Q:  Panic/Anxiety Disorder or BP?

Dear Dr. Phelps:

About four years ago, after the death of my brother from a long battle with cancer, I developed what was diagnosed as "Panic/Anxiety disorder".  I hadn't slept in about one month and was very anxious all the time.  I went to a psychiatrist who prescribed Paxil and Xanax to sleep at night.  I recovered completely and after two years was weaned off this medication.  Last November, after the death of my mother, these symptoms returned with a vengeance.  I was crying, suffered severe insomnia, depression and anxiety and again was put back on the Paxil.  The Paxil did nothing for me this time and I was switched to Serzone which made me much worse.  From reading your very informative message boards, I believe that I was in a hypomanic state.  I then went to a new doctor who prescribed 1000 mgs of Depakote and 100 mgs of Seroquel for sleeping.  I have been on this combo for 5 months now and other than some breakthrough anxiety seem to be okay.  This doctor still hasn't said whether or not I am bipolar.I guess my question is "am I bipolar or is this "panic/Anxiety disorder" and do they have the same symptoms. 

Thanks



Dear Ms. S' -- 
I can see why you'd want to ask this question.  It's almost more a matter of definition than diagnosis:  what do you do if you have symptoms of anxiety and depression, which doesn't make a person "bipolar"; but then respond better to a mood stabilizer than an antidepressant?  After all, Depakote has been used to treat panic disorder with some success...

Well, if it wasn't for the "Serzone which made me much worse" part, I'd say this question was a little on the moot side, because you're better.  But with that, I'd weigh pretty heavily for the BPII side of the interpretation, while reminding you that it's a spectrum deal, not a "yes or no" deal, if you read that section of the diagnosis stuff on my site.  

Granted that most people would prefer to have "anxious depression", or panic disorder, to "bipolar disorder", which sounds way too much like a serious "mental illness".   Hard to enjoy being improved, under that label, and it would be nice to substitute something else -- or so many of may patients feel.  

I guess I'd fall back on my emphasis that the two (e.g. Generalized Anxiety Disorder, with depression; and bipolar disorder) have some much overlap, it's a matter of definition more than diagnosis -- so you can probably call it whichever you prefer.  

Dr.Phelps