Q. I'm a 38 yr old woman diagnosed with borderline personality disorder and Bipolar II. I've been on lithium (eskalith) 450mg, tid, for 12 years, on Paxil (60mg) and trazodone (100 mg) for eight years. I also take .125 synthroid for hypothyroidism. Since I've been on Paxil I've had very low libido. I'm doing very well the last two years, with only one hospitalization. I really don't want to change what seems to be working. Is there an antidepressant that shows a clear and substantial difference as far as sex drive? Or would a change in dose be helpful. What do you know about gingko biloba increasing libido and safety. I value my sanity above all else, but is it possible to treat BPD/bipolar and retain some sexual appetite.

A. The possibilities for improving sex drive are decent, but not great. There have been a number of studies adding on BuSpar or amphetamines or Wellbutrin or Periactin or Viagra to the medications you are already on to help out. Sexual dysfunction is a side effect of Paxil (as well as Prozac, Zoloft, Luvox and Celexa) in treating BPD. Effexor has less sexual dysfunction as you increase the dosage, and is a possible alternative. Serzone has virtually no sexual dysfunction, but may not be the right drug for you. You are doing well, and have the good insight to know that sanity is of paramount importance. Discuss the sexual dysfunction frankly with your physician and see if he or she has any thoughts to help out.