Depression is a part of bipolar disorder. It is, in fact, one of the poles. The question of experiencing depression is not “if” but “when.” Depression on its own is a horrible experience, but sometimes other problems pile on. More than half of people with bipolar disorder also have some form of anxiety disorder. These can include generalized anxiety disorder, panic disorder, post-traumatic stress disorder, obsessive compulsive disorder and social anxiety. When anxiety occurs during a depressive episode of bipolar disorder it is called depression “with anxious distress.” Distress is exactly the term to describe how it feels.
When I experience anxiety, I communicate how I am feeling by comparing my mood to a pot of water. When I am feeling fine, the water is ambient temperature. The more anxiety I feel, the hotter the water becomes. Lately I’ve been sitting at a simmer with occasional panic attacks that put me into a rolling boil. This is in addition to the depressive symptoms I feel like depressed mood, loss of interest, weight gain, fatigue and feelings of hopelessness. It’s a debilitating combination.
In order to be qualified as an episode with anxious distress, you have to experience at least two of the following:
- Feeling keyed up or tense.
- Feeling unusually restless.
- Difficulty concentrating because of worry.
- Fear that something awful may happen.
- Feeling that you might lose control yourself.
If you experience two of these symptoms, the anxious distress is considered mild. Three symptoms is moderate and four or more is moderate to severe. If physical restlessness is involved, it’s considered severe.
Having bipolar disorder with anxiety can lead to extra complications with the disorder. People who have episodes with anxious distress typically have longer episodes, don’t respond to treatment as well and have a higher suicide risk.
Experiencing severe anxiety mingled with depression is incredibly distressing. On the one hand my brain is telling me that all I can do is to go to bed and not do anything. On the other hand my anxiety is telling me how horrible I am for ignoring other responsibilities. The two sensations fight each other and leave me frozen, not knowing what part of my brain I should listen to. The anxiety is usually louder than the depression, but that doesn’t mean I succeed at getting out of bed. It just means I end up having a panic attack while I’m there.
I’m continuing to talk to my therapist and psychiatrist about my situation. My therapist gave me a list of ways to combat distress and my psychiatrist gave me additional medication to manage the anxiety acutely. In the meantime, I hope this is a short phase and that I will reach a level of normality soon.
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Primary source: American Psychiatric Publication. Diagnostic and Statistical Manual of Mental Disorders (DSM-5(tm)): American Psychiatric Pub; 5 edition (Page 187). American Psychiatric Pub; 5 edition. Kindle Edition.