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.

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It’s feedback time, chiiiiildren!

housekeeping

 

I’ve published twenty-odd posts and have apparently picked up enough steam to receive a few spam comments, much to my delight and amusement. Now, I’d like to hear from all of you! What should I write about/post more of on this blog? I’ll keep doing what I’m doing, of course, but I feel like I could use some direction at this point. Also, who doesn’t love to share their opinion on the Intarwebz? I’ve enabled custom answers for this poll as well, and you can always leave comments with suggestions.

I’d like to do a few more vlogs, but I feel like I’m super-awkward on camera and only have the webcam that came with the laptop; therefore, whatever I produce isn’t likely to be very high-quality, and I want to provide you guys with high-quality stuff whenever possible.

I’m not opposed to writing a few fluffy posts here and there to lighten the mood, or even do a picspam every once in a while, because I know the content here can get pretty dark/dreary. On the other hand, I don’t want to stray too far from the original intent of this blog–to share what it’s like to live with major depressive disorder and PTSD, as well as what the therapy process has been like for me so far. I’ll probably also throw up a post with some stats about MDD and PTSD sometime in the very near future, because mental illness is a lot more common than people think. I believe that putting myself out there to add another “face” to the illness is important for diminishing the stigma, but hard facts are also helpful when framing mental illness in a larger context.

But instead of rambling at you about my future plans, let’s get on with the poll!

PTSD, part I.

ptsd, self-harm, stigma

I was looking up some signs of unresolved trauma (mostly relating to dissociation) and came across this awesome list. The ones that apply to me are in bold (and there are way more than I thought).

1. Addictive behaviors – excessively turning to drugs, alcohol, sex, shopping, gambling as a way to push difficult emotions and upsetting trauma content further away.

2. An inability to tolerate conflicts with others – having a fear of conflict, running from conflict, avoiding conflict, maintaining skewed perceptions of conflict

3. An inability to tolerate intense feelings, preferring to avoid feeling by any number of ways

4. An innate belief that they are bad, worthless, without value or importance

5. Black and white thinking, all or nothing thinking, even if this approach ends up harming themselves

6. Chronic and repeated suicidal thoughts and feelings

7. Disorganized attachment patterns – having a variety of short but intense relationships, refusing to have any relationships, dysfunctional relationships, frequent love/hate relationships

8. Dissociation, spacing out, losing time, missing time, feeling like you are two completely different people (or more than two) *

9. Eating disorders – anorexia, bulimia, obesity, etc

10. Excessive sense of self-blame – taking on inappropriate responsibility as if everything is their fault, making excessive apologies

11. Inappropriate attachments to mother figures or father figures, even with dysfunctional or unhealthy people

12. Intense anxiety and repeated panic attacks

13. Intrusive thoughts, upsetting visual images, flashbacks, body memories / unexplained body pain, or distressing nightmares

14. Ongoing, chronic depression

15. Repeatedly acting from a victim role in current day relationships

16. Repeatedly taking on the rescuer role, even when inappropriate to do so

17. Self-harm, self-mutilation, self-injury, self-destruction

18. Suicidal actions and behaviors, failed attempts to suicide

19. Taking the perpetrator role / angry aggressor in relationships

20. Unexplained but intense fears of people, places, things

* My most frequent dissociative symptoms are derealization and depersonalization.

Depersonalization is characterized by a feeling of detachment or estrangement from one’s self.  During an episode of depersonalization, the sense of ‘self’ is disturbed.  There is an overall feeling of estrangement and detachment from the self.  …Depersonalization can be very distressing because it seems like one is losing their grip on reality, losing control, or ‘going insane.'”

Derealization – During the experience of derealization, the perception of reality feels distorted and there is a sense of being detached from the outside world.  It can feel like living in a dream.”

(Source)

In the next post on PTSD, I’ll get into some of the messier stuff–mainly, how I ended up with PTSD and how it affects my life. It’s something that is going to require a lot of effort on my part because (as anyone who knows me well can tell you) I don’t really like to talk about it. Joke about it? God, yes, I’ll do that all day long. I’m also able to write about it, to some extent–just the facts, ma’am. But really getting into the heart of it is something I still find incredibly difficult and try to avoid as much as possible.