Q. I began having panic attacks when I first turned 19 years old. Then as time went on, I modified my diet and cut out all caffeine and nicotine; cut down on my sugar intake and seemed to feel better. 

I had my first child at age 26 and the panic got much worse a year later. I am now housebound at times. I have been tried on Zoloft, Luvox, Paxil, Serzone, Elavil, BuSpar, and a number of other antidepressants. This is where, I believe that the bipolar comes in to play. I have severe hypomania whenever I take these type meds. My mind races as does my heart rate also. I get very paranoid and have major thoughts of suicide. Like I want to escape those horrible side effects. Anyway, I have seen a psychiatrist and told her of these episodes and she didn't suggest bipolar disorder. I have done some research and found out that Bipolars need mood stabilizing meds. What is your advice? My father had bipolar disorder and had obsessive compulsive disorder and paranoid schizoid and alcoholic.


  A. I do not have enough data to give you a really good answer, but I will go with the data you gave me and tell you what I think. First, mood swings do not equal bipolar, nor do racing thoughts. The former occur in a number of psychiatric illnesses, and the latter are more often than not an anxiety symptom. In short, it sounds like your current psychiatrist is correct in not calling you bipolar.

If you still have carbohydrate craving, I would take increasing amounts of any of the SSRIs (Zoloft, Prozac, Luvox, Celexa, or Paxil) or SNRIs (Effexor XR) until carbohydrate craving goes away. This tends to be between 200 and 400 mg for Zoloft, 80 mg for Prozac, and 300-450 of Effexor XR. Obviously you will review any medication changes with your psychiatrist before changing.