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  1. 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...
  2. 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.
  3. 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.
  4. 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.
  5. I am so worried about this.
  6. Hey, I've also been through repeated hospitalizations, as have many here. I think asking for those extra medications is a good idea - I also have emergency medications that I don't take everyday but only if it looks like I could spiral out of control with mania or psychosis. The only reasons i can think of for a doctor saying no is if you pose a suicide risk and the medications can get you there, or if they're addictive. In that case, it might be worth asking if you can leave them with a family member who can judge if you need them or not. My mum moved to another country to watch me and administer my meds at my most unstable (she's great). Hospitalization is inconvenient and really expensive, so I think your doctor would likely agree that the best outcome is preventing it where possible.
  7. What you're going through sounds dreadful, and if there's anything I or anyone else can do, let us know. 1) Are you in a country with socialized health care? If so, it should be more affordable for foreigners than healthcare is in the US for people without insurance. 2) I would strongly, strongly recommend going to an ER because they will keep you in a safe place for the next day, week, whatever they think you need in order to not be an imminent risk of dying. 3) Professionally, people might expect you to be productive and successful, but people usually expect a little less of us than what we think they do, and people are always more sympathetic than you might imagine. You don't need to disclose the details of what's going on, but you can always say that something needed your attention in your personal life and needed to take some time off. You might be through the absolute worst patch of this episode within a few weeks or a month or two, and that length of time off is pretty easy to pass off for whatever you want to say. Work means nothing if you can't survive. You can only gain benefits that it brings if you're alive. Everyone who matters who is linked to your work wants you to survive. Even though it's really important, I would try and remember that your life is the most significant thing there is, and that there is a pathway forward where you will be much healthier than you are now, and consequently, be able to deliver on your work and other things that matter to you.
  8. I was diagnosed with anxiety disorders 12 years ago but my doctors have never really spoken about it in depth since my bipolar diagnosis. So I don't really know as much about anxiety as I probably should. I was wondering, can panic attacks feel different in different circumstances? I was wondering, because over the last few months I've had spells where I start shaking so badly I can't hold a pen or paper, whole body burns up and I turn bright pink, can't swallow, struggle to breathe, sometimes throw up, mind races until it hurts my head and I can just cry and nothing else. On the other hand, I've had a lot of panic attacks while manic and they felt quite different... A lot more numbness rather than burning up... Can panic attacks be different from time to time? Not sure if mania makes it different somehow...
  9. Sleep disturbances, followed by stress.
  10. I narrowly avoided being killed or severely injured. Others around me weren't so lucky. I am grieving for people I never knew, for what could have happened, and for how these events can even exist.
  11. I keep on hearing classical music from the phone in my office, but it's off and no one in my whole office is listening to music...
  12. Insurance covered it all. I would be bankrupt if they hadn't. The issue was this - my university involuntarily forced me to withdraw from school because of a hospitalisation for mania. If I withdrew, I wouldn't have legally been a student anymore .That also meant I was ineligible for the insurance I was on, and had no backup because I wasn't a US citizen and was from a developed country with a fantastic government-run medical system. My parents and academic administrators had to fight for me (I also would have lost my visa). Eventually, the mental health board at my university allowed me to take a "voluntary" leave on paper with admission requirements (including interviews) to return. This meant I could keep my insurance. I was so sick when all of this was going on, I am horrified to think of what would have happened without such a proactive and determined family and dean. I would never have graduated, I would have been too snowed under in debt to ever enter the US, get a credit card, get a mortgage, maybe even a job. My life would have been ruined in many senses.
  13. I was admitted twice involuntarily in the US, and each time the bill was $40,000-$80,000. I almost lost my insurance because I was admitted and had to withdraw from school, but thankfully my social worker and family were able to find a solution that kept my insurance. If I hadn't, I would have had to declare bankruptcy and would have been banned from re-entering the US. Brutal.