Q:  Over-talkative a Side Effect?

My wife is using 30 mg of PAXIL daily.

Initially, I thought PAXIL was a life saver, she was very depressed about her loss of job, and even considered suicide. Luckily I convinced my wife to see a doctor and they prescribed PAXIL. For over 2 months, Paxil was great, but now she seems very very talkative and her friends often ask her to be quiet or shut up.

Is Over-Talkative a sign of being under or over medicated with Paxil?

I love my wife, but even I have a hard time with her constant talking. When she see's the doctor she is probably a little more calm, because they said she was cured and didn't need to see anyone anymore. However both her friends and family are worried about the talking and giddiness. Any suggestions?

Dear John --
Well, looks like you have your suspicions, being here on BipolarWorld.net to ask that question. You're right to have that suspicion, all right. It's very clear that taking a medication like Paxil (or virtually any other antidepressant) can cause manic symptoms.

However, if she's sleeping just fine; if she's not irritable or agitated; if she's not running around doing far more now than she used to before she became depressed; if she's not spending too much money (ooh, tricky one there, be careful); if she's not much more sexually active now than she used to be before the depression; and if she doesn't have any family members with severe depression, or a bunch of family members with alcohol problems, or any family member who's ever been diagnosed as "bipolar" -- if she doesn't have any of those things, then you may just have to wonder about this a while longer.

On the other hand, you could just report your observation of the over-talkativeness to her doctor (ask to leave voicemail and be brief) and your concern that this might represent a "bipolar-like" symptom, and see what she/he does with that input. It's really her responsibility to monitor your wife for this kind of problem, but lots of doc's don't know how to watch or how concerned to be -- so you could boost that a bit by passing along your concern, and let go of some of the responsibility yourself, which is sometimes good for relationships. The list of things to watch for, plus a few more, can be found on the "Mood Disorders Questionnaire" at the end of the "Diagnosis" section of my website, in the section on bipolar II (read "How can I tell if I have if for sure?").

Whatever you choose to do, I'd recommend that you move on it right away, though. As you can probably tell from the rest of what I write, my level of concern, along the lines you're already suggesting, would be quite high.

Dr. Phelps

Published January, 2004