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  1. Also bipolar 2 and 1 are treated very differently for obtaining other forms of insurance, like life insurance. A bipolar 1 diagnosis on paper might bring practical difficulties. Maybe the bp2 diagnosis is just pragmatism, even if it doesn't match your symptoms.
  2. I think it depends. Our bodies are chemical factories. Exercise, meditation and diet do drive chemicals in the brain even though we don't pop them as pills just before we go to bed. I'm not going to speak for anyone else, but I know I need meds to live and function now. This may not always be the case. However, I can definitely see exercise and meditation lessening residual symptoms, such as anger, anxiety and hopelessness. This can mean better sleep, taking a PRN less frequently, better interpersonal functioning, and maybe even gaining insight about when I start to cycle. All of this helps. I do know someone with bipolar 1 who is off meds and functions fine. He's a mental health professional though, and has incredible insight into when he starts to cycle and how to nip it in the bud. I don't think most of us normal people have the self awareness to pull that off.
  3. Just because side effects are well established doesn't mean that they're not dangerous and don't need to be taken seriously. Heck, I've been on lithium for less than three years and I'm already showing signs of kidney damage. I'm in my mid 20s. I do get the allure of not nudging medication that works, and I completely respect people who make that choice for themselves. Trying to change has landed me in hospital more than once. However, I do think sometimes mental health professionals prioritize mental health over physical too much. I saw some well-publicized studies recently which showed that people with bipolar and schizophrenia had much shortened life spans from physical health conditions after adjusting for suicide. Some of these health problems are associated with negative symptoms and depression, but a lot are medication related. If most neurotypicals were having their life expectancies reduced by decades there would be substantial action taken, but society cares little about the seriously mental ill. So for people who are thinking of consolidating meds - it's definitely a cost / benefit analysis worth discussing, but the results of that analysis are different for each person. If you do change, change slowly, under close supervision and with a Plan B in case things unravel. I wish governments and charities - and even inpatient facilities - would at least acknowledge the physical health issues that affect people which serious mental illness at a much higher rate because of our medications and conditions. Whether it be diet education when on medications that risk diabetes, physical activity that is achievable when on low energy, weaning people off cigarettes (schizophrenia patients apparently smoke much more?), more accessible resources to reduce alcohol and drug abuse. Our health matters. We matter.
  4. I personally find the none at all works best for me, and I'm doing it long enough that no one really expects me to drink anymore. My mood used to really suffer for days after drinking.
  5. It made me manic within a few days, which persisted for a couple of weeks before being taken off it and having something fast acting to bring me down. I've heard that's not the most common reaction, but be aware.
  6. I definitely have noticed cognitive effects and negative effects that you mentioned during all moods, including stable. Not sure if it's the meds or something else..
  7. I can't take the IR - I used to be on it but it doesn't hold my symptoms throughout the day. I also previously was taking it at different times during the day and wasn't able to function for half hour blocks after I took it. I'll try taking it a little earlier, but I do get tired quite quickly from it (maybe due to dosage), so if that becomes an issue, I'll just do so on days when I have early meetings. @mcjimjam also Australia based so don't think I'll be able to get Provigil.
  8. I'm on 900mg of Seroquel XR, which I take each night about half an hour before going to sleep. I've been on this dose for over a year, previously higher. I'm usually OK in the mornings if I have tasks to do. However, I had a morning meeting at 8am today and I almost passed out, letters changed on the paper in front of me, felt dizzy from drowsiness, and I think someone from the other firm noticed, which isn't really acceptable in my line of work. I've had this before, so it's not a once off. Does anyone have tips of how to be more alert in the morning? I can't drink coffee because of physical health stuff, and I find that the drowsiness from Seroquel for me starts to come on within 45 minutes (maybe because of the size of the dose). Really hoping to find a way to combat this.
  9. My anxiety has gotten way out of control recently. A lot of panic and a lot of obsessing and constant researching compulsively and meltdowns constantly. I feel terrible and can't do things like walk down the street with the fear that I'll need to go to the restroom if I do... So I end up hiding next to public restrooms but can't go inside because people are hiding to kill me inside...
  10. I struggle with this because I can't see a clean line of how I ended up with bipolar. Those of my grandparents who survived beyond middle age all showed signs of depression, but it may have been situational as they aged. My cousin had an eating disorder (though no one talks about it), and there's probably a few members of my immediate family who have mild/moderate anxiety. The only thing that keeps me taking my meds is seeing how my brain accelerates into mania when I don't, the bizarre online conversations that I used to have that sometimes accidentally resurface, and seeing the blog entries and diaries where I started contemplating suicide almost 15 years ago. Whatever might be happening, the meds don't let me jump too high or plummet as low, or at least as often as I once did.
  11. Much of my initial treatment and diagnosis was in a foreign country, although I'm not too sure this is what you're looking for, because this foreign country is the US. However, there might be some takeaways of the US vis-a-vis other places. Apologies for the block of text. Someone representing you in hospital: I found that when you're involuntary patient and decisions are being made about your care and path outside of hospital, you need to have an advocate. This can be harder when there's a linguistic barrier or when people are far away. Example: during my third and final hospitalization in the US, my university tried to withdraw me involuntarily, which would have cancelled my insurance and visa and left me with about $80k in debt - bankruptcy. This would have barred me from ever re-entering the US, so I would have never finished my degree - obviously this something a domestic student would not have faced. I was in no state to figure out what was going on, and had no resources to do so. What saved my bacon here was work done by my parents, and the fact a parent flew to the US. I would try and suss out who could recommend you, and any translation channels, before you go. Transporting medications: The US is one of the countries with the most relaxed regulations about how you can get prescribed things, and also what you can carry on your person. In many countries, legislators don't draw a huge thick line between unlicensed psychotropic and addictive medication and narcotics (and carrying narcotics is often met with the death penalty). I recently went traveling and I could only take ten days of my medication with me legally (it would be seven days for addictive medications), and also had to carry a letter from my psychiatrist. I would encourage making sure that your medications are readily available before you travel, knowing where to pick them up, and knowing who can prescribe them on the ground. If certain medications are not available readily in Egypt, I would recommend substituting the medication before you go. Being prescribed new medications: The US is also a lot more relaxed and even experimental with medications than other countries, from my experience. For example, where I am now, doctors have to call up government authorities to prescribe restricted medications (eg. seroquel), and there are strict guidelines on exactly what can be prescribed, otherwise the government won't let you have it. What I noticed when I moved back here was that medications I had been on that were widely used for bipolar depression in the US, and sometimes even MDD, were restricted to acute bipolar mania and psychosis (no maintenance treatment either). Sometimes doctors can get around that by lying, but it's likely that many doctors can't or won't want to prescribe drugs that work off-label (or even sometimes on-label). Accessibility of hospital: The US - and a handful of other developed countries - have many more hospital beds available per capita (or per insured capita) than most countries in the developing world. As in - many people with mental illnesses spend their lives in chains or crates because there's nowhere else for them to go. This means that symptoms that would land someone in a ward (even involuntarily) in the US may not put someone into a ward in other places. This means that you may need to construct a detailed safety plan of what to do if something goes badly, because hospital may or may not be an option. I say this because my friend's (Australian) father now lives in Malaysia and has a history of mania. He was clearly very unwell and his family couldn't look after him at home, so they took him to the hospital. To even get them to assess him, they had to lie and say he was homicidal and had tried to kill themelves and himself, and that he was floridly psychotic. The hospital discharged him a day or two later when they realized he wasn't homicidal. In places where the resources are limited, often suicidal isn't enough - you need to have had had a very serious attempt to be admitted, and you won't be in long. Psychotic isn't enough - you need to be in a completely different world, putting the lives of others at a large risk - basically the kind of obviousness where if you walk down the street, people will call emergency services because they are terrified. So if Egypt is like Malaysia, hospital may or may not be an option. Procedures to get psychological care: There are different procedures for accessing care in different jurisdictions, and some therapists or services may not be accessible for foreigners where there is universal health care. You may also need to jump through more loops. I know here, you need to get a referral for a mental health plan from a GP first, then you can go to a psychologist and have up to six sessions (the rebate is capped, and very few psychologists don't charge a premium above this). Then, the psychologist and the GP need to communicate and present a report saying that you require more sessions. From there, you can have an addition four sessions. However, these 10 sessions are all you get per year, irrespective of how sick you are. I remember my GP expressing frustration that someone people had all these sessions for trivial issues and I couldn't get more sessions. Just the way the cookie crumbles with socialized healthcare. Nuances in insurance: A lot of travel insurance has loopholes that may not seem immediately obvious, including pre existing conditions, waiting periods and mental health - sometimes mental health can be excluded altogether, and sometimes any pre existing condition isn't covered. I would make sure to know exactly what the loopholes are in the policy. I have found the best way to do this for insurance products is to call up the hotline associated with an aggregator (eg. compare the market), as if you call the company directly they might not be completely honest or might hike up the price. The aggregator has no incentive to do that. Ambulance fees: In many countries or states, ambulance cover is not provided through universal healthcare or private insurance. Where I live, it costs about $40 to join for a single adult. The average ambulance bill is over $1000, so it's a worthwhile investment if you think there's a risk someone could call emergency services on you. Could you also do phone therapy? One of my friends did that when moving from China to Singapore, and it worked well for her.
  12. Can you take the XR all at night if you're not on it already? Then you might be able to take it all at night.
  13. I am so worried about this.