What you are experiencing is a common reaction known as discontinuation syndrome. Your medication, paroxetine, has a very short half-life, meaning it leaves your system quickly. When you miss a dose, your brain reacts to the sudden drop in serotonin levels, causing temporary symptoms like dizziness and "brain zaps."Please be reassured that these symptoms are not dangerous and will resolve quickly once you resume your dose. To manage this, try to take your medication at the same time every day to keep levels stable. If you ever decide to stop this medication, consult your doctor so they can help you taper off the dose gradually and safely.

Paroxetine is highly effective for anxiety, but significant weight gain is a known side effect of long-term use. While it remains medically safe to continue, gaining 20 kg warrants a discussion with your doctor. Anxiety treatment typically lasts 6 to 12 months after your symptoms stabilize, though some individuals require longer. Since you have been on it for a year, you may be ready to discuss a gradual tapering plan or switching to a more weight-neutral medication. Please do not stop taking this medication abruptly, as this can cause withdrawal symptoms. Schedule a consultation with your doctor to safely evaluate your options.

It is very common to experience temporary withdrawal symptoms like headaches when tapering paroxetine. Fortunately, side effects like weight gain and ankle swelling typically resolve once the medicine is fully cleared from your system. For alternatives with a lower risk of these side effects, your doctor might consider selective serotonin reuptake inhibitors (SSRIs) like escitalopram or sertraline, which generally have more favorable metabolic profiles. Alternatively, buspirone is an effective anti-anxiety medication with minimal side effects and no association with weight gain. Please consult your healthcare provider to discuss these options and to establish a safe, gradual transition plan to minimize your withdrawal symptoms.