Antidepressants and anti-anxiety medications too often get a bad rap—and frankly, that’s a damn shame because they offer help to literally millions of people in the U.S. alone (12.7 percent of Americans take antidepressants, according to the Centers for Disease Control).

Paxil, or paroxetene, is one of those medications—and it actually does double-duty, by treating both anxiety and depressive disorders. But, while it can make living with anxiety or depression more manageable, the side effects of Paxil aren’t necessarily harmless.

What is Paxil?

Like Zoloft and Prozac, Paxil is “an SSRI, or selective serotonin reuptake inhibitor, which means it works on the serotonin system in your brain,” says Alison Hermann, M.D., a clinical psychiatrist at Weill Cornell Medicine and New York-Presbyterian Hospital.

“Manipulating the levels of serotonin in your brain will work on a number of systems, including the ones that regulate mood and behavior, as well as arousal and sleep,” says Hermann. Since serotonin is the “feel-good” hormone, boosting those levels can make a major difference in the way you feel.

Paxil is one one of the top five prescribed SSRIs, according to a 2017 study published in the Journal of the American Medical Association (JAMA), but there’s no particular reason your doctor would prescribe Paxil over a different SSRI, says Hermann. “You actually may need to try a number of different SSRIs before you find the one that works the best for you as an individual,” she advises.

Most people tolerate antidepressants, including Paxil, pretty well, Herman acknowledges. But, like any other drugs, it has the potential to make you feel kind of sh*tty. Here are a few common Paxil side effects to watch out for if you’re on the drug or are interested in taking it.

Side effect #1: You haven’t changed your diet, but you’re gaining weight.

Antidepressants and anti-anxiety medications in general are often linked to weight gain, but some, including Paxil, might cause more weight gain than others, according to the Mayo Clinic. A 2014 study in the journal JAMA Psychiatry also found that, out of 11 different antidepressants, Paxil was one of two medications with the highest risk of weight gain.

1 out of every 6 adults will have depression at some time in their life.*

Researchers aren’t sure why Paxil or other antidepressants can cause weight gain, but they believe it may be linked to its effects on serotonin, which controls and regulates appetite.

If you notice an increase in your weight after starting Paxil, talk to your doctor about lifestyle changes, like eating a healthier diet and getting more exercise, or other medication options.

Side effect #2: You’ve got stomach issues galore.

Gastrointestinal issues are the most common side effects with any SSRI. “That’s because there are actually more serotonin receptors in your gut than in your brain,” says Hermann. “So just like the drug can affect arousal in the brain, it can also affect arousal in the gut.”

The best way to minimize this reaction is to start with a low dose and take the meds with food. And if things don’t settle within one to two weeks, talk to your doctor about potentially switching to a different drug.

Side effect #3: You’re actually feeling more anxious.

That sounds counterintuitive, right? But feeling “activated” or a little extra anxious is actually a common feeling when starting Paxil, says Hermann. “Usually, anxiety is the reason you’re taking this med, so I know this might scare people, but it’s just a matter of your body getting used to the drug and its longer-term effects,” she says.

Depression affects about 16 million American adults every year.*

Again, you can minimize that risk by starting with a low dose and increasing only as tolerated. Typically, you’ll wait one to two weeks, meet with your doc, and then up the dosage, if necessary; that gives you time to wait out initial side effects and assess your progress as you get up to an effective dose, says Hermann.

Side effect #4: You’re never in the mood.

A decreased libido, difficulty getting aroused, and difficulty orgasming are all side effects associated with Paxil and SSRIs in general. “A significant portion of people who take the med are affected,” says Hermann. “We don’t really know why this particular side effect comes up, but it’s a longer-term side effect and it’s worse at higher doses.”

Your doctor may want to weigh the benefits of the drug helping what it was originally intended to help with against how disruptive a particular sexual issue to your life, and they may eventually switch you over to a different prescription.

Side effect #5: You feel weak and start slurring your speech.

This is a sign of low sodium levels, a.k.a. hyponatremia, which can also cause other symptoms like headaches, confusion, loss of coordination, and feeling unsteady. It’s an unusual side effect, but can happen when your liver and kidneys have trouble metabolizing the medication. “Some people’s bodies just can’t hold on to sodium as well when they take antidepressants like Paxil,” says Hermann.

It’s important to keep your electrolyte levels in check when taking this medication, so to play it safe, make sure to schedule annual bloodwork to check those levels with your doctor, suggests Hermann.

Side effect #6: You’ve been having suicidal thoughts.

Like with any antidepressant or anti-anxiety med, Paxil comes with a warning of increased feelings of depression. “The thing to keep in mind is the underlying condition: The reason Paxil would be prescribed is for anxiety or depression, which themselves really increase the risk for suicidal thinking or behaviors,” says Hermann.

Depression can happen at any age and in any type of person.*

Another thing to note: Paxil may have negative effects on undiagnosed bipolar disorder. “If someone has bipolar disorder that’s gone undiagnosed or hasn’t manifested yet, taking an antidepressant like Paxil does put you at risk for switching from depression to mania or hypomania,” says Hermann.

Don’t write off any unusual feelings; if you’re experiencing thoughts of suicide or manic episodes on the drug, talk to your doctor ASAP.

*According to the Centers for Disease Control.

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