QUESTION:
Dear Dr. Heller,
I am a 31 year old woman recently diagnosed as bipolar. I believe seriously that this diagnoses was wrong. I have depression, mood swings and panic attacks. Lately my panic attacks have turned into a general feeling of anxiousness all the time. One thing I do not understand is how I could be diagnosed as bipolar when I do not have manic or any manic type episodes. Sure I have days when I feel better than others, but most of the time I am down. I have mood swings that are very quick, i.e I will be fine and the next minute sad or angry for no reason. I was given Neurontin to take but I am confused about Neurontin and it's purpose. Does Neurontin control panic attacks and the general anxiety feelings? How long does it usually take to work? Help please if you can, as I am very confused.
Thank You.
ANSWER:
I agree with you. How can a person be diagnosed as bipolar without mania or hypomania?
The official criteria can be found at
http://www.BiologicalUnhappiness.com/BUD_Crit.htm
You are likely describing the BPD with panic. This is a tough combination because of the
need for moderately high doses of benzodiazepines such as Xanax - which has been shown to
worsen the severity of behavioral "dyscontrol" in those with BPD. Needing Xanax
or an equivalent medication is a "risk/benefit" evaluation. I almost always have
my BPD/panic patients on Prozac and Tegretol, only using Xanax if they need it - which
many do. Untreated, the combination of BPD and panic has been reported to have a 25%
suicide risk.
Neurontin can sometimes help with bipolar, and rarely with BPD. It's very unusual for
Neurontin to help with BPD. I've never encountered an individual with panic who
improved with Neurontin.
http://www.BiologicalUnhappiness.com/AskDoc/First-Do.htm will
be of help for you in determining what should be done next.
