Question: Hello Doctor,

I have been diagnosed with Bipolar I Rapid Cycling during a hospitalization in 2005 for severe. depression. Prior to that time, I was misdiagnosed as having Unipolar Depression for a number of years, which seems to be typical for Bipokar Disorder.

I have experience depressed, manic and mixed states throughout my adult life. I have always had a small amount of co-morbid anxiety along with the Bipolar.

However, this year I experienced an episode unlike anything I've experienced before. Starting on March 3rd I started experiencing full-blown panic attacks. I know work was a partial reason for these attacks but the panic attacks did not occur after a significant change in my work or in my personal life.

I think that it is important to note that even during my worst depressive episode, the one that led to hospitalization, I did not experience panic attacks.

I had almost daily attacks for four months until I could not work anymore. At the beginning of this episode, I did not know what I was experiencing since I never had these symptoms before. However, I knew that this would prove to be the worst experience I would gave in my life. I tried to get ny girlfriend to leave since I dud not know what was happening, I did not know how to treat it nor did I know how long it would last. Thankfully, she insisted on staying by my side to help me get through this period.

During those four months, I experienced severe panic attacks, depersonalization derealization, sleep paralysis, cold sweats, heart palpitations, uncontrolled shaking and shallow breathing. I only experienced a slight amount off depression. Not enough to interfere with my ability to work.

During those months, my girlfriend had to everything for me, including waking me up, making me eat, making sure I showered, making sure I dressed and making sure that I left my apartment to go to work.

Unlike most people who experience depersonalization derealization, I was not that concerned with them. I interpreted them as a religious experience. In my mind, I started to create a whole theology based on these experiences. I am now quite uncomfortable with how I interpreted having these experiences.

I also experienced sleep paralysis but I did not feel an evil presence was by my side like so many other people report when they have this type of experience. I was scared but also fascinated. The first time it happened, I thought I was still dreaming and had entered someone else's apartment in my dream. However, there was an iPad on a coffee table playing the same TV show that I was watching before I fell asleep. But the dialogue and closed captioning seemed pretty consistent even though I could not really understand either.

I'm a pretty intelligent and analytical person but I started to doubt that this was a dream since I didn't think I had the brain power to create such a full and quickly changing environment. At that point, I noticed that my side table that has vases on top of it was sticking horizontally out of the wall. At that point, in my mind, I rotated my perspective counter-clockwise by 90 degrees. At that point, everything feel into place and I realized that I was awake but paralyzed. I tried to scream at the top of my lungs to let my girlfriend known I needed help but all I could manage, from what my girlfriend told me, was a small whimper which my girlfriend eventually heard and proceeded to wake me up.

Within a few minutes, I fell back asleep and continued to have this experience. In total. I had 5 episodes of sleep paralysis in a two or three hour period. I know that most people have this experience a few times in their lives but not to the degree I had them.

One night, the panic attack was so bad, I could not sit down. I thought of calling 911 but could not bear the thought of sitting still for hours until the doctors saw me. Instead I started to mixed medications slowly. I took a Xanax but after a short period of time, I did not feel any better at all. Next, I had left over Percocet from a complete tear I have in my left ACL. I did address the knee injury right away since I just started my new position. Instead my orthopedic surgeon injected a gel into my knee which could relieve my symptoms for up to a year and a half.

However my internist prescribed Percocet, three times a day as needed for the excruciating pain I was having. The pain went away during the second month of the Percocet treatment. Since I had a lot of left over Percocet, I took one of those. After a short time, a took a shot of vodka to see if that might calm me down enough so I could sit down. I continued doing this until the anxiety went away enough so I could watch TV with my girlfriend. I wound up taking 7 Percocet, 4 Xanax, 4 shots of Vodka, two Benadryl and 1 sleeping pill.

I wasn't trying to harm myself. I was just trying to get rid of the Panic Attack. Needless to say, my doctor was vey upset with what I did. He said it read like a toxically report from a celebrity that died from an overdose. I was glad that did not happen to me. However, based on my doctor's reaction, I realized that I might have stumbled upon an effective means of harming myself.

During this time, I would often experience the beginning of a panic attack during work. When I tried to suppress it, my whole body would start to shake. When no one was looking, I swallowed one or two Xanax and tried to hold still until the feeling of panic subsided. No one knew that anything was wrong with me until the last week of work. I started to look sick and I started to miss multiple meetings. It is very important to me to maintain a professional demeanor at work and to produce quality product. I was able to do that until that last week.

The last week I worked, I started talking about taking the 60 Clonazepam and the 60 Xanax I had on me. I truly didn't think I could die this way. I've read up on how many Benzodiazepine it would take to put me in serious trouble and I did not think I had nearly this number. I was just curious as to what would happen if I did. Mixing medications, on the other hand, as I described above, would have been much more effective.

I also do not think I was trying to harm myself since I let my girlfriend, my Mother and my Sister know what I was thinking of doing. My Mother contacted my Psychiatrist who set up an emergency appointment for me. He was not going to allow me to leave his office. Thankfully, my girlfriend was in the waiting area. I brought her into the office and asked my doctor if my girlfriend took control of my medication would I be able to leave. The three of us agreed. I still don't have control of my medication. She either hid it very well in my apartment or she takes it with her when she leaves the apartment.

Since the symptoms of this episode were unlike any experience I had before and since this episode does not seem to "fit in" with the episodes that a Bipolar person typically experiences, I feel that it might be a new disorder (perhaps a Panic Disorder) that is now co-morbid with my Bipolar Disorder.

Since I've had Bipolar Disorder for quite sometime, I have researched this disorder as well as illnesses that are commonly co-morbid with Bipolar and have not found illnesses with the symptoms I have described. In fact, I have recently finished a new Bipolar Safety Plan, which I will distribute to my support network. No where in this plan is any mention of the symptoms I experienced this year.

I have found information on the Internet that describes almost verbatim the symptoms I experienced. They are in two Panic Disorder websites. There is no mention In the first article of it being co-morbid with Bipolar Disorder. It appears that it can be co-morbid with unipolar depression. As far as treatment goes, there is no mention of mood stabilizers, then mainstay for treating Bipolar Disorder. The two websites are:

http://panicdisorder.about.com/od/symptoms/a/Panic-Disorder-And-Sleep-Issues.htm

http://panicdisorder.about.com/od/diagnosis/a/The-Diagnostic-Criteria-For-Panic-Disorder.htm

I need to know if this is a distinct co-morbid illness for two reasons: the first is because I would like to know how to treat this disorder so I don't experience it again. The second is because if my insurance company considers this episode to be part of my Bipolar Disorder, they will consider it a pre-existing condition for which I will not be covered. If it is a newly expressed co-morbid disorder than I would be covered.

I truly appreciate you reading this lengthy email but I did not know how to communicate my experience more succinctly.

I look forward to your feedback,

XXXX