Does Paxil Help Social Anxiety? (+5 Studies)

In this article, we will answer the question “Does Paxil help social anxiety?” we will also discuss the possible mechanisms through which Paxil works for social anxiety and its dosage recommendations for social anxiety. 

Does Paxil Help Social Anxiety?

Yes, Paxil helps with social anxiety. Paxil is an FDA-approved drug for social anxiety disorder. Paxil or paroxetine is a selective serotonin reuptake inhibitor (SSRI) and it is prescribed for disorders like major depressive disorder, obsessive-compulsive disorder, and social anxiety disorder (SAD). It is also used off-label to manage SAD in children and adolescents (1). 

SSRIs are the first line of treatment for social anxiety and their efficacy in treating SAD is well-established (2). If you experience social anxiety you must consult your healthcare provider. A detailed assessment is required to confirm the diagnosis of SAD after which your healthcare provider may prescribe Paxil to manage your symptoms. 

What are the symptoms of social anxiety disorder?

Social anxiety is a common human experience of discomfort or nervousness in social situations. Every human experiences some level of social anxiety that doesn’t require medical intervention. 

Social anxiety disorder (SAD) is a mental health condition where the fear of social situations becomes so intense and persistent that it interferes with daily life. SAD is also known as social phobia and is characterized by intense fear and anxiety of social situations (3). 

Individuals with SAD experience a fear of judgment and embarrassment in social situations and are afraid that they will act a certain way which will be judged negatively. This fear causes them great distress or complete avoidance of social situations (3). 

If you are experiencing the symptoms of SAD your healthcare provider will evaluate and assess you using different instruments and make the diagnosis based on the established criteria of SAD. 

How does Paxil help social anxiety? 

The mechanism of action of Paxil is that it blocks the serotonin reuptake transporter and increases the level of serotonin in the brain (1). Neurotransmitters like serotonin, dopamine, and glutamate are known to play a role in the development of SAD (3). 

Studies have revealed that low levels of serotonin and dopamine might be present in patients with SAD (4). Paxil being an antidepressant regulates these neurotransmitters, improves mood and mental well-being, and reduces the symptoms of anxiety. 

Studies also suggest that SAD is associated with increased activity in some brain regions such as the amygdala. The serotonergic role of Paxil can also reverse these abnormalities and improve SAD symptoms (4). 

What does research suggest? 

The efficacy of Paxil in treating SAD is well established.  A randomized controlled trial enrolled 183 patients of SAD out of which 91 patients were treated with Paxil for 11 weeks. The results revealed that Paxil was effective in reducing the symptoms and disability associated with SAD (5). 

One review included three large clinical trials of Paxil in patients with SAD. The treatment period was 12 weeks and the patients receiving Paxil showed statistically significant improvement in their symptoms. The study concluded that Paxil is effective for SAD and recommended a starting dose of 20mg/day (6). 

Another randomized double-blind study assessed the effects of 12-week treatment with Paxil on patients with SAD. The results demonstrated that Paxil is an effective and well-tolerated treatment of SAD (7). 

One randomized placebo-controlled study included 44 patients who were treated with Paxil for 3 months. Based on patient-reported outcome measures and the clinician’s assessment, it was concluded that Paxil reduced symptoms and avoidance behavior associated with SAD (8).

One study was conducted to assess the performance of a controlled-release (CR) formulation of Paxil in adult patients with SAD. The results showed that Paxil was effective in treating SAD and the CR formulation resulted in fewer side effects and improved the tolerability of Paxil (9). 

What is the dosage recommendation of Paxil for social anxiety? 

The general dosage recommendation of Paxil for social anxiety disorder or social phobia is as follows (1). Your healthcare provider will prescribe Paxil based on the severity of symptoms and other factors. 

Age Group Daily dosage recommendation Maximum daily dosage 
Adults 20 mg 60mg
Geriatric adults 10 mg 40 mg
Children and adolescents (8 years and older) 10 mg 50 mg

What side effects you may experience while taking Paxil? 

SSRIs like Paxil and Escitalopram are effective in managing social anxiety however, you might experience some side effects. During the first two weeks of treatment, you may experience increased anxiety or jitteriness due to an initial increase in serotonin levels. Once your body adjusts to the medication this side effect will reduce and you will experience symptom improvement (2). 

Other side effects you might experience while taking Paxil are as follows (1)

  • drowsiness
  • dizziness
  • dry mouth
  • sweating
  • sexual dysfunction
  • sleep disturbance 

If you experience some unusual side effects or are unable to tolerate the common side effects of Paxil, you must discuss it with your healthcare provider. 

What is the appropriate way to take Paxil for social anxiety?

You must take Paxil orally as prescribed by your healthcare provider. You can take it with or without food at any time of the day (1). You must not change the dose without the guidance of your healthcare provider. Do not discontinue the medication abruptly as it can lead to withdrawal symptoms which include (1)

  • dizziness
  • fatigue
  • vomiting
  • headache
  • vivid dreams
  • anxiety
  • depersonalization

To avoid withdrawal symptoms, your healthcare provider will decrease the dose of Paxil gradually once it is decided to discontinue the medication.  

What are some other ways to manage social anxiety? 

Cognitive behavioral therapy (CBT) and Paxil are the recommended treatments for social anxiety. Studies have shown that a combination of Paxil and CBT is effective in improving the outcomes and superior to using Paxil alone (10). 

CBT allows the individual to identify their thoughts related to social anxiety and restructure those negative thought patterns. A combination of in-session exposure experiments and cognitive restructuring exercises allows the individual to confront and overcome their anxiety (10). 


From my perspective, the research shows that Paxil helps with social anxiety. It works by increasing the levels of serotonin in the brain and is effective for treating social anxiety. Its effectiveness is well-documented in the literature and it is an FDA-approved drug to treat social anxiety disorder. 

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