Q. I see in one of the previous questions you stated that Paxil levels must be at least 60 mg. per day and up to 90 mg. per day to be effective for borderlines.

I have borderline personality disorder, bipolar disorder I and obsessive compulsive disorder. I take Paxil for the depression, but am staying at 30 mg. per day due to psychiatrist concern over triggering a manic episode. I also take 750 mg. Epival per day. I have been on Paxil for 4 months and Epival for 2 months.

I am still quite depressed, have a hard time with daily activities, have a lot of suicidal ideation and horrible nightmares. I have started talk therapy. I frequently sit in a corner and cry. It does make me feel better. Fatigue is a problem as is concentration and memory and processing information that I hear. I have to really concentrate and mentally repeat what someone is saying if I want to understand and remember it.

So, the real question is: can I find a level of Paxil that will be effective for both bpd's?

Is there any other medication to consider in the context of my dual dx? I am beginning to understand how my three play off each other and interact, but I am sort of stranded in the middle of BC with few options for professional help. Not a lot of specialists up here.

A. I like Effexor and Zoloft a lot better than Paxil. They are markedly less sedating, and seem to work better than Paxil in my clients. Zoloft and Effexor both need to be used at a dose where carbohydrate craving goes away. This averages about 325 mg + 150 mg for both.

If you are worried about the Paxil making you manic, it is a legitimate concern. However, staying depressed on an ineffectual dosage is illogical. If you are going to take a medication, at least take enough to work. Talk to your doctor about this.