I don't have enough manic symptoms to fit the diagnosis of agitated depression right now, but because of my history, I'd normally use exactly that type of criteria before I would suspect I was having a mixed episode. Apparently there's a broad spectrum, though.

I didn't pick up on my last episode (or more likely earlier on in one long episode) until I finally started treating some significant anxiety symptoms towards the end of July. By that time it had been going on for weeks. In retrospect, it fit the pattern of a more typical mixed episode, but I was just less manic than what I'm used to.
Currently: I never would have considered the agitation to be a feature of mania, or a clue that I was having a mixed episode, despite the presence of paranoia. I mistook it for a symptom of depression.

I'm lacking my usual insight here. I'm at a disadvantage because I've been in the trenches dealing with hypo/mania for so long that depression is foreign to me now. Actually being depressed and paranoid doesn't help either.

At least this time I'm aware that I'm paranoid. It's upsetting, but at least this way, I can create separation, or keep quiet, so I don't do any damage because I know things may not be as they seem.

I'll give the gabapentin about a week to work, unless I have any issues.


I'm getting really upset because my BP has been so difficult to control in the past, I'm already on so much med, and now I'm a different kind of mess. I'm so afraid that if this episode doesn't respond to the increase in gabapentin, it may lead to a big-time med shake up, adding another heavy-duty med or having to take an antidepressant… because any one of those things could land me back in the hospital.

I'm also worrying about the evolution of my BP in general.