Black hairy tongue (BHT), also known as “lingua villosa nigra,” is a benign and reversible disorder characterized by hypertrophy of filiform papillae (longer than 3 mm) on the surface of the tongue. Although BHT is usually asymptomatic, in some cases nausea, halitosis and gagging may accompany to BHT. Poor oral hygiene, smoking, alcohol, cancer, and drugs are important in etiology of BHT. Previously reported drugs associated with BHT are antibiotics and psychotropics such as olanzapine, fluoxetine, clonazepam, thiothixene, and benztropine mesylate. BHT has not been reported with paroxetine before. Here we report a case of BHT occurred after initiation of paroxetine in a 30-year-old man for his anxiety disorder and disappeared after discontinuation, which identifies a probable association with paroxetine..