From Hypomanic to Panic

I mentioned in other posts, namely The Hypomanic Toll Booth that I was going through a serious episode. To make a note, it was the most intense and longest hypomanic episode since I started treatment. I made it something like 16 or 17 days. This is coming from someone who has maxed out at 14. I can thank some virus for knocking me down around Tuesday or Wednesday.

Now, I am still running on high. I do have symptoms like rambling speech and hyper-speed thoughts. No sleep problems and no desire to be social. In fact, I have the complete opposite.

For the last week, I have been suffering from full on panic attacks. I’d be in the middle of something and come to a screeching halt, like the deer in the headlights. At first, it was very irregular. I was stricken at 5:30PM during a Kindergarten class. Another day, it was in the shower, first thing in the morning. Then, it settled into what I thought was about 12:30PM-1:30PM.

Today, I first got hit at T.D.’s pediatrician appointment at 9AM – but, there was a specific reason for that. (More to come on that). Ok, I rode that out, until I was out of the office. I got hit again at 11AM. I figured out why later – I woke up an hour and a half before I usually get up.

Instead of instantly medicating, I attempted the navigate the choppy waves with mantras and breathing. No dice. With panic, those techniques are only effective in the moment. They won’t prevent another attack. Panic comes when panic wants, ready or not.

I finally broke down at 1PM because the panic was quickly seizing my ability to function. I took a half a milligram of Xanax like I usually do. I suppose I waited too long. A half a milligram didn’t do it. I had to take the other half at 1:30PM. Even a milligram wasn’t enough to keep the anxiety completely at bay. But, at least the panic attacks stopped.

I was thinking about it the other day. I’m not sure I’ve ever experienced anxiety outside of a depressive episode. Nor have I ever, ever, ever experienced panic without provocation, such as being faced with a phobia.

So, here comes the questions. Note, I did not have a depressive crash after the last hypomanic episode. I’m not being plagued with constant underlying anxiety. I’m having seemingly random panic attacks.

Is running on high causing the panic? Or, is the panic actually a result anxiety that makes me appear on the edge of hypomania? Or am I still hypomanic except on the lower side and I’m experiencing panic as a result? Or is the panic a separate entity all its own?

So many questions. So few answers.

Pillbox

After working through numerous scheduling conflicts, I finally had my visit with the psychiatrist today. And I finally had a chance to express to him everything that has been going on.

His first reaction was not what I had expected. Instead of generalized anxiety disorder or a medication reaction, my doctor seems to think I’ve had underlying panic disorder. He wanted to change my antidepressant to Effexor. I very kindly reminded him that my depression had caused significant weight gain in a short time. He changed his sights to Prozac. I stopped him there.

I didn’t think it was the antidepressant that was the problem. We just changed the dosage on my Wellbutrin and there was no change. None. Not better and not worse. But we haven’t moved anything around with my mood stabilizer or my anti-anxiety meds in six months or more. I told him that irritability was always the calling card of destabilization. And I’ve been a firecracker lately.

So I have some new things to add to my pillbox. Xanax, 1 mg 3 times daily, and temazepam 30 mg once daily. C.S. added a couple of nutraceutical add-ons to help.

My daily regimen looks as such:

Morning:
300mg Wellbutrin
1 capsule Cogni-flex
1 capsule Ubiquinol
1 capsule Adrenomend
1mg Xanax
100mg Lamictal

Afternoon:
1mg Xanax

Bedtime:
1mg Xanax
30mg Temazepam
150mg Lamictal
1 tablet Orthosept
1 capsule Quell
1 capsule L-glutithione
1 capsule Seditol

As needed:
2 puffs Ventolin
1 capsule Maxalt

Note: The nutraceuticals are not all aimed at mood support. I take some for heart support, weight management, and immune support. Some psychiatric medications lower white blood cell count and leave a person susceptible to infection.

I am also aware of the potentially dangerous interactions between several of these medications. Don’t worry. Dr. Husband (with some sarcasm) has vowed to look after me. Mainly, we’re concerned with too much sedation. Orthocept increrases Xanax and Xanax and Temazepam are both benzo’s. Temazepam isn’t forever – it’s temporarily treating the insomnia until we can get things under control$

If you see something I might have missed, let me know.