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What Causes Panic Attacks In A Person With Bipolar Disorder Type 1?

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Posted on Fri, 8 May 2015
Question: I was diagnosed with bi-polar 1 disease 2 years ago. Prior to that diagnoses I had major depression and acute anxiety problems, These are my daily medications: Effexor 300mg, Ambien, 10mg, Remeron 45mg,,
klonopin 5mg, Lamyctal, 200 mg. Over the last week I had 4 panic attacks. The first was the worst I have ever had, but I don't think I have had more than 5 in my lifetime. I have many real-life stressors, but these attacks came from nowhere. Yesterday my psychiatrist prescribed imipramine HCL 25 mg at night for one week, 50 mg starting the second week? He tells me that it will help with the panic I am feeling. Do you agree, and do you think this was a good choice for my problems?
doctor
Answered by Dr. Dr. Chintan Solanki (57 minutes later)
Brief Answer:
no I don't think it is a good choice, SSRI is better choice

Detailed Answer:
Hello,

Thanks for writing to us.

I read your query and got the point that you are suffering from bipolar disorder type 1. Currently you have more panic attacks.

In this case antidepressant must be used with under cover of mood stabilizer.You are on effexor and remeron those are anti depressant medicines and they are with lamictal which is mood stabilizer.

Imipramine is tri cyclic anti(TCA) depressant.Optimum dose is 75-150 mg to be effective in panic symptoms. It is used for depression and panic disorder but it can precipitate episode of mania in person with
bipolar disorder 1. Better to use SSRI (like sertraline) in stead of for panic symptoms in case of bipolar.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Chintan Solanki (27 hours later)
Please explain to me what tri cyclic antidepressant is. How does it differ from an SSRI -and explain please what exactly an SSRI is.(I have a Masters Degree in XXXXXXX Literature, and really don't understand much about the types of medication. I have never heard of sertaline.
I should mention that I am most anxious in the morning -physically shaking, heart pounding, etc. and I seem to get better as the day goes on. My recent panic attacks, however have been at night, around 8 PM
doctor
Answered by Dr. Dr. Chintan Solanki (10 hours later)
Brief Answer:
you seem to have melancholic type of depression and TCA are useful

Detailed Answer:
Hi,

Thanks for follow up.

Tri cyclic antidepressants (TCA - Imipramine, amitriptyline, dothepine) are older anti depressant medicines which acts on serotonin as well as on norepinephrine re uptake. While SSRI (Selective Serotonin Reuptake inhibitor - Sertraline, escitalopram, fluoxetine, paroxetine)are newer medicines for depression with less side effect profile than TCA. They mainly act on serotonin.

Still both groups of medicines are used. Indication varies according to age, type of depression, patient and doctor's choice,cost and co morbid physical/psychiatric problems.

For more detail and comparison of both groups you can refer to following link.
http://www.emedexpert.com/compare/ssris-vs-tca.shtml

As your symptoms are more in morning and improve as day passes it suggests possibility of melancholia or severe resistant depression.

And in this type of depression TCA are really useful medicines.

(Note: If you had any episode of mania in past your diagnosis was made bipolar on that ground. If diagnosis of bipolar is confirmed, TCA should be used with caution as it can elevate mood too high and can precipitate episode of mania.)


Hope this answer clarifies your doubts.

Do not hesitate to ask if you have more questions.

take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Chintan Solanki (20 hours later)
You are very perceptive, Doctor Solanki. How could you tell from my previous questions that indeed, my depression is melancholic. My "manic" periods are never mood elevating or grandiose. I have never had "flights of fancy", shopping sprees, etc. (My brother has bi-polar II and has struggled with all of those symptoms.

Rather my manic states are characterized by irritability, impatience, weepiness and impulsivity , as well as alcoholic drinking which has been in remission for some time. Alcohol does not elevate my mood as it used to, and I rarely have any cravings. I have not discovered anything that elevates my mood: I almost always just feel very sad.

Why do my morning symptoms indicate a more severe type of depression? That is very interesting to me, especially since these symptoms are manifested by horrible feelings of anxiety?

You have been very helpful to me, and I thank you.
doctor
Answered by Dr. Dr. Chintan Solanki (2 hours later)
Brief Answer:
re evaluation/confirmation of diagnosis should be done

Detailed Answer:
Hello,

Thanks for writing back.

I assumed from your history that your depression is of melancholic type.For confirmation of diagnosis detail history and mental status examination in person to be done by a psychiatrist.

From symptoms, " irritability, impatience, weepiness and impulsivity" it is difficult to judge that your diagnosis o f bipolar is really true or not.Melancholic can be part of either major depression or bipolar depression. In both treatment approach varies.
In Major Depressive Disorder TCA would be beneficial while in Bipolar disorder Lithium, ECT or TCA with sufficient mood stabilizer cover should be used.
In my opinion re evaluation or confirmation of your diagnosis of Bipolar should be done and then treatment plan should be changed.

For your reference I have posted a link below which gives brief idea about Melancholic depression.

http://en.wikipedia.org/wiki/Melancholic_depression.

Hope I have answered your concern. If still any query is there , you can ask or close the discussion and give your rating and feedback to the answer so I can improve my service.

In future if you wish you can contact me directly on this site through following link
http://bit.ly/drchintansolanki

All the best and wish you good health.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2407 Questions

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What Causes Panic Attacks In A Person With Bipolar Disorder Type 1?

Brief Answer: no I don't think it is a good choice, SSRI is better choice Detailed Answer: Hello, Thanks for writing to us. I read your query and got the point that you are suffering from bipolar disorder type 1. Currently you have more panic attacks. In this case antidepressant must be used with under cover of mood stabilizer.You are on effexor and remeron those are anti depressant medicines and they are with lamictal which is mood stabilizer. Imipramine is tri cyclic anti(TCA) depressant.Optimum dose is 75-150 mg to be effective in panic symptoms. It is used for depression and panic disorder but it can precipitate episode of mania in person with bipolar disorder 1. Better to use SSRI (like sertraline) in stead of for panic symptoms in case of bipolar. Hope I have answered your query, I will be happy to help further. Regards, Dr.Chintan Solanki.