Your Experience

I experience extreme anxiety that is so severe and relentless that I don't know how to categorize it - generalized anxiety? A dysphoric mania (because the anxiety definitely has a tone of depression)? A delusional anxiety?

I've been in therapy for just over a year. The anxiety is no better than it's been for at least 8 years. I haven't found any medication that truly subdues the anxiety (Klonopin takes the edge off, a little bit, for about 2 hours).

I'm at a loss, at this point, as to whether my anxiety needs to be treated with therapy or whether it would respond to a more powerful medication.
I feel so on edge that sometimes it hard to breathe.

I'm wondering if anyone else with BP experiences such a powerful anxiety and, if so, how do you know whether to treat it with therapy or medication?

I think one of my dx's is GAD (generalized anxiety disorder?) and I used to get panic attacks and was heavily loaded up on all kinds of benzos yeara ago.. like maybe 17 years ago before they paid too much attention or researched the dangers of benzos. I think at one point I was on Klonipin waffers and xanax and tempazepam at night maybe? But I was heavily sedated and a spectator of my own life. I slept a lot and probably would have been a better person if I had known more. But I had gastric bypass in 08' and now that I metabolize drugs differently and due to the fact that being overweight played into my issues I stopped all of that medicine. I also became an alcoholic in my 30's post bypass so benzos are mostly a no go for me now. I take buspar which a lot of people say is useless but it takes about 6-8 weeks to work and is not meant for intense anxiety attacks. It basically made it seem like I woke up one day and instead of feeling like the world had me in a choke hold the moment I opened my eyes...I was better able to start my day. All of that time was also while I was in therapy. I think the therapy helped more. Dont get me wrong, I am not anti-benzo I believe they have their place and for some people that place is everyday. I have a tiny bit of valium for severe days but I really never take it. I think its a matter of finding the correct balance. I do not know if any of this was helpful or not.

I am so sorry yu are struggling with this, Beth. But I am very glad you posted this, because I have a very similar situation at times. I don't carry a GAD dx, but I have had legit panic attacks, I have a terrible phobia, and my bp 1 often consists of a horrific dysphoric mania--those are exactly the words I use to describe it.

I was on Buspar for a few years--no help, really. Klonoin works, but aggravates my despression, so, no-go. Seroquel and Vistaril are useless. I dunno.

So, am meeting with pdoc this week again and we will discuss this. The problem is, is it the chicken, or the egg? Is this anxiety experience due to an underlying manic/mixed/whatever you wanna call it thing? Or, does the anxiety arise independently? I do not know the answer to that question. But if I did, I think we would have a better shot at treating me. Personally, I think it is the former. And maybe, for me, what I need is just a little Ativan or something to sort of help calm me down. We'll see.

I have gotten good at soothing myself with Buddhist breathing stuff--really seems to help me. But is is still awful to go through this.

I was also lastly just wondering if for you, maybe a higher dose of Klonopin might be needed. Just a thought.

Sending you calm and peace. I hope this gets sorted soon.

Soo I’ve got GAD and social anxiety in addition to the bipolar.....scientifically they just started studying anxiety by GWAS and a lot of the anxiety genes overlap with bp and sz so there is potentially some intertwining of these dxes.

I personally don’t take an ssri which is the med of choice for anxiety ...imo too risky with the bipolar because I’m at a very low dose of antipsychotic with no other mood stabilizer. So I use therapy. The only effective therapy I’ve found is cbt.

Do i still get anxiety yes but I can usually talk myself out of it using
Cbt techniques....the most effective cbt I’ve had is from the woebot because he doesn’t mind repeating things because he’s a bot...available in app form. So if you can stop things from swirling in your mind that’s step 1.

Step 2 is breathing....I can’t do the more complicated breathing patterns because I get nervous about not breathing so I just put my hands on my belly and breath into my belly....you just want your belly to expand into your hands...do it as long as needed.

Step 3 distractions....do something, pretty much anything fun.

Usually something on this list works.

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Originally Posted by sarahsweets I think one of my dx's is GAD (generalized anxiety disorder?) and I used to get panic attacks and was heavily loaded up on all kinds of benzos yeara ago.. like maybe 17 years ago before they paid too much attention or researched the dangers of benzos. I think at one point I was on Klonipin waffers and xanax and tempazepam at night maybe? But I was heavily sedated and a spectator of my own life. I slept a lot and probably would have been a better person if I had known more. But I had gastric bypass in 08' and now that I metabolize drugs differently and due to the fact that being overweight played into my issues I stopped all of that medicine. I also became an alcoholic in my 30's post bypass so benzos are mostly a no go for me now. I take buspar which a lot of people say is useless but it takes about 6-8 weeks to work and is not meant for intense anxiety attacks. It basically made it seem like I woke up one day and instead of feeling like the world had me in a choke hold the moment I opened my eyes...I was better able to start my day. All of that time was also while I was in therapy. I think the therapy helped more. Dont get me wrong, I am not anti-benzo I believe they have their place and for some people that place is everyday. I have a tiny bit of valium for severe days but I really never take it. I think its a matter of finding the correct balance. I do not know if any of this was helpful or not.

Very helpful! See, my pdoc offered Buspar as something to consider. Your comment "in a choke hold the moment I opened my eyes" - that's it, exactly...what I would give not to be in that chokehold! I'll see her on Thursday & discuss Buspar.

Thank you, sarahsweets

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Originally Posted by bpcyclist I am so sorry yu are struggling with this, Beth. But I am very glad you posted this, because I have a very similar situation at times. I don't carry a GAD dx, but I have had legit panic attacks, I have a terrible phobia, and my bp 1 often consists of a horrific dysphoric mania--those are exactly the words I use to describe it. My anxiety circles around a specific phobia, too. But it's nuts because I am constantly ruminating over the phobia, then it sends ripples out to more anxieties until I feel like I have 2 minds. One mind is doing life while the other mind is spending its life twisting, turning, spinning over the anxieties until I feel completely insane. And afraid that I will truly reach a point at which I cannot reign it in. I was on Buspar for a few years--no help, really. Klonoin works, but aggravates my despression, so, no-go. Seroquel and Vistaril are useless. I dunno. Seroquel was useless for me, as was Vistaril. When I'm completely desperate I take the K-pin, but the depression scares me, too. So, am meeting with pdoc this week again and we will discuss this. The problem is, is it the chicken, or the egg? Is this anxiety experience due to an underlying manic/mixed/whatever you wanna call it thing? Or, does the anxiety arise independently? I do not know the answer to that question. But if I did, I think we would have a better shot at treating me. Personally, I think it is the former. And maybe, for me, what I need is just a little Ativan or something to sort of help calm me down. We'll see. Exactly. Chicken or egg. But I agree with you; I tend to think that a level of anxiety as high as we're describing is an aspect of a dysphoric mania. This is not situational anxiety that comes/goes, or even decreases or increases. It's a non-stop constant. Like being plugged into a high-voltage something and being electrocuted constantly. The only time I have a break is when I sedate myself at bedtime and fall asleep. I have gotten good at soothing myself with Buddhist breathing stuff--really seems to help me. But is is still awful to go through this. Yeah, it does help for a very short time. It's a short break, at least. I was also lastly just wondering if for you, maybe a higher dose of Klonopin might be needed. Just a thought. That's one possibility my pdoc has suggested. Frankly, at this point I'd like a day of being doped up on Thorazine - 1950 style - sit in a chair drooling all day...just for a day of blankness. Sending you calm and peace. I hope this gets sorted soon. Thank you so much. Keep me posted on how it goes with your pdoc. I hope, hope you get some peace, too.

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Originally Posted by Sometimes psychotic Soo I’ve got GAD and social anxiety in addition to the bipolar.....scientifically they just started studying anxiety by GWAS and a lot of the anxiety genes overlap with bp and sz so there is potentially some intertwining of these dxes. Yes, just reading this thread it's so clear how these disorders are intertwined. I personally don’t take an ssri which is the med of choice for anxiety ...imo too risky with the bipolar because I’m at a very low dose of antipsychotic with no other mood stabilizer. So I use therapy. The only effective therapy I’ve found is cbt. Do i still get anxiety yes but I can usually talk myself out of it using Cbt techniques....the most effective cbt I’ve had is from the woebot because he doesn’t mind repeating things because he’s a bot...available in app form. So if you can stop things from swirling in your mind that’s step 1. Step 2 is breathing....I can’t do the more complicated breathing patterns because I get nervous about not breathing so I just put my hands on my belly and breath into my belly....you just want your belly to expand into your hands...do it as long as needed. Step 3 distractions....do something, pretty much anything fun. Usually something on this list works.

It sounds like you're doing some terrific work with your anxiety! Thanks for your encouragement.

I have panic disorder and GAD in addition to schizoaffective bipolar type. My anxiety is severe even when I'm not in the midst of a panic attack. I have klonopin to take as needed but I try not to take it often. I tend to rely more on self help techniques and coping skills. I think sometimes the anxiety comes from manic agitation or psychosis but sometimes it doesn't. I think the anxiety issue would still be there even if I didn't have sza/bipolar, it's definitely can be part of it but it's also it's it's own thing too.

Mindfulness helps me a lot. As do distraction techniques and doing things I enjoy (art, playing musical instruments, videogames, playing with my cats)

I'm on a moodstabilizer, two APs, and antidepressant, aside from the klonopin I'm not on anything specifically for anxiety so I try to do what I can to manage it, I haven't found anything that really helps medication wise long term, but coping skills have made a big difference

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Originally Posted by Blue_Bird I have panic disorder and GAD in addition to schizoaffective bipolar type. My anxiety is severe even when I'm not in the midst of a panic attack. I have klonopin to take as needed but I try not to take it often. I tend to rely more on self help techniques and coping skills. I think sometimes the anxiety comes from manic agitation or psychosis but sometimes it doesn't. I think the anxiety issue would still be there even if I didn't have sza/bipolar, it's definitely can be part of it but it's also it's it's own thing too. Mindfulness helps me a lot. As do distraction techniques and doing things I enjoy (art, playing musical instruments, videogames, playing with my cats) I'm on a moodstabilizer, two APs, and antidepressant, aside from the klonopin I'm not on anything specifically for anxiety so I try to do what I can to manage it, I haven't found anything that really helps medication wise long term, but coping skills have made a big difference

Thank you, Blue_Bird. It's encouraging to hear that coping skills are helping you so much. I think the one thing that can truly help intervene with my anxiety is listening to music.

Do you feel like the AP's decrease your anxiety at all?

Somewhat, but they take away more of the paranoia type stuff from the psychosis and manic agitation, I take abilify and Thorazine

I find music helpful too,I hope you find something to help you

I deal with a constant current of anxiety but that is due to chronic pain and since there’s no real hope for that resolving, that low level anxiety is here to stay.

Another part of my anxiety is lack of control, going to Florida really ramps up that constant current because we typically always stay at different hotels so I’m unsure of the area and we have been in some horrible areas where I don’t take the dogs out alone even during the day, I truly don’t want hookers touching my dogs (ack) ... even tho we always request a bottom floor we don’t always get one, so the oxygen concentrator is easily 40-45 lbs. plus dragging our other luggage and dog supplies up stairs is exhausting , Steve can typically make one trip and must sit to catch his breath...

Then concern of where I can walk the dogs ? One place had just a maybe 14x14 chain length area full of shyt , no way was I letting my boys in there, so it was a few blocks walk to find a suitable area, and I always pick up after my dogs.

Last place we got lucky it had a big open lot out back I walked making sure no junkie needles or broken glass.

Every place we go is on or half block away from a raging traffic area, so each dog has 2 collars and 2 leashes on at the same time just in case one breaks.

So when I have little to no control my anxiety just spikes.

At least 1-2 times a week I just have a big ole traditional panic attack and not sure why. I guess pain spikes? maybe no sleep for a couple days ? or I get overloaded sensory wise? Or just because it’s my lucky day.

I have worked so much in T , I have lessened my anxiety ALOT .. I know the above doesn’t sound like it but I use to have near constant nausea from high anxiety All. The. Freaking. Time.

I know you have pain your dealing with.. maybe part of an issue ?

Do you feel in control of parts of your life? Or does your life feel scattered ?

I have tried Buspar and gabapentin a good try years ago , neither helped me, but they sure helped my daughter.

I do all the standard coping skills to de escalate my feelings, breathing , mindfulness, distraction , lots of times I just had to physically remove myself from XYZ.

I have Xanax 1mg tid prn .... I try to just take one a night to help sleep , but sometimes I’ll need 3 because the pain becomes unbearable.

Honestly I think the only Med that might totally end my anxiety is high dose Zyprexa and no way no how will I ever take that again. Even 100-200 mg of Thorazine does nothing.

I do know some people get great relief from anxiety from acupuncture, it’s not covered by insurance so I haven’t tried it.

I think if you can sit with yourself maybe free writing , you might find out some triggers you didn’t even think of.

I hope you find relief soon

Thank you for the hug, Blue_Bird

Christina, what you've described sounds exceedingly stressful. Geez. Interesting - Buspar has helped my daughter's anxiety for years. But she has GAD (specific external triggers that cause stomach upset and 'nervousness').

Chronic pain is a beeyotch of an issue, as you well know. And yes - chronic pain all by itself, everything else a perfect paradise - causes at least some degree of stress. Actually, I'm going to ask my pdoc to test my ANA. It's been elevated for many years and doctors always blow that off. But my entire body aches all of the time. I believe there's an immune system connection...be nice if I could get a doctor who would hear me.

My niece is an acupuncturist; I have had outstanding results from acupuncture for some physical probs (kidney infections).

So here we have general anxiety that is triggered by certain things, and stress, and the spinning "crazy" anxiety that might be an aspect of mania, and manic agitation....

A flourishing garden of anxieties! Oh, hurray! And which witch is which and who's who....

Witch is a good word lol

Have your Doctor run ANA and. SED rate , that is how they caught my autoimmune PsA ... Fibro has like 18 specific pressure points , Fibro also hurts bilaterally if right shoulder hurts so will left. Bytch of am illness

I hope you find a Doctor that will truly take a full deep history and questions for maternal and paternal sides.

Did you have the genetic testing done to show what psych meds are more likely to actually help ??

No, I didn't have that test done - but I'd sure like to. My mother had fibro, so does my sister. I am just fed up with being in constant pain. It's been going on for years.

Ask your Pdoc about the DNA testing it might help find the right psych Med.

I wish I had advice about Fibro pain, I went through lots of doctors and enormous amounts of tests, they are mainly ruling out lupus and other illness, if they don’t find anything they just toss Fibromyalgia at a person and usually say exercise and lose weight or when I was going through all the testing I was very underweight and told to gain.

I just read recently that the brain shows signs of inflammation in Fibro patients using a Pet Scan , that’s great and all but not helpful other than to possibly finally confirm it.

There are rumors a new Med is in the pipeline for Fibro ... but who knows.

Sorry you suffer chronic pain

I have had social anxiety my entire life, and bipolar since my mid teens.

My next appt in mid Feb I am going to be asking for trileptal (oxcarbazepine). It looks like a one pill does everything for me. On the reviews on drugs.com, reviewers claim it helps with pain, anxiety, sleeping, calming the mind, bipolar symptoms, and a few other things.

I asked for it my last appt, but he claimed it wasn't "evidenced based", and prescribed tegretol. Tegretol helped with my mood tremendously, but unfortunately, my pupils stayed dilated in the sun, so I had to wear big wrap around sun glasses when it was sunny.

I then put on 6 lbs in 4 weeks, and that was a deal breaker. Went back on my divalproex until I see him next month.

I'm going to push him on the trileptal so I can hopefully get off both divalproex and buspar.
I plan on being fully prepared to make my case.

If you're able to take mood stabilizers, this might be worth looking into.

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Originally Posted by RockyRoad007 I have had social anxiety my entire life, and bipolar since my mid teens. My next appt in mid Feb I am going to be asking for trileptal (oxcarbazepine). It looks like a one pill does everything for me. On the reviews on drugs.com, reviewers claim it helps with pain, anxiety, sleeping, calming the mind, bipolar symptoms, and a few other things. I asked for it my last appt, but he claimed it wasn't "evidenced based", and prescribed tegretol. Tegretol helped with my mood tremendously, but unfortunately, my pupils stayed dilated in the sun, so I had to wear big wrap around sun glasses when it was sunny. I then put on 6 lbs in 4 weeks, and that was a deal breaker. Went back on my divalproex until I see him next month. I'm going to push him on the trileptal so I can hopefully get off both divalproex and buspar. I plan on being fully prepared to make my case. If you're able to take mood stabilizers, this might be worth looking into.

Good for you for being well prepared! I hope he does prescribe the Trileptal, and that it works for you.

I do take Lamictal - 400mg, which is absurdly high. It decreases anger, but doesn't do a thing for anxiety (or depression, as far as I can tell).

My anxiety can be brutal at times. It tends to pop up in social settings when I'm feeling like I have nothing in common with anyone else in the room and it leaves me quite upset.

Meds have not worked very well in the past for myself. My emotions would be numbed, then at some point down the road once everything was bottled up for too long and end up being sad for weeks.

What I do is still a work in progress, but it's just opening up to someone. I don't start the conversation with "I'm bipolar and you will sit and listen to me rant!", that might turn people off I figure. I try and chat about how big crowds make me feel tired, or something like that.

I have GAD and suffer severe anxiety with occasional panic attacks. Seroquel has helped as has a beta blocker (originally for my blood pressure) as have techniques that I have either learnt from therapy or self taught. I find that regularly practising mindfulness has made a big difference.

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Originally Posted by BadNews4321 .... "I'm bipolar and you will sit and listen to me rant!"....

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