Is It:  Panic, Depression or Bipolar Disorder?

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Symptoms of depression, anxiety disorder and bipolar disorder have similarities -- but each condition requires a unique approach to treatment. Jeanie Lerche Davis explains that various mood disorders and their symptoms often overlap.  There has been an increase in people reporting symptoms of depression and anxiety over the past 100+ years, and there is an ever increasing demand at home and work with regard to finances.  Many people are feeling overwhelmed, so depressive and anxiety symptoms can often be reported together. 

Panic Attacks

If you experience the sudden onset of four or more of the following symptoms, you may be having a panic attack: 

• Sudden high anxiety with or without a cause Heart palpitations Sweating Shaking 
• A "smothering" sensation or shortness of breath 
• A feeling of choking 
• Chest pain  
• Discomfort Nausea Dizziness or faintness 
• A sense of unreality 
• A fear of going crazy or losing control 
• A fear of dying 
• Numbness
• Tingling Chills 
• Hot flashes 

"Very often, we find that people have more than one condition -- both depression and anxiety disorder," says Charles Goodstein, MD a professor of psychiatry at New York University School of Medicine, with a clinical practice in Tenafly, N.J. "As a matter of fact, it's very hard to find patients who are depressed who don't also have anxiety. It's equally hard to find people with anxiety who don't have some depression."

"We see this very frequently," he tells WebMD. "Financial, relationship, and family problems - all these can trigger anxiety and sadness, so we consider these feelings to be normal. They are not normal when the feelings are extremely intense, when they impair everyday functioning, affect quality of life. When all that is happening, it becomes difficult to solve the very problems that started the depression."

Symptoms of Depression (NIH)

• Persistent sad, anxious, or "empty" feelings
• Feelings of hopelessness or pessimism
• Feelings of guilt, worthlessness, or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details, and making decisions
• Insomnia, early-morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

There may also be other psychiatric issues such as bipolar disorder.  In a diagnosis of depression, the focus is on the depressed mood or symptoms around depressive sates in functioning.  With anxiety disorder, the focus is on symptoms of constant worry and panic.  In bipolar disorder, the focus is on rapidly shifting intense moods or mood swings.  However, some of the symptoms of these 3 disorders overlap.  

Symptoms of Bipolar Mania: (NIH)

"Mood Changes

• A long period of feeling "high," or an overly happy or outgoing mood
• Extreme irritability

Behavioral Changes

• Talking very fast, jumping from one idea to another, having racing thoughts
• Being easily distracted
• Increasing activities, such as taking on new projects
• Being overly restless
• Sleeping little or not being tired
• Having an unrealistic belief in one's abilities
• Behaving impulsively and engaging in pleasurable, high-risk behaviors

Symptoms of Bipolar Depression:

Mood Changes

• An overly long period of feeling sad or hopeless
• Loss of interest in activities once enjoyed, including sex.

Behavioral Changes

• Feeling tired or "slowed down"
• Having problems concentrating, remembering, and making decisions
• Being restless or irritable
• Changing eating, sleeping, or other habits
• Thinking of death or suicide, or attempting suicide."

Antidepressant Medications?  Maybe Not.

Davis recommends speaking openly with one's doctor in order to determine the correct diagnosis.  The physician must have the most accurate information about their patient's inner life and complete a thorough evaluation to determine if medication is appropriate and what medication would be correct for the individual.  In addition, the doctor may want to see their patientl for further evaluation before prescribing medication, or they may refer them to a specialist such as a psychiatrist.  There should also be a follow up appointment after medication is prescribed, often 30 days or 3 months to evaluate the effectiveness of the medication as well as to monitor the side effects.

Under those circumstances, an antidepressant is often prescribed - yet that may or may not be the right choice. "Antidepressants are used to treat both anxiety disorders and depression. However, someone with bipolar disorder needs a different set of drugs -- a mood stabilizer and antimanic medication," Fagiolini tells WebMD. There are several types of mood-stabilizing drugs, which include medications like lithium and anticonvulsive drugs such as Depakote or Lamictal.

The danger: "Giving an antidepressant to someone with bipolar disorder could trigger a manic episode," he explains. "Manic episodes can be dangerous, because you have very poor judgment, tend to use more drugs, drive recklessly, spend a lot of money, have much more sex - and have it completely unprotected. There's a higher risk of high-risk behaviors because there is poor judgment."

There are two major types of antidepressants, tricyclics and selective serotonin reuptake inhibitors (SSRIs).  According to the Harvard mental health letter, “Both drug classes act in brain pathways that regulate mood and the perception of pain. Tricyclics heighten the activity of the neurotransmitters norepinephrine and serotonin; SSRIs act more selectively on serotonin."

It is very important to prescribe the correct medication so that there is not an increase in negative symptoms or an onset of new symptoms.  In addition, if the incorrect medication is prescribed, it could make the person feel worse and they may not like the effects of the medication.   When this occurs, there is often resistance or non compliance not only with the medication prescribed, but for other alternative medications. Someone with Bipolar disorder can be very stable with mood and behavior when they are on the correct medication and are compliant.

Because bipolar disorder is a long term chronic condition, The National Institute of Mental Health recommends long-term preventive treatment. The institute notes that a combination of medication and psychotherapy works best to keep the disorder under control over time. Most psychiatrists and clinicians in practice recommend this combined therapy.  Combining medication and psychotherapy is also recommended for persons with anxiety disorders and depression as well as most psychiatric diagnoses.  The medication helps to stabilize the symptoms, while therapy can use techniques such as Cognitive Behavioral therapy, to address the emotional states, cognitive patterns and behaviors that lead to the symptoms.  Therapy can also help to identify underlying issues and provide new positive coping skills and behaviors. 

If you or a loved one are experiencing depressive symptoms, anxiety symptoms or mood disorder symptoms, talk to your primary car physician.  They may prescribe medication or refer you to a psychiatrist or therapist or both.  The most important thing is to recognize if a problem is occurring and seek out professional help. 

- Kim B.

Insightful Comments

In today’s society most people will self-diagnose their own issues.  We live in an era when most people prefer to avoid the medical community at all cost. Our nation has seen the Affordable Healthcare Act; also referred to as Obamacare require healthcare insurance. However, Obamacare does not force participants to seek or receive medical care, it simply requires them to have a way to help pay for treatment. There is still necessary action and participation from the patient to actually receive the healthcare.

I am not writing an explanation of Obamacare or praising the benefits. I am not qualified on any level to do so, and I don’t know if anyone is qualified to do so. I am still uncertain if there are more than a dozen people in the United States today that have actually read the entire Affordable Care Act legislation.

I am concerned that, though perhaps well intended, Obamacare is no more effective at getting participants to use their available healthcare centers and personnel than before. This is a study that needs to happen and a discussion on the results to follow.

I believe we are faced with a technology generation that would rather use WebMD than Marcus Welby, MD. We have television talk shows devoted to advice from doctors, psychiatrists and psychologist.  There are infomercials that focus on our health and wellbeing trying to sell us the latest and greatest wonder pill or lotion that will solve all our problems. Many of these infomercials are directed at fixing our self-diagnosed problems or us. 

Have you noticed that many if not most are about our libido? ‘If you only fix your libido issues, whatever they may be, then you will be a whole new person on your way to great sex and a great life.’  I am a believer in practicing a safe, healthy, regular sex life within my marriage. Though, I do not believe that it is the 'be-all cure-all' for our physical, emotional, and/or mental problems, it certainly is help.  This mentality is indicative of the society in which we live. The issues that have plagued people since perhaps the dawn of time, but certainly since the industrial revolution are the same. They occur repetitively throughout society and across generations. They are a cyclical endeavor, a merry-go-round if you will, that has yet to stop and rarely slows down.

Societally we have suffered or seen sufferers of mental disorders and/or illnesses perpetually. Times have come and gone when we have diagnosed or even discovered disorders.

The question that comes to my mind and forces me to ponder is this. Why do we try to rediscover and then rename an illness or disorder after it has already been discovered and named?   Would it not be more prudent and productive to use our scientific energies in an effort to develop more and more effective treatments for the already discovered and named? Are we just looking to have our fifteen minutes of fame or are we really devoted to helping people?


- Bergen

Feature, J. (n.d.). Depression, Anxiety, or Bipolar Disorder - Which Is It? Retrieved December 17, 2014, from http://www.webmd.com/anxiety-panic/guide/is-really-depression

http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

http://www.nimh.nih.gov/health/topics/depression/index.shtml