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  1. When I'm coming down from hypomania I often get short bursts of intense agitation where I feel a combination of depressed, overwhelmed and restless. Obviously for me, being on a mood stabilizer that controls the hypomania is the best long-term solution, and lamotrigine has helped cut that down a fair bit. I have had some breakthrough periods though of this and I've found that ativan helps in those moments. I discovered this when my previous psych had prescribed me ativan prn for anxiety and I decided to see if it would help since there is often anxiety mixed in for me. I don't really need ativan for pure anxiety anymore, but when I had some breakthrough hypo this summer that we didn't catch until I was already coming down and I was starting to experience more agitation and uncomfortable energy, current psych was ok prescribing ativan based on my reports of it previously working for similar symptoms and it seemed to work. I leveled off without crashing, which is always good.
  2. I take it in the morning. When I was originally put on it, my psychiatrist recommended morning but told me I could switch to evenings if I had any issues with mornings (for example, when I was on celexa I took it at nights because it made me slightly nauseous, but taking it right before bed didn't cause problems). At one point I tried to switch my Zoloft to nights since I was having a hard time remembering to take it in the mornings, but it gave me insomnia, so I switched back to mornings and worked on other ways to make sure I took it.
  3. It sounds like she is trying to push you farther right now that you feel like you can manage. Would you be able to tell her that you need to slow down and that adding one new activity a week feels like too much to take on? Maybe see if you can pick one activity outside your house and talk about little steps to break it down, what your fears are at each point, and how you can handle them when they come up. Then try to take one step that week and come back and talk about how it went and if you are ready to try another step.
  4. My reaction to lexapro was pretty similar to dancesintherain - irritable, anxious, agitated and what I thought was akathisia, although my psychiatrist at the time told me it couldn't cause that. She also denied that I could possibly be bipolar despite very clear (in retrospect) hypomania, so there's that. Celexa was actually less problematic for that, although without a mood stabilizer I eventually became hypo and then cycled down to depression and it didn't work anymore for that. Similarly, Zoloft helped with my depression initially without immediately causing hypomania, although like celexa I eventually returned to cycling. I still take it with lamotrigine now, and even though it felt like it had stopped working prior to adding lamotrigine, if I try to lower it beyond 100mg, my anxiety starts to get worse.
  5. I was originally prescribed lorazapam for anxiety, but I do get some benefits when I am hypomanic. It helps me sleep, which in turn can help control hypomania. It also helps with some of the symptoms when I am already on the wind-down from hypomania. I often get really irritable after a few days of feeling really good. This often precipitates a crash towards depression, but it seems that lorazapam can reduce the irritability and soften how I come down from being hypo. I've never been fully manic and since being on my current dose of lamotrigine (400mg), my hypo's have been pretty mild. However, my psychiatrist has mentioned that if I ever have more severe symptoms, he would want to go with some form of AAP to more reliable bring me down.
  6. Pretty similar when I'm depressed. Any little negative thing feels like another huge indicator that I am worthless and the world is a terrible place. I sometimes experience the flip side when I'm manic and in a way become hypersensitive to negative feedback and get angry quickly and feel like everyone else in the world is doing everything wrong and why can't they just realize that they should have included me or let me make the decision or whatever.
  7. I wonder if your doctor could give you some general guidance as to what sort of symptoms merit getting checked out quickly in case they do indicate something serious vs those that you can try to ride out with your ERP for a while and then come in if they don't subside. There are a lot of variables, so I don't know how much help they can actually give toward that, but it might be worth asking about since it sounds like you have a pretty understanding doctor.
  8. One term that a therapist I had used was "aborted suicide attempt" to describe an action I took. I feel like this captures the fact that I began something that I hoped would kill me, but stopped myself before I did anything that I thought could kill me. I feel it validates the severity of the suicidal intent while still acknowledging that I did ultimately decide to stop and keep living.
  9. If you haven't already, I would carefully double check the language in your insurance plan. Some plans will have a way of getting an additional number of sessions approved through some sort of appeal process where you show medical necessity.
  10. I took it briefly a few years ago when I had an anti-benzo pdoc and we were considering a PRN anxiety med. Propranol helps with physical anxiety symptoms, like racing heartbeat, but this also means that it decreases your cardiac output during physical exertion by not allowing your heartbeat to get as elevated then. I'm a serious runner, and this was noticeable, even if I had taken it in the morning and wasn't running until 8+ hours later (my pdoc told me that this effect should wear off within 2-3 hours, which was NOT true for me). It wasn't worth it for me and I just managed without a PRN for a while until I moved and got a new pdoc. That pdoc prescribed me ativan, which I have taken on and off since, and for me, this has fewer side effects. But if you want/need a non-benzo PRN and are ok with the possibility that it might make strenuous physical activity more difficult, it might be a good med.
  11. Specific policies will vary from school to school. Most will have a certain period of time during which you can withdraw and get a partial or full refund, but generally the further you are into the quarter/semester the less refund you'll receive if you receive on at all. Generally, after whatever deadline the school has set, you would have to petition to receive a refund because of exceptional circumstances. Your, professors, were grading your assignments and you were using school resources, and funds for these have to come from somewhere. I can only speak to the environment I work in, which is a community college. The bar for being able to receive a refund is pretty high, but it's not impossible. So, if you were in the hospital and could not attend, you would need to provide documentation of this, such as a letter from a doctor stating the dates of your hospitalization. It would be very unlikely that you would get a refund if you withdrew for medical reasons unless you were in the hospital or IOP.
  12. Every school is going to be different in exactly what they offer as far as mental health services and how they structure these. In my experience, disability services are usually separate. In college, I saw a therapist & pdoc at our student health center. My grad school had more limited student health services and I used a community clinic. In school I never identified myself as having a disability or used any sort of accommodations, partly because I did well academically, and partly because I had a lot of internalized stigma around mental illness. I now work at a community college as an academic advisor and specifically work with students who are or have struggled academically, so I often refer students to our disability services and collaborate with these staff. Assuming you are in the US, you should always be able to seek out or choose not to use any disability services at any point during your education. Legally, all they can ever reveal to your professors without additional written consent is that you are eligible for XY&Z accommodations. They cannot tell your professors what medical conditions you have. Our process is that students schedule an appointment with our disability services coordinator, which they can do right when they register, or at any point afterward. They bring in any relevant medical documents and then discuss what accommodations are appropriate to their needs. These are considered "approved accommodations," but then each quarter the student has indicate to this office that they would like to arrange accommodations for their classes. Your professor will only get notified if you have requested accommodations for that class. So, if you are approved for extended test time, you could decide to request it for math, but maybe you feel you don't need it for psychology. In that case, your psychology professor would not even be notified that you have a disability. We do have a question in our enrollment forms as to whether you identify as an individual with a disability, but this is only for statistical purposes (like the way collecting info on race or gender is), and it generates a pop-up window when completing the form online with the contact information for our disability services office. Indicating no there does not impact your ability to later pursue accommodations; likewise, some students may indicate yes there choose never to meet with disability services.
  13. I've been dealing with this recently too. I haven't found a full solution - I'm seeing my doc in a few days so we'll see if I might need something med wise to bring me down a bit. Putting as many steps between you and hooking up helps. I'm a gay man, so its super easy to find quick sex using several different apps. I've tried deleting apps (but have a few times ended up re-downloading them in moments where I lack self-control), since it's my main way of identifying partners, but it might be harder for someone who is straight since most men could be a potential partner - maybe some others can come up with suggestions here. Also, masturbation helps take the edge off. TMI, but doing it before situations where I might be tempted or opportunities to find a partner helps control the "need" to find someone.
  14. Before I even schedule the first appointment, I check about general availability to make sure I'm going to be able to see them consistently. Then I have a couple of specific things I ask about. What's their experience and approach to working with people with mood disorders & potential suicidality? Even if suicidality is a current concern, I have enough experience with it, that I want to know someones ability to handle it if it comes up. What's their experience working with transgender individuals? Even though I'm long past transition, I still want to make sure someone is knowledgeable and sensitive to trans-issues so I don't feel like I have to monitor if/how it comes up. What's their general approach to sessions? I don't do well with purely psycho-dynamic talk therapy. I need someone who is a little more actively involved, and I like some goals and structure, but I also don't want super rigid CBT or such where I I can't have a couple of free-form sessions where I just talk about what's on my mind. Beyond those, I mostly just go with my gut feeling.
  15. You say that half the session is spent on more-or-less checking in how things are going and, "what's next" rather than addressing your goals. Does he actively steer you away from these goals, or just not bring them up on his own? Would it be possible at the start of the session when he askes how you are/how your week has been/whatever opening question he asks to give a brief summary and then explicitly bring up your goals? Like give a one or two-minute summaries of your week and then transition and say something like, "what I'd really like to talk today is [whatever it is you want to talk about]." If he steers you back to other topics then that's bad, but otherwise it might be just his style to let the session evolve naturally, so he might be assuming that if you're not referencing back to prior goals, that it's not what's on your mind on a given day.
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