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Re: mania or anxiety? Or what???

Posted by Lisa on November 4, 1998, at 3:41:46

In reply to mania or anxiety? Or what???, posted by Erik on November 3, 1998, at 22:08:29

Let me see if I can help here since I've gone through a very similar ordeal for most of my life. I too was diagnosed for years with depression and anxiety until the hypomanic episodes began, got worse, and then came the bipolar diagnosis.

You seem very concerned with fitting the "classic" symptoms of some form of mental illness. I don't think you should waste time dwelling on that since so many of us are not classic anything but yet a mix of two and even three disorders. All on top of each other can make for one confusing diagnosis! Let me try to address this one problem at a time :)

There are so many ways of looking at this can I have no concrete answers for you, only suggestions. Sometimes the manic part of bipolar disorder can manifest itself as extreme anxiety, especially since bipolar is a progressive illness where a manic or hypomanic episode may not show up for years. There are also many instances where bipolar can be coupled with an anxiety disorder, as in my case. How do you know the difference? Well, is the anxiety always there or does it come and go between the depressions (it can also mix)? Are you on an anti-anxiety medication? If not, try one out for now. If you can decrease or eliminate the anxiety, you can then possibly notice any "high" periods. If there are none, then you may only have depression and anxiety, and I stress the "may." Manias can also be much more that irritability. They can be dysphoric episodes where you despise the whole world, throw things in agitation, or do things harmful to yourself or others. You don't necessarily have to be happy, manias are destructive.

Regarding a "classic anxiety disorder," you don't have to have a panic attack to fit the profile. There is also Generalized Anxiety Disorder (GAD) where a person can have a constant level of anxiety but no panic. I am also med intolerant, but have had good luck with benzos, particularly Klonopin, though there are still other very good anti-anxiety drugs that could help you. Maybe Toby or Dr. Bob can help in that department. Another question to consider is the lack of sleep. Is it caused mainly by the anxiety? Do you wake up because you have to and are tired throughout the day, or do you finally fall asleep and stay that way for a good amount of time? IOW, is there a *decreased* need for sleep -- 4 hours and you're still energetic, or is it insomnia caused by anxiety and an alarm clock that wakes you up before you're fully rested? Do you have racing thoughts at the time, or is your mind clear?

One other way of knowing whether or not you are bipolar is by inducing a mania with one of the antidepressants known to cause manias in bipolars. Unfortunately, they've also been known to cause manias in some people who are not bipolar, but I think that is much less infrequent. I don't condone this and would rather see an approach based on a patient's history with good, targeted questions, still it *can* answer the question. I have bipolar and panic and generalized anxiety disorder, am currently taking Neurontin and Klonopin, and am doing well. I sure hope this helps.





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