Counting respirations for one minute with a stop watch is the only way to detect this condition. Breathing at rest will be chronically too slow [like Paula] or too fast [again like Paula with further pH deterioration]. Arterial blood gas tests MUST be done to determine PCO2. Non invasive breathing support MUST be given till crisis passes or forever. In Paula’s case Paxil, a SSRI seems to stabilize PCO2 despite her respiratory defect, which is a permanent injury. SSRI agonists are involved in everything in the body, serotonin co-ordinates bone, tissue repair, breathing, liver regeneration, and is an anti fungal agent….one of these effects or all of these effects are treating Paula’s mental status and has been responsible for her recovery, despite her 5 breaths per minute respiratory rate with active exhaling.