CurlyQ - In treatment-refractory depression (ie. depression that does not respond well to even ECT) lithium is usually used as an augmenting agent to one of the SSRIs, depending upon how the depression presents itself.

The risk of acquiring serotonin syndrome from mixing an SSRI with lithium is much, much less that what can be seen when combining lithium with most TCAs and MAOIs. Fatalities have been reported when the latter have been taken in combination (esp. in cases of "accidental suicide" - ie. a cry for help), as the doses of either need not be high to cause problems, depending upon one's individual biochemical mix.

Many researchers say that those that respond to lithium augmentation of an antidepressant were really suffering from bipolar depresssion and not unipolar depression. I tend to disagree; I think that certain subsets of depressions have as a major contributing factor, an intraneuronal problem possibly due to nerve membrane instability, problems with calcium ion flux/modulation, ditto perhaps for the sodium ions, &/or intracellular energy production fluxes.

All that being said, lithium is probably the first choice as an augmenting agent, especially for those who do have a small, but still unsatisfatory response to a certain antidepressant after a history of non-response to a number of other antidepressants.

Overall, if you can handle (or better yet, don't develop) the myriad of side effects associated with lithium (potential weight gain, hair loss, diarrhea, etc.) the drug can be a godsend to some of those with treatment-resistant depressions.

I hope that this answers your question. Oh BTW, yeas I have seen Paxil™ (paroxetine) and lithium used together successfully. We monitored this person closely for about a month, because at the time Paxil was new, and we weren't completely confident that combining it with lithium wouldn't cause serotonin syndrome (it didn't in this case).

I hope that your doc and you have a productive discussion on all of the potential benefits and liabilities of your trying lithium with the Paxil. See if he/she has any concerns with you personally using lithium (ie. if the doc thinks that you have any contraindications to taking the drugs together).

Hang in there little dove - Cam

<font color=blue>"History will keep repeating
itself forever like the woman
in the image on the Dutch Cleanser box"</font color=blue>
<font color=green>- Allen Ginsberg (from "Laughing Gas"- c.1958-60)</font color=green>