The client is experiencing a dose-dependent antidepressant-related hyperhidrosis.

Selective serotonin reuptake inhibitors (SSRIs) may be less effective in women over 50, especially if they are not taking estrogen.

The PMHNP should switch the client to escitalopram (Lexapro), which has a lower potential for dose-dependent hyperhidrosis.

An appropriate next step would be to reduce the dose of paroxetine back to 20 mg, add a short-term adjunctive treatment for acute anxiety, and draw labs to check her hormone levels prior to making further medication changes.