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Penny Rayas, MFT
Penny Rayas, MFT, Therapist
Category: Mental Health
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Experience:  I have 20 years experience in the mental health field
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Differentiating between mania & anxiety

Customer Question

How hard is it to differentiate between mild bipolar/hypomania (bipolar II) and severe anxiety and depression? I know anxiety and depression feed off each other. I'm one of those that started a self-help program (CBT) back in 2002 that really helped me get rid of my panic attacks, so i've been very self-aware (too self-aware) and I dissect everything and have a lot of racing thoughts. My doctor tries not to worry about what the diagnosis and more focuses on treating the symptoms and finding what works for me. Well, I've tried about 1000 different medications, and I can't find a solution. It's very frustrating. I would rather her say "john, ur bipolar II, you'll have to take some sort of mood stabilizer the rest of your life, here's what you need to do from a lifestlye standpoint, etc. Or say, I'm not really sure yet. She thinks I have atypical mood disorder that seems to have been very treatment-resistant.
Submitted: 4 years ago.
Category: Mental Health
Expert:  Penny Rayas, MFT replied 4 years ago.

The way we can differenciate between bipolar II and depression with anxiety is that bi-polar has periods of hypomania.


For a person to be diagnosed as hypomanic, the first requirement is that there must be a sustained, elevated, expansive or irritable mood, plus unusually and persistently increased activity for most of the day over at least four days. The mood and the activity must be observable by others and clearly different from the way you are when you are not depressed. That means there isn't just a big contrast to a depressive state, but there's also a marked contrast to your everyday state when you're not having any bipolar symptoms. Before you can be diagnosed as having a hypomanic episode, you'll also have to be experiencing at least three of the following symptoms - or four if your unusually sustained mood is only irritable:

  • You don't need much sleep.
  • You're more talkative than usual or feel pressure to keep talking
  • You are experiencing a flight of ideas or feel that your thoughts are racing.
  • You are easily distracted.
  • You are driven toward accomplishing specific goals (either socially - at work or school - or sexually) or you are experiencing psychomotor agitation.
  • You have grandiose thinking. For example, you believe you are better than anyone else at doing something or that you can accomplish a difficult task in hours instead of days.
  • You've become excessively involved with pleasurable activities that have a high potential for painful consequences, such as unrestrained buying sprees, sexual indiscretions or foolish business investments.

Sometimes I see client with rapid mood swings in bipolar II and that can look so much like anxiety but the flight of ideas give the bi-polar away.

I dissagree with you psychiatrist I think diagnosis is very imprortant. I am wondering why she is not adding a mood stableliser to your medications. I also wonder if you therapist can call and talk to your psychiatrist. I have a feeling after 4-5 years your therapist would have noticed if you had bi-polar II.

Penny Rayas, MFT and other Mental Health Specialists are ready to help you
Customer: replied 4 years ago.
Thank you.....that was very helpful. I have seen a few other doctors in the past, one of which prescribed me a few different mood stabilizers, one of which worked but sedated me a lot (seroquel)....that same dr. also tried depakote and lamictal, but I got off each of those for some reason, don't remember why. I've been on wellbutrin for a while, so my current dr. has put me back on that to get out of the horrible depression i've been in for the last month or two (relationship issues, weather, went off my wellbutrin for a while.....kinda the perfect storm in early december right before the holidays.......then when she tried me back on meds, she tried effexor, which really made it ten times worse and so did zoloft. Got to the point where i almost had to check myself in the hospital for the first time in my life). The whole medication process and uncertainty of diagnosis has been very frustrating, not to mention the amount of money i've spent on dr. visits ($125 per visit, she doesn't accept insurance but she is much more accessible than previous doctors and spends more time with me), therapy appts, and prescriptions. The money piles up quick. I keep trying to maintain a positive attitude, but its very very tough.
Expert:  Penny Rayas, MFT replied 4 years ago.
Thanks for working with me. I hope you doctor can figure things out.

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