Dr Phelps
Please answer to my question in my email if you can't publish it. It's very important to me.  I was diagnosed with depression and I was prescribed Paxil 20mg.From the 3rd day on it I felt very euphoric, very sleepy (sometimes I couldn't get up from the bed) and all I wanted to do is lying on the bed. That kept going on all the time of the day for  10 days and then I stopped it and this symptoms disappeared. In your opinion what do you think was that: hypomania or serotonin syndrome?

Thank you.
 

Dear Spark -- 
As you seem to have figured out, it could be either.  I just checked to see how common serotonin syndrome is if one is just taking a single antidepressant like Paxil; here's an article that might review the subject if you try to get the whole printout (e.g. your local hospital librarian, maybe); but suffice to say that there clearly are such cases, and they appear to be extremely rare.  

Meanwhile, I hear all the time about people who took Paxil (and less often even Prozac, which is generally thought to be more "activating") and felt "sleepy" on it.  One patient called it "my lost year".  These people did not report euphoria.  Was this some sort of subtle "serotonin syndrome"?  Or is this sleepiness just what we would otherwise call a "side effect"?  That is a distinction with rather little difference, probably.  

And then there's the "euphoria" you report, and as you've learned, yes, that does sound a bit more like antidepressant-induced hypomania, especially if as you look back on that episode you can say that the euphoria was clearly not normal for you compared to your usual experience.  In that case at minimum I'd have you take a Mood Disorders Questionnaire.  If that was "negative", and there was no other reason to worry about bipolar disorder (e.g. there is no huge history of bipolar disorder in your family), then you could probably try an antidepressant again in the future -- a different one, obviously.  That would be an issue for discussion with your doctor.  

Dr. Phelps

Published January, 2003