Q. . I am writing to you on a good day when I feel fairly grounded so hopefully I will make sense. I am 37 years old, female, and am trying to figure out what is wrong with me... I was on Paxil for 1.5 years for depression and moodiness. went off last June because I didn't want to be on drugs. I did feel better, I only took 15 mg. once a day. I do have some of the symptoms of both bi polar and personality disorder... I am confused... can a woman's monthly cycle have anything to do with this? I escalate concurrently with the arrival of my period, typically settling down as it arrives. is this just PMS?

I have remarried and my partner is ready to leave due to my moodiness-is always feeling like walking on eggshells in case they say the wrong thing-I have outbursts of rage, violence, I have such opposite moods of great or terrible, I do feel hopeless and suicidal, can switch from loving to hating in one second depending on what the person says, am feeling not worthwhile, my 2 children have both moved to their dads because of my up and downs, my mom is dying of cancer, I am scared, should I go back on Paxil? I live in a very tiny town in Canada-only 250 people. I don't know where to go for help...I did read through your list of questions asked, I didn't see anything relating to serotonin levels and hormones. I am only having about one week of "normalcy" out of the month right now. thank you for listening.

  A. Without an interview, it is not easy to decide what your diagnosis might be, but there are some assumptions that seem safe. First, if you were a bipolar I, you probably would have gotten manic on Paxil alone. The mood swings as you describe them sound more like affective instability. Whether we call it a personality disorder (borderline personality disorder = BPD) or an affective disorder (bipolar II) is irrelevant. We need to treat it.

I am not a big Paxil fan, as I feel all the other selective serotonin reuptake inhibitors (SSRI) (Zoloft, Prozac, Luvox, and Celexa) work better. I also believe Effexor XR, a serotonin noradrenaline reuptake inhibitor (SNRI) is overall the best first line treatment for BPD. So, if you think you have BPD, I would go with Effexor XR and titrate it up to 300 or 450 mg/day. If you are going to use an SSRI, I like Zoloft best because you can measure if there is enough in you to work or not (see archives on this site). Hope this helps.