Sorry for the slip (in edit/blog mode most of the time so I lost track).

Of course, people know that when they write to Cary (and his advice alone is brilliant) we're all part of the package. After all, the column is judged in part by how many letters - good, bad, critical and supportive - each question draws (hence the early demise of whatever that week was).

This sounds like a major brain trauma to me. I would definitely have her checked for a brain tumor, bleeding on the brain, or some other biological cause for this major shift in behavoir. I sincerely doubt merely withdrawing from Paxil would cause this magnitude of a reaction.

I do hope you can get to the bottom of this.

Situations like this require some clear thinking.

First: Your mom needs help. If it is possible to get her to a gp or reputable psychiatrist, do so. Is there's anyone she trusts? Maybe see if she'll talk to them or have that person take her to an appt.

Someone recommended NAMI, which is a great resource. Call the chapter in your area and they can give you names of good people to help. NAMI people know their way around.

If you can't get your mom to go voluntarily, then see

if you can't get her help involuntarily. This isn't a lifetime sentence, but may serve to get her evaluated.

Her reactions could be any number of things. If she is

psychotic, then she may not have the insight necessary

to receive help, that is, in layman's terms, the part of her brain that is affected by the psychosis is the

same part that is in charge of reasoning. The book,

I'm Not Sick, I Don't Need Help, by Xavier Amador

is extremely useful, more so than a number of those

on the link. Also, Surviving Schizophrenia, which

is useful beyond that diagnosis.

Your letter never mentions you know that your mother has gone off the Paxil. Do you know this for sure?Medications are tricky. Sometimes people on antidepressants develop medication

related mania, sometimes people have strange withdrawal/rebound reactions. This may not be a permanent condition is what I'm trying to say.

Second: Get yourself help. NAMI offers a wonderful resource called Family to Family, which is the best thing out there for navigating the complex and fractured

private and public mental health care system. It will

also serve to help you set boundaries and be most useful to yourself and to her.

Good luck with this.

Good for you for being concerned about this and prepared to intervene. Knowing where to start is the hardest part.

Advice along the lines of "you have to have her committed, right now" is great, and probably what should happen in this case, but unfortunately, the system is not set up that way. The gatekeepers of the services that protect people from themselves are the professionals in mental health and law enforcement, not the family members. This system is designed to protect people from the abuse of being locked up at anyone's whim, but it unfortunately doesn't always give credibility to those who are experiencing life with a troubled person, and who know them best.

So recognize that this is a process, that will involve gathering information and evidence over time, and ensuring that the gatekeepers have all of that information in front of them as often and for as long as it takes for them to make the right decision. The first time she's admitted, as one letter writer noted, she can be on her best behaviour and be discharged, or discharge herself against medical advice once the 72 hours is up. The first time she's admitted, they'll be prepared to give her the benefit of the doubt. But this doesn't mean you shouldn't try taking this first step. The next time, or the next, or maybe the seventh time this happens, the "system" and the gatekeepers will begin to see what you see, and your chances of finding a solution will get better.

Not easy. Probably not fair. But it's what you and your sister have to work with, knowing that working with your mother is just not possible right now.

PS - I have such limited patience with those who are prepared to spend effort on telling someone how stupid they are when they're here looking for help. What exactly do you think you're contributing to the world? If only life were as simple as you'd like it to be.

...the CDC is reporting that fatal overdoses are way up (~63% in five years) and that a substantial portion of those are with psychotherapeutic drugs. They call, among other things, for "increasing physician awareness regarding appropriate pharmacologic treatment of pain and psychiatric problems, supporting best practices for treating drug dependence, and potentially modifying prescription drugs to reduce their potential for abuse."

http://www.cdc.gov:80/mmwr/preview/mmwrhtml/mm5605a1.htm?s_cid=mm5605a1_e

IOW, psychotherapeutic drug prescribing is problematic enough in the US that this gov't agency says doctors need to improve how they do it to get the overdose rate down.

The first thing to check is if she stopped Paxil cold turkey. If she did, then that alone is capable of causing this behavior, and more.

My sister, after several years on Paxil, attempted to quit cold turkey a few years ago. This set off a chain of incredibly frightening events for her and her family over the course of the next 2 months, as her brain was *completely* unable to normalize, triggering delusions, psychotic episodes, and constant unbearable anxiety. We almost had to commit her to a facility as we (and she) was worried she was going to hurt herself. She had been taking the Paxil originally for panic attacks that ensued after the birth of her first child.

The whole experience was the most painful mental trauma I have ever watched another human being endure. The doctors were trying klonopin, buspar, xanax, and combinations thereof just to try get her mind to calm down. Eventually she went back on another SSRI (Celexa) as nothing worked.

To this day the word "Paxil" makes me feel angry. There have been some class action lawsuits suggested as I've seen evidence that the makers of Paxil suppressed reports that going off Paxil creates this horrifying scenario more often than you would think.