Feelings of Intense Dread/Fear
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Q:  Feelings of Intense Dread/Fear


The other day I started to experience a feeling a dread. Intense fear that I was going to die or my son was going to die. I cannot shake this. I feel like I'm on death row waiting to be sentence to death.  I went to my doctor and she increased some of my medication. I have no interest in things I used to. My thoughts are "what does it matter". I am starting to pull away from my family. Have you ever heard of this? And what did they do to pull out of this?
Thank you.


Dear Mr. P' -- 
You indicated "been diagnosed", I presume with bipolar disorder from the context here; and so you're asking if I've heard of this kind of thinking in patients with bipolar disorder?  Absolutely, very commonly.  There is an obvious depressive feel to the content of these thoughts, no?  So most psychiatrists I think would regard this as depressive thinking, i.e. thinking bipolar depression.  They might even consider adding an antidepressant, and would probably be looking at antidepressants that affect serotonin, because they would listen to this and hear an "obsessive" component also. 

As you can gather, I find such thinking frustrating to hear because it leads toward medications that can make the manic side of things worse, or cause "mixed states" of depressive symptoms and manic/hypomanic symptoms together.  So I would look closely in you for any other signs that this thinking could also be somewhat "manic-side" in nature, to makes sure I didn't make that mistake.  I'd look at your sleep, which on the basis of this I'd suspect was decreased or much more broken up (as opposed to increased, which is what it's supposed to do in a relatively pure bipolar depression).  And your other activities; your speech rate; what your significant others might say about how you've been acting lately (more revved up? irritable? agitated?)  Only if I found nothing along those lines would I consider an antidepressant.  Otherwise, I'd be thinking, as your psychiatrist has probably already done, about increasing the mood stabilizers and making sure nothing else was exacerbating cycling: sleep deprivation, alcohol, some modifiable stress source, steroid, travel -- that kind of thing.  Good luck with that. 

Dr. Phelps
 

Published April, 2004
 

 

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