Informational post: panic attacks versus mixed episodes.

a cure for what ails you, explanations, medication, ptsd, rapid-cycle bipolar disorder, self-harm, stigma, suicidal ideation

In May, I woke up feeling rather odd—jittery, teary, completely unable to calm down. I’d felt this way before, but it had never been that bad. After about an hour of trying (and failing) to steady myself, I asked my husband to take me to the emergency room because I was afraid for my safety.

I thought I was having a severe panic attack and spent four and a half hours confined to a bed in the ER on suicide watch; after demonstrating that I really was okay and didn’t need to be committed to the psych ward upstairs, I was released with a prescription for lorazepam. At the time, we thought panic attacks were a reasonable explanation, given that I have C-PTSD and a couple of dissociative disorders as a result.

I continued taking lorazepam whenever I felt that way, even after I’d learned I was having mixed episodes and not panic attacks. I needed a couple of milligrams before I started feeling okay again, but that much knocked me out for a couple of hours…not really the most productive way to handle the situation. I talked to my psychiatrist and learned that benzos are pretty much the worst thing to take during a mixed episode because they heighten the feeling of detachment, which can lead to more anxiety and make things worse. He prescribed quetiapine (Seroquel) and so far, it’s worked; I usually don’t need a very high dose, about 50 mg, whenever I feel a severe mixed episode coming on.

Having learned more about panic attacks, it seems strange to me that the ER staff didn’t recognize my mixed episode for what it was. While panic attacks tend to produce more physical symptoms (racing heartbeat, shortness of breath, chills, hot flashes, nausea, trembling, sweating), mixed episodes (also called mixed mania) tend to produce more mental symptoms, such as the highs of mania with the lows and despair of major depression, urge to self-harm or attempt suicide, and uncontrollable swings between moods and thoughts.

I think the reason the two were confused that day was because of the mental symptoms present during a panic attack—fear of loss of control and a sense of impending doom, which is how my fear of self-injuring or attempting suicide was interpreted. I was having cold sweats and my heart was racing, but as I’ve started paying closer attention to my moods and symptoms, I’ve found that those, along with an overall feeling of panic or being out of control, generally accompany my mixed states.

There are many great resources online about how to help and what not to do when someone is having a panic disorder, so I won’t touch on those. Below are a list of things that I find particularly helpful when I’m going through a mixed episode (and what to avoid doing). Feel free to chime in with your suggestions in the comment section!

  • I really dislike being touched in general, so touching me is likely to make things worse. However, I’ve found that if my husband holds me in a particularly tight embrace, the compression is soothing and helps me calm down and feel safe and loved. During a mixed episode, I tend to feel very guilty and my self-worth plummets, so the physical contact from a loved one helps reassure me that I am worthy and do not need to harm myself as “penance” (the main reason I used to self-injure) or “eliminate my own map” to relieve loved ones of the burden.
  • Obviously, confiscating my sharps prevents me from hurting myself and is very helpful.
  • If I’m too far gone to realize I have medication that will help me calm down, being brought a Seroquel (which is an antipsychotic) and a glass of water with tons of ice cubes in it (which I love) is very helpful. It takes a few minutes for it to kick in, but when it does, the noise in my head quiets down, the psychomotor agitation goes away, and I’m able to focus again. The worst case scenario is that it knocks me out for a few hours if I’m given too much, but at least I’m not in danger of harming myself.
  • Saying comforting things that are not in the form of absolutes is very helpful. For example, saying specific things such as “You are worth something because you’re spreading the word about mental illness” is much more helpful than saying “Stop it, you’re not a bad person.” If you reference specific things, my brain can recognize those as true—I am writing about mental illness in the interest of raising awareness and fighting the stigma—I will not be able to argue with it, whereas I could go in circles all day long with all the reasons I think I’m a bad person.
  • Playing music or doing something over-the-top to make me laugh has been a good way to “break” the episode in the past. It’s important to note that not everything works as a distraction, but if you can get me laughing (which is not difficult because I have an entire folder of gifs/images/text posts that have made me laugh hard enough to cry in the past; also, my sense of humor runs extremely dark, so saying something really fucked-up is likely to make me lose it), there’s a good chance it’ll shorten the duration of the episode by giving me something else to think about.
  • I cannot stress enough how important it is to avoid saying the things I mentioned above: “It’s going to be okay,” “You’re not a bad person,” “Stop getting down on yourself,” “Just try to calm down,” etc. They’re not helpful, they just make me feel worse, and they usually cause the situation to escalate.

I’ll put together a post like this on C-PTSD and what my specific triggers are, what people can do to avoid triggering me, etc. I’d really like to hear from my readers, though—I want to hear about your coping techniques and how people can avoid triggering you.

Love and antipsychotics,

J.

Advertisements

2 thoughts on “Informational post: panic attacks versus mixed episodes.

  1. Thank you for this post. I’m new to a bipolar II dx, but beginning to recognize the variations of moods I experience and this helps me immensely. Your detailing of a mixed episode – and what helps – I am pretty sure I’m having one. (Already on Seroquel daily, so will address different meds with pdoc tmw.) thank you.

    1. I’m glad you’re becoming aware of your moods! I’d strongly recommend journaling about them, especially at the beginning. I’ve fallen out of the habit now that I’m more or less stable (thanks to the right combination of meds), but I used to divide my moods on a scale from 1—10, 10 being the highest high, 1 being the lowest low. Mixed episodes kind of had their own 1—5 categorization based on severity, but obviously, you can make up your own system. 🙂

      And welcome to the blog!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s