I've been experiencing a lot of anxiety without depression or suicidal thoughts lately due to bipolar II, so I went to my family practitioner for some help and was prescribed Paxil with Restoril for a mood stabilizer. I had never heard of using Restoril for mood stabilization, so I called back and she said that's common to keep the cost down. She mentioned that her office isn't to comfortable prescribing fancy medication like Lamictal, which I think might be best for bipolar II. I'm also not sure about Paxil. Would Cymbalta or Effexor be better? Is an antidepressant a good idea at all? Would Lamictal alone be better? All of these questions, what to do?

This is a very important question, and there is always more than meets the eye on the surface. Diagnosis always leads the way, and usually guides treatment, as anxiety is caused by many things, including life itself. Talking about the anxiety is always my first advice.

I have never heard of using Restoril as a mood stabilizer, although a related medication called clonazepam is often helpful in episodes of mania and anxiety (anything that has anti-anxiety, tranquilizing, or sedating effects is anti-manic). Thus, Restoril may fulfill that potential.

The cost of Lamictal may be less, as it is now generic (the generics cost less, can be as effective, although they should cost a lot less than they do, and sometimes they are not as effective as the trade name medication). One of my favorite quotes, from a colleague in Indianapolis, is "the cheapest health care is always the best health care". The more effective a treatment is, the better the result, the sooner people and their loved one's get back to their lives, and maybe even working and paying taxes.

Antidepressants are excellent for all forms of anxiety, however they can cause mood swings in bipolar patients (although not all bipolar patients, and maybe Bipolar I's (manic episodes) are at greater risk than Bipolar II's (hypo-manic episodes). Paxil is no better than other antidepressants, causes weight gain in many, and withdrawal symptoms can be troublesome. I prefer Cymbalta or Celexa for anxiety that doesn't respond to the alternative measures.

Alternatives to medication for anxiety is here and now thinking (the future provokes anxiety, so the present is the antidote); exercise (just walking puts you in the here and now); meditation; Omega 3 Fatty Acids. If medication is necessary, I like Lamictal and Li for bipolar patients, with the other alternative options for the anxiety.

I hope this helps, and good luck.