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  1. Personally, I'm not sure how much I would rely on fantasies while masturbating to tell me about my sexual orientation or other sexual interests. I certainly have fantasized about people, situations, and activities that I have no interest in doing in real life. It's hard to do, but it may be best not to try to label it for now. Be interested in whatever you are interested in during the current moment. When not manic, allow yourself to safely experiment if you are so inclined. Over time, you can choose a label that seems to fit, or just continue dating, sleeping with, or having a relationship with whoever you want, so long as you are open with potential partners and protect yourself while doing anything casual.
  2. Since you say that you were initially prescribed it for depression, and that it never really helped with the depression, my first thought is that you are experiencing underlying symptoms rather than the things like apathy, poor hygiene, low mood, self harm being caused by sertraline. 50 mg is generally considered the minimum dose, and depending on who you ask may not even be considered a full therapeutic dose, so you might need more in order to effectively treat your depression. I would be more concerned about the anger and irritability, and make sure your prescribing doctor knows that as well as the fact that you still are depressed. They may decide either to increase your dose while monitoring the other stuff, or may feel that a different medication would be better.
  3. I have an alarm on my phone. It's set to vibrate, so it's not disruptive to other people that I might be around, but is enough to remind me.
  4. For me it seems that generally when I start questioning whether I really have a mental illness is often when I am starting to become hypomanic. For a long time I was misdiagnosed with only depression, there were several episode where I concluded that not only were my meds "working" but that I was ALL BETTER and in fact, nothing had ever been wrong or I had solved all my problems and didn't need these meds anymore. Then I would crash, and eventually start the cycle all over again.
  5. I usually spend the drive to my therapists office and any time in the waiting room thinking about what I want to talk about. Other than that, I don't really prepare most of the time. I will sometime prepare if I have something major I want to talk about, but is hard for me to talk about, in which case I'll go over what I want/need to say in order to psych myself up to talk about it. We'll often end my sessions with a topic that needs to be continued in the future (sometimes we don't get to it next time, because something comes up in the intervening period) so that gives us something to go to.
  6. Nine weeks is a long time. You say you have a job offer, but is it 100% contingent on completing your courses by a certain date? If you have one class that is giving you particular difficulty, would you be able to take an incomplete and finish it while working - I know some people who have had this sort of thing happen, but it depends on the courses and the job. I realize this may be more stressful, and therefore not a good solution if it is even possible. Or if you do withdraw, could you postpone the job offer? Regardless, no degree or job is worth your health. I had to learn that the hard way. It sucks to have to give something up because of your illness, but in the long run, its better to do that than try to stick it out and do irreparable harm. But hopefully it doesn't come to that, and you're able to make it manageable. Good luck!
  7. I'm on 250 mg of lamotrigine and 75 mg sertraline. I'd been on 100-150 mg of sertraline for about 2 years before my new pdoc finally listened to me when I described my cycling and diagnosed me with bipolar. We added the lamotrigine and then dropped the sertraline down to 75 mg (I was super depressed when I started the lamotridge, after crashing off of a hypomanic state). I've been at these doses for about 3 months, after a couple months of tapering and adjusting doses. We decided to leave the sertraline for now since I tend towards depression at it seems to be working well at these doses so far. We're keeping a close eye to make sure I don't start trending towards hypo, in which case we'll drop the sertraline. So I haven't been on the combo for long, but so far, so good.
  8. Since (correct me if I'm wrong) this is your first time in therapy, it can seem a little weird at first, and can be difficult to figure out what you should be talking about.That being said,your therapist should be working with you to determine goals, and help you identify what you need to work on. If you know what you want to discuss - either in general or on a specific day - they should pretty much let you talk about that. And if something doesn't feel right with this therapist, try someone new. It can be okay to take a little bit of time before you spend much time on the big stuff if you need some time to develop rapport with your therapist.When I first started therapy, I had a difficult time naming my feelings and identifying what I needed to talk about, and it can take a bit for a therapist to get a context for you and your life that will enable them to steer the conversation during those silences. But, in that case they generally at least ask substantive questions about my life - what do you do for work, what do you do to relax, what are your hobbies, are you in a relationship, what's your family life like. That way at least they are getting to know you as a person, which can help later on, or it might bring up a starting point for conversation.
  9. I have a similar issue. One thing my therapist recommended was to track not just mood, but other factors like sleep, energy, irritability, anxiety, social activity, concentration etc. The idea is that while I may not always accurately label my mood, we can catch if say, I'm sleeping more, but yet less energetic, that I may be trending towards depression. Or if I'm irritable, not sleeping, and have excess energy I may be hypomanic. I've only been doing it for a month or two, so I can't really say how well it works, but it seems like a good idea. I've been using an app called MoodDiary on my phone (Android). I chose it because you can customize it to add whatever categories you want, but the chart/visual output isn't as clear as ideal, but it works okay.
  10. I don't know of anything that would help significantly long term. Support groups might be of some use, if one is open to those and there are good ones around. I also had found these online meetings when I was working on finding good treatment in a new location. I was always to nervous to actually participate, so I have no idea if they are any good. I also know some people who have gotten short term support from clergy members if that's your thing. Not from, "just accept God and he will solve all your problems" religions, but from pastors in more liberal denominations who will meet with congregants and offer more real-life support and problem solving. It likely will only go so far, but I've known people who this has helped them get through a particularly tough time, or help them fill a gap when for whatever reason they do not have adequate current mental health providers.
  11. My therapy appointments vary from week to week depending on what's happening in my life. My current therapist starts by asking me how my week has been. I like this better than when they ask me "how are you?" since that's so easy to answer with okay, fine, good, or whatever that doesn't really get us anywhere and I still require more prompting to start talking. If we had talked at my last session about something I was going to try to work on, or something that I had coming up that I was anxious about - or just something significant coming up, even if it was something good - my therapist will ask me how whatever it was went. Sometimes we'll then talk about coping skills that I could have used in something that happened in the past week, or feeling that I'm having at the moment and work on trying to understand them and whether there is something I can do to change my current situation. If I'm really depressed and not really doing anything, like you mention, we'll brainstorm on little things I can try to do during the week that will make me feel better, even if it seems to hard to do them. We also have some bigger "goals" although those are pretty vague. I'm working on figuring out what "normal" human emotional reactions are versus something that indicates I'm in a mood episode. This also includes working on being more aware of specifically what I'm feeling, since I've tried to avoid my feelings for a long time, partly as a way to cope with things that were too big and scary to face. We're also working on some mindfulness and relaxation strategies that can help with my anxiety and irritability. I have a hard time with identifying long term goals in therapy, but this mix of day-to-day and larger coping strategy and mood identification/regulation stuff works well for me. It sounds like you want more concrete "goals" to address in therapy. Are you able to identify what these goals are? If not, it is still worth mentioning that you feel like there isn't much continuity and purpose to your sessions. Ideally your therapist would then be able to help you identify and target your therapy towards what you're looking for, even if you can't yet articulate it. Sometimes even discussing what exactly it is you want to work on and trying to identify it can be helpful on its own. Some therapists do tend to be more open ended, "let's just talk" types, so if that's basically what your therapist does, it may be time to look for someone who does more directed therapy, if that's what you want. Edit: You posted while I was typing. It's frustrating because it never seems like its doing anything, but sometimes when I'm waiting for meds to kick in, just having someone consistently "there" for me is helpful. It never feels like enough when it's happening, but in retrospect, I can see that I needed help existing and enduring until I was a little more stable, and that just having the consistency and compassion of therapy helps me to survive. .
  12. If you tell them you think about suicide, they'll generally ask you if your safe, if you have a plan, whether you intend to act on that plan and such. Generally, they'll only consider hospitalizing you if you have a plan along with the means and intent to follow through with the plan. If you can assure than that you're safe then they won't hospitalize you.
  13. I am not in Arizona, so I don't know the specifics of their Medicaid plans, but I do have Medicaid in the state I live in. I had previously been on insurance through my employer, but I had to leave that job, at which point I got Medicaid. Honestly, for me, its such a relief to have Medicaid, to the point that it makes me sad to think that when I go back to working full time (I'm working again, but my income is still low enough that I can keep Medicaid) that I'll have to go back to either employer-based or ACA health insurance. I haven't had issues finding providers who take it, and its so nice not to have to worry about copays and deductibles and all that. I'd take a close look at exactly what having the ACA plan instead of just Medicaid would get you as far as providers. It should cover basically any medical condition that private insurance covers. Medications vary so much by plans, that it's hard to say. My Medicaid plan actually covers one medication that my previous insurance didn't. The size of the provider network is likely to be the biggest drawback of a state Medicaid plan. Do you have any established medical providers? If so, check whether they take the available ACA insurance, Medicaid, or both. If you don't have any, I'd suggest really looking and seeing if you have a couple options for pdocs, therapists and endocrinologists who take Medicaid. I know you said you looked at endocrinologists and couldn't find much, but are there ones on the ACA plan that look significantly better? I've generally found that regardless of how good or well established a doctor may be, most doctors don't really have much internet presence. You may actually find that just having Medicaid is actually less stressful than private insurance, since it means you'll be able to make healthcare decisions based on what helps you the most not what helps you enough for the lowest cost. And remember, if you do have someone you really want to see who's not covered by Medicaid, you can still pay out of pocket. It wouldn't likely make sense to do that for something like a tdoc who you see regularly, but paying $300 twice a year to see an endo who you like is still a lot cheaper than paying $6000 a year in premiums, and then still having to pay the $300 because you haven't hit your deductible.
  14. I suspect it has more to do with the alcohol+Xanax+melatonin, as well as the effect of alcohol alone for someone who very rarely drinks, than it does strictly the Lexapro. Although the Lexapro might have contributed to the effect.
  15. I didn't gain weight on Zoloft. It helped my anxiety some, but I think therapy made a bigger dent. I also didn't gain significant weight on Celexa, but it didn't help my anxiety as much as Zoloft. Oddly, Lexapro sucked more for me (hypomania/mixed episodes that were not diagnosed at the time as such). I eventually ended up cycling on Zoloft, although I did have probably a year or so of good results on it before that.