Selective serotonin reuptake inhibitors, such as paroxetine, are widely used for major depressive disorder and social anxiety disorder. Although generally safe, SSRI discontinuation or tapering can rarely precipitate a withdrawal syndrome that includes autonomic dysregulation, anxiety exacerbation, and, in susceptible individuals, significant hypertensive crises. Heavy alcohol consumption during tapering further amplifies risk through sympathetic activation, dehydration, and potential pharmacokinetic interactions. This case illustrates the intersection of psychiatric treatment, substance use, and acute hypertension in primary care.A 43-year-old male with long-standing major depressive disorder and social anxiety disorder treated with paroxetine 10 mg daily presented during medication tapering with severe hypertension (200/100 mmHg) at a psychiatric clinic. Initial captopril 12.5 mg reduced blood pressure (BP) to 190/90 mmHg, but the patient refused emergency services. Later that day in family practice, BP was 190/90 mmHg with HR102/min and oxygen saturation 98%. No symptoms were reported; ECG showed sinus tachycardia without ischaemic changes. The patient disclosed consuming 750 ml of whiskey the previous night. Nitrendipine 20 mg lowered BP to 180/90 mmHg. Hospital referral was declined.This case uniquely demonstrates a severe hypertensive crisis triggered by the combination of low-dose paroxetine tapering and acute heavy alcohol intake in an otherwise asymptomatic patient with psychiatric comorbidity and stage-one obesity. The rapid onset, absence of end-organ symptoms, and patient refusal of acute hospitalisation highlight challenges in managing acute cardiovascular complications during psychiatric medication adjustment in ambulatory settings.Early recognition of SSRI withdrawal and alcohol-related sympathetic surge enables prompt outpatient management with antihypertensive polytherapy and electrolyte support. Lifestyle intervention combined with nephroprotective multidrug regimens can achieve rapid BP normalisation without excessive HR reduction.Acute hypertension during SSRI tapering may be exacerbated by alcohol-induced catecholamine release and volume shifts. Fixed-dose combination antihypertensives with nephroprotective properties, alongside aggressive lifestyle modification, offer effective and tolerable control in motivated patients.Initiation of triple antihypertensive therapy (hydrochlorothiazide/ARB/calcium channel antagonist), beta-blocker titration adjustment, electrolyte replacement, and strict DASH diet with alcohol abstinence rapidly normalised BP, reduced weight, and improved cholesterol. This integrated approach successfully managed a potentially life-threatening hypertensive crisis in an outpatient psychiatric-primary care interface.