-authority entity references.
Regulatory sources
Official prescribing information and safety notices.
Peer-reviewed research
Primary literature cited in this taper guide.
- Horowitz MA, Taylor D 2019 — Tapering of SSRI treatment to mitigate withdrawal symptoms (hyperbolic taper) (The Lancet Psychiatry)
- Davies J, Read J 2019 — A systematic review into the incidence, severity and duration of antidepressant withdrawal effects (Addictive Behaviors)
- Framer A 2021 — The patient voice: an exploration of the experience of withdrawal from antidepressants (Therapeutic Advances in Psychopharmacology)
Clinical guidelines
Evidence-based deprescribing and prescribing standards.
Deprescribing-specific resources
Clinician-facing references on tapering protocols.
- Deprescribing.org — Evidence-based deprescribing algorithms from the Bruyère Research Institute
- Royal College of Psychiatrists — Stopping antidepressants — UK clinical guidance on safely discontinuing antidepressants
Patient-advocacy & lived-experience
Long-running communities documenting withdrawal experience.
- Surviving Antidepressants — tapering forum — Long-running community archive of antidepressant taper experiences
- Inner Compass Initiative — Withdrawal Project — Peer-led resources for psychiatric drug withdrawal
- Mad in America — antidepressant withdrawal archive — Journalism and personal narratives on SSRI/SNRI discontinuation
- RxISK — adverse drug reaction reporting — Independent database of patient-reported adverse effects
TaperCommunity does not provide medical advice. Always consult a qualified prescriber before adjusting psychiatric medication.