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How to distinguish anxiety from hypo or mixed state?


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This was a recent CM thread that had enough value to me to reinvent it over here. It's a two parter this time, though.

1. How can you tell the difference between anxiety and hypo/mania when co-occurring?

2. How can you distinguish anxiety from the first warning signs of hypo/mania or mixed state?

I'm particularly interested because up until about two weeks ago, I didn't think I did much anxiety. Then two weeks ago after stopping Seroquel and starting Zyprexa (for depression) it seemed like, whoah, anxiety is my issue. Yesterday, my pdoc sent me home for three weeks with some Klonopin and a "we'll see if you are right" after having said that she was fairly sure it was a mixed state starting to congeal. Well, damn it, I think she may very well be right. But, I don't know, and it's my own friggin' body hosting my own friggin' mind.

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i wonder the same thing. sometimes i know its just anxiety (like trying to get out the door with 3 kids to make it on time to one of their practices). other times with generalized non-specific anxiety, i really feel like its the bubbling inside the volcano. like its building up to something more. but i try to keep the anxiety in check by taking a 1/2 a klonopin the moment i start to feel anxious. sometimes that works. other times the build up continues despite the klonopin and i find i have to take more klonopin (i'm allowed up to 2 a day prn) just to keep this helium balloon of myself from floating too high.

interested in hearing other responses.....

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We had a good one, that Sorrel started, with some excellent references, on the CM talk site. Which is in status TBD, apparently. If it comes back, I'll post the link.

I don't have the heart to recreate my little writeup of the cognitive model right now - sorry, SZS. I'm whipped. I'll try to rally tonight.

Glen can maybe redo his part with the KCC2 deficient mice. Those were a big hit.

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I'm really interested in that question too.

I've been diagnosed bipolar and, well, not bipolar--whatever that would be! ;)

One former pdoc (the landscape is littered with them lol--one of them even gave up psychiatry altogether and went into pediatrics after meeting me! :) )--anyway, sorry for getting distracted, one former pdoc said he didn't think I was bipolar but he could see why someone might think so--due to the fact that I talk very fast (and frequently *blush*) and that my anxiety sometimes comes across as hypomania. But he thought it was "just" excessive anxiety.

I guess the pdocs who thought I was bipolar figured it was hypomania--maybe mixed with anxiety, which can definitely happen.

It's all really confusing and I would love to figure it out somehow!!

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This was a recent CM thread that had enough value to me to reinvent it over here. It's a two parter this time, though.

1. How can you tell the difference between anxiety and hypo/mania when co-occurring?

2. How can you distinguish anxiety from the first warning signs of hypo/mania or mixed state?

I'm particularly interested because up until about two weeks ago, I didn't think I did much anxiety. Then two weeks ago after stopping Seroquel and starting Zyprexa (for depression) it seemed like, whoah, anxiety is my issue. Yesterday, my pdoc sent me home for three weeks with some Klonopin and a "we'll see if you are right" after having said that she was fairly sure it was a mixed state starting to congeal. Well, damn it, I think she may very well be right. But, I don't know, and it's my own friggin' body hosting my own friggin' mind.

For me, anxiety is this kind of free floating dread, that can attach itself to just about any thing, and tends to disappear when I'm actually having a mood episode. It's not much of an issue for me in the first place, fortunately, but I guess what I'm trying to say is that the difference between anxiety and hypo is so huge for me that I don't even quite know where to start.

I'm wondering though, if the klonopin is helping?

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I believe that, with bipolar, the anxiety manifests itself along with irritation and action. Jenn, my roommate and friend, has bipolar, while I get the plain anxiety..

She tends to have more of a push towards something else at the same time; whereas, I just feel this sense of dread and pressure inward. They're both debilitating, but I can see a difference.

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We've had several variants on this thread over the years if anyone feels like searching.

I think the distinction between anxiety and agitation is probably an important one to make here. Do you want to hide or do you want to scrape your skin off with a potato peeler? Is your brain made of jello or of battery acid? Can you sleep?

Anxiety is a huge, huge concept since it includes the subjective experience of clinical anxiety, existential dread, apprehension and forboding, etc. It might be easier to toss it out the window and try to find other terms to describe what you're experiencing.

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I'm going to get anal on this one and go all DSM. Because really, it's kinda that simple, if the noticeable switch came after a med change. The DSm difference is striking.

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General anxiety (and I'm going to presume this is what you're talking about):

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The person finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.

restlessness or feeling keyed up or on edge

being easily fatigued

difficulty concentrating or mind going blank

irritability

muscle tension

sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in a Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.

E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.

http://anxiety.psy.ohio-state.edu/gad-dsm-.htm

Hypomania:

A) A distinct period of persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

1) inflated self-esteem or grandiosity

2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)

3) more talkative than usual or pressure to keep talking

4) flight of ideas or subjective experience that thoughts are racing

5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)

6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation

7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C) The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D) The disturbance in mood and the change in functioning are observable by others.

E) The mood disturbance not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F) The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication or other treatment) or a general medical condition (e.g., hyperthyroidism)

http://www.biologicalunhappiness.com/Hypomani.htm

Mixed episode:

A. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

B. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment), or a general medical condition (e.g., hyperthyroidism)

http://www.biologicalunhappiness.com/MixEpisd.htm

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Everything clear then? Yeh, thought so. Really, more specific symptoms would help...

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I think the distinction between anxiety and agitation is probably an important one to make here. Do you want to hide or do you want to scrape your skin off with a potato peeler? Is your brain made of jello or of battery acid? Can you sleep?

No worrying, no hiding, some scraping, and very fair to say battery acid. Sleep, ha. I don't do that w/o sleepers even when stable, but yes, it's worse.

I think I just *want* this to be anxiety. Really, really, really I do. It's such a better alternative cuz I'm battling depression right now already.

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CNS, sometimes DSM is useful. (I'd say not often, but that's my pet peeve.) This would be one of the useful times. I don't really meet the GAD criteria sufficiently to say anxiety. Where DSM is not so useful is for things like BPII mixed episodes, or how much closer to BPI some BPII can be. There's a grey area than that's more like a void. My day further helped clarify the state, and I dread where this is going.

Anyway, thanks for the GAD info.

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I'm wondering though, if the klonopin is helping?

Hey Sasha,

Nope. Not hardly, so I already know which it is and I don't much care for it. My footer will probably include an add on of Depakote soon. I'm trying to be on more meds at the same time than you once were. Really, that's the sole goal. ;)

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I'm wondering though, if the klonopin is helping?

Hey Sasha,

Nope. Not hardly, so I already know which it is and I don't much care for it. My footer will probably include an add on of Depakote soon. I'm trying to be on more meds at the same time than you once were. Really, that's the sole goal. ;)

Well, that's certainly quite a goal you've set for yourself! Let's see, at my peak I was taking... Keppra, Neurontin, Topa, Seroquel, Lamictal, and Provigil. I think that's right... So good luck with that!

Why Depakote rather than going back on the Seroquel?

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I can only take 50mg of Seroquel at a time and need to space it 2-3 hours. This totally wipes out my evening. Even at that, I still wake up a couple times due to congestion. If I could take 100-200mg to put me to sleep, I'd be there in a heartbeat.

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I can only take 50mg of Seroquel at a time and need to space it 2-3 hours. This totally wipes out my evening. Even at that, I still wake up a couple times due to congestion. If I could take 100-200mg to put me to sleep, I'd be there in a heartbeat.

Got it. So then, depakote it is! Any clue when you'll be starting, or how much?

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The plan was three weeks from now. Get a light box, see if it helped, lower Z in two weeks, then stop while adding Depakote. That's when my anxiety idea was being humored a bit. It's two days later, and I'm not so sure it's anxiety. The light box kind of scares me cuz if this hypo/mixed starting, it's apt to fuel it instead of working on the depression. We'll see. For the time being, it's three weeks. How much, dunno. "Low dose" was all I caught. The idea is to not replace Lithium. My pdoc gets it that Li is the most neuroprotective, so understands my no wanting to give it up. Besides, Depa is another fattening med for some. If I can do a minimal amount and stop the APs, I'll be happy (or at least that's the goal ;)).

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