Question: Hello Doctor,

I have been diagnosed with Bipolar I Rapid Cycling since a hospitalization in 2005. Prior to that time, I was misdiagnosed as having Unipolar Depression for a number of years prior to this time.

I have experience depressed, manic and mixed states throughout my adult life. I have always had a small amount of co-morbid anxiety along with the Bipolar.

However, this year I experienced an episode unlike anything I've experienced before. Starting on March 3rd I started experiencing full-blown panic attacks. I know work was a significant reason for these attacks but the panic attacks did not occur after a significant change in work or in my personal life.

I had almost daily attacks for four months until I could not work anymore. During those four months, I experienced severe panic attacks, depersonalization derealization and sleep paralysis.

During those months, my girlfriend had to everything for me, including waking me up, making me eat, making sure I showered, dressed and left my apartment to go to work.

Unlike most people who experience depersonalization derealization, I was not concerned with them I interpreted them as a religious experience. In my mind, I started to create a whole theology based on this experience. I am now quite uncomfortable with having this experience.

I also experienced sleep paralysis but I did not feel an evil presence by me like so many other people report when they have this type of experience. I was scared but also fascinated. The first time it happen, I thoughts iras still dreaming and had entered someone else's apartment in my dream. However. In this "dream", there was an iPad playing a TV show that I was watching before I fell asleep. But the dialogue and closed captioning seemed pretty consistent even though I could not really understand either.

Im a pretty smart person but I started to doubt that this was a dream since I didn't think I had the creative power to create such a full and quickly changing environment with my mind. At that point I noticed my side table with vases sticking horizontally off of the wall. At that point, in my mind, I rotated my perspective counter-clockwise by 90 degrees. At that point, I realized I was awake but paralyzed. I tried to scream but all I could manage, from what my girlfriend told my girlfriend told me, is to let out a small whimper which my girlfriend heard and proceeded to wake me up.

I continued to have this experience that night and had 5 episodes of sleep paralysis in a two or three hour period. I know that most people have this experience a few times in their lives but not to the degree I had them.

Since thus episode was not like any experience I had before and because this episode does not seem to "fit in" with the episodes that a Bipolar person experiences, I feel that it might be a new disorder (perhaps a Panic Disorder) that is now co-morbid with my Bipolar experience.

I need to know if thus is a distinct illness for two reasons: the first is because I would like to know how to treat this disorder so I don't experience it again. The second is because if my insurance company considers this episode to be part of my Bipolar Disorder, they will consider it a pre-existing condition for which I will not be covered. If it is a newly expressed disorder than I would be covered.

I truly appreciate you reading this lengthy email but I did not know how to communicate my experience more succinctly.

I look forward to your feedback,

XXXX

Hello Doctor,

Thank you for your message. I wanted to ask a follow up question.. I have experience numerous depressive episodes, before and after being properly diagnosed as being. During these episodes, I did not experience any of the symptoms I described to you, not even during my worst depressive episode, which led to my only hospitalization back in 2005.

Also, during this episode, I also experienced cold sweats, shaking and heart palpitations. There was some very mild depression that was triggered by my concern about my continuing ability to work because of the panic attacks and high levels of anxiety. The depression, on its own, was not nearly severe or disruptive enough to interfere with work during this episode.

Since I've been diagnosed with Bipolar for years, I have done much research on the topic. I have never read about a co-morbid illness that describes these types of illnesses. I have reviewed information through the Internet which describes almost all the symptoms I described to you. The article makes no mention of Bipolar Disorder. It does mention unipolar depression but not Bipolar Disorder.

The treatment options it lists are anti-depressants and anti-anxiety medications but it does not mention mood stabilizers, which are the mainstay treatment for Bipolar Disorder.

Just for your information the website's URL is:

http://panicdisorder.about.com/od/symptoms/a/Panic-Disorder-And-Sleep-Issues.htm

I thought this additional information might prove useful to you.

Thank you again,

XXXX