Q:  Paxil & Jumbled Thoughts, Spaciness

Dea r Dr. Phelps, I am currently taking 50 mgs if paxil three yrs ago i was put on 1,000mgs of depakote didnt like it after one month with docs okay i went off it (depokote was given for anxiety) I have since went back on up to 1750mgs have been tapering down now on 375mgs My question is could the paxil at 50mgs be causing my jumbled thoughts, spaciness, I had never expereinced this before i went off depokote the first time I have read that lowering the paxil might help so that i wouldnt need mood stabilizer.

Dear Linda - - 
Most of what you're asking has to be worked out closely with your own doctor, so don't take what I say here as "telling you what to do"; I also am known amongst my colleagues to be "anti-antidepressant" to a greater degree than many psychiatrists are.  With those warnings, here are a few things we know for sure:  

First, we know for sure that antidepressants can make bipolar disorder worse.  (From what you wrote, of course, it wouldn't be a certain thing that you do have bipolar disorder).  So whereas Paxil might have been okay at one point, it might not be now; whether it made your symptoms worse, or they just worsened on their own, you could have a bad reaction to Paxil now that you didn't at first. 

Second, we know bipolar disorder can cause anxiety. 

Finally, at least in my experience, Paxil (and other antidepressants) can indeed cause the jumbled thoughts and spaciness you describe.  Just this past week a patient of mine described getting better from symptoms just like that after we lowered her Paxil by only 2.5 mg, while keeping the rest of her mood stabilizer mix the same.  (Don't you go lowering your Paxil, though, until you talk about this with your doctor, okay?)

So you might benefit from reversing the current arrangement: instead of full antidepressant and a little mood stabilizer, you might do better on low or no antidepressant.  Yes, as you wrote, it is possible you'd need less mood stabilizer without an antidepressant on board.  I tell people all the time that they haven't had a fair trial of a mood stabilizer until they've had it without an antidepressant; however, it may be that something other than Depakote would be more obviously beneficial.  Here's a list of mood stabilizer options to discuss with your doctor if you're looking for alternatives at some point.  

Dr. Phelps