Q:  Depression & Anxiety, Anxiety & Bipolar

Histry - My ex husband was diagnosed with bipolar disorder about 20 years ago(he's now 48) He suffered with symptoms from the age of 18. (Others in his family also suffer with same)  My daughter who is now 23 has been experiencing some anxiety (sometimes acutely) and also some depression.  She sometimes has difficulty sleeping.  She had a panic attack one night when home alone and called everyone she knew until she found a friend at 3:00 in the am to take her in.   She graduated from college in May. She received excellent grades, has a very active social life, holds a job and seems from all outward appearances to be a well integrated, happy person, with some anxiety about her life, where its going, what she will do etc.  She has been seeing a therapist and a psychiatrist who recently put her on Paxil and Topomax. When I saw the Topomax indications I questioned why she would be put on an anti- seizure medication.  She told me it was for sleeping. Can this meidcatio!n be used for sleeping and as a mood stabilizer?  Is is ok to take with Paxil?  Aren't there any other mild sleeping aids have less side effects.

Does bi polar mean that you have manic phases with the depression?  How interrelated are depression and anxiety.  Does one lead to the other?

I apprecite any feedback you hcan give me.  Thank you

Dear Sue -- 
Depression and anxiety are so intertwined that separating them in our "diagnoses" is pretty difficult: something like 50-75% of folks with clear depression also have substantial anxiety, for example.  

However, with the history you provide (and writing here), it sure makes one other question come to mind, namely "how interrelated are anxiety and bipolar disorder?"  Here's a little essay on anxiety and bipolar disorder I'd want you to start with;  although it could be off target.  After that you might want to read the diagnosis section on bipolar II; again, not that this is certain by any means, but just to know about.  

Finally on Topomax: not clear what the doc' was thinking there.  This could be trying to block weight gain with Paxil, as well as help with sleep (an unusual approach); or it could be that the doc' was thinking about bipolar disorder (it would still be an unusual  approach...). 

Dr. Phelps