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Most of the time I can tell when I'm starting to hit a period of mania or depression. My cycles aren't entriely predictable, but most of the time the moods don't just hit me immediately. It's a gradual sort of thing. Anyways, just yesterday I realized that I'm getting a bit out of control again. During any period of mania I tend to get a little crazy. I do all the normal things - talk fast, don't sleep, that sort of thing - and I also get pretty irritable and lose patience with people very easily. I go out a party all the time and I spend WAY too much money.

I'm unmedicated right now because my psychiatrist just retired and my insurance is being ridiculous. I know I should probably be on medication, as many people who are unmedicated have a MUCH harder time. I know I've been struggling but that isn't anything new.

What I was wondering is this: What do you guys do when you get depressed or manic? Aside from medication, I mean. Is there any special activity you do that helps? I was talking to my aunt, who has a bachelors in Psychology (she isn't a doctor but she's pretty smart), and she said that sometimes there are things that depressed people do (maybe routines or something) that help them to cope. Have any of you found anything that helps?

Thanks in advance.

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I'll give ya the short answer. There a lots of incremental things you can do, but if you are much more than cyclothymic, you still go crazy be it depressed or hypo/manic.

Focus your efforts on resolving your insurance issues. Call Tuesday. Talk to the people who line you up with docs. If need be, tell them you are bipolar and need help getting a pdoc asap or you might end up in emergency which is far more expensive. Insurance people don't like expensive. That might motivate them to assist.

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I would also agree with the other poster... you can do things like stay at home if you get manic and spend money (or get paranoid) or eliminate caffeine intake. I personally believe massage therapy is beneficial for mind/body balance, but that may be just me (and I currently don't have the money for it right now). For depression, keeping active helps keep the mind occupied and off depressive thoughts.

However, it will never replace medication. You state that your insurance company is being rediculous. I suggest calling your insurance company up and ask them for the names of several psychiatrists that they will cover at their highest benefit level. They should freely give you this information, and you will cut through a lot of their red tape by following their rules by using one of their contracting physicians.

If this doesn't work, ask to speak to the insurance company's patient advocate. Since the implementation of HIPPA and other laws, most, if not all, insurance companies have a patient advocate who is supposed to assist you in navigating the insurance company's system. They are free. I used one when I was first being diagnosed.

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Here's my short answer: A whole lot of fucking nothing. The only solace for me was thinking of it like a bad trip on drugs: It's only a bad trip and it'll be over soon.

You need drugs if you're hitting a real spell of depression or mania that's taking you to the edge of reality. Hoping that you won't off yourself or someone else through (silly) coping mechanisms is a huge gamble in which the loss far outweighs the chance of a winning result. Luckily for me, I was able to do things that would prevent me from doing overtly stupid things. And sometimes that might have meant "eating" a little hippie lettuce here and there, but you know what? It kept me from killing myself. Now don't misinterpret that as an endorsement for the use of illicit substances because they're definitely a bad idea with mental illness.

Going back to what I said before, thinking of it like a bad trip sounds far easier said than done. Thinking about much of anything is a pretty futile task when you're so goddamn depressed you want you life to end, but for me, anyway, it was possible enough for me to live through it.

Bottom line is that you, like the two other people mentioned, need to talk to the necessary entities to get back into the med swing.

I wish you luck.

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I am trying to get through to the insurance. I live in Wichita, KS and for some reason, every time I call I get some stupid person who says that Wichita doesn't exist. They keep telling me there aren't any doctors in the area that they cover and I'd have to drive 3 hours to either Kansas City or Oklahoma City. I can't afford that.

I didn't know about the patient advocate thing though. I might ask about that. Also, mentioning the emergency thing is a good idea too. Thanks!

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What I was wondering is this: What do you guys do when you get depressed or manic? Aside from medication, I mean.

Aside from medication ... how about in addition to it? Most of the positive coping strategies anyone can teach you are going to still be useful even on the best med regime.

1. Good sleep habits - abso-freaking-lutely important for bipolars (and just about avery other kind of crazy there is, including epileptics)

2. A balanced diet - look carefully at what you eat. If you suspect it's not as healthy as it should be, supplement for the things you are missing (I'm almost completely lactose intolerant so I avoid dairy products ... Vitamin D and calcium aren't going to teleport themselves into my body) and take an appropriate multivitamin daily. Eat more healthy things.

3. Moderate exercise. Especially if you do not want to, but set reasonable goals and limits. Remember that too much of a good thing in this area can fuck you up.

4. Have a backup. When the rollercoaster tries to jump the tracks - and it will - you may need someone to visit when you just cannot be alone. You may also need to call in sick when you cannot be around others. (Been there, done that, both cases)

5. Give yourself permission to hide under the covers and refuse to leave the bedroom. That may require advance arrangements to take care of children, spouses, and other pets, but sometimes it's a lifesaver.

Of course you should work towards getting the correct medications and support, starting right now, even if it's the only thing you can get done. The other stuff should help support you in getting that done.

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With depression, I try to keep my life as normal as possible. I put on make-up, make myself go to work, go out with my husband, clean my house, play some video games, exercise etc. It all takes considerably more energy than when I am not depressed, so I do take life a little easier. I've been fortunate in that my last two jobs have given me some flex time, and I can work fewer hours if I need to.

When my mood was elevated (which is an uncommon occurrence), I turn the lights off, take a concoction of something sedating, and make myself sleep until I can talk to the psychiatrist. My highs aren't particularly high and life-impairing, and I want to keep it that way. No fucking around.

Coping skills help to a point, but they do not make symptoms go away. At best, they keep you from jumping off of a ledge while you're waiting to see a shrink.

If you're interested in some specific tips, you might want to see if you can get a hold of a Wellness Recovery Action Plan (WRAP) workbook, or maybe even join a group. I don't agree with everything that the creator of the program proposes, but it's a good program overall.

If you absolutely need to, see a GP in the meantime.

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There's a thing called IPSRT - interpersonal social rhythm therapy - which is pretty much summed up in the above posts with a few refinements.

Basically: you get up every day at the same time; you should have meals at pretty steady times; first social contact of the day at a steady time; first leave the house at the same time; et cetera.

Ellen Frank has written the book on it. There's no workbook, just the text. It's not a fascinating read, but it's not a tricky concept. If there's a university library handy, they'll probably have it.

But it's not enough without the medications when someone is in an episode, and probably not enough to maintain without meds in between episodes. In combination with the meds, it's rather impressive in preventing relapse. It's probably helpful in stabilization if it can be started soon enough (more so in depression than mania) (probably because, well, manic people just don't stay on schedule that well). I place it in the "necessary but not sufficient" category for my own brain.

The WRAP program draws from this, actually - NAMI has the WRAP classes in my area, and they are free. Here they are set up as an open-cycle class that you can start at any time in the cycle, but, in my old town, you had to wait til the new cycle started... worth checking.

If you had medications that worked well, I agree: go see a GP and see if you can get started on the mood stabilizer again. (I am not so thrilled about GPs managing antidepressants in manic-depressive illness, but the lithium/anticonvulsant/AAP piece is usually OK for the short term.) As nervous as s/he may be about this, if you go in and explain your situation, that you are actively working with insurance, that you are not using intoxicants, and that you are controlling these other lifestyle factors - and that you are just trying to get this mood stabilizer bridged for the short term - may make you a much more safe-looking candidate for a GP who is really just trying to do a good job and not kill patients... and I think most GPs will empathize with your frustration with the stupid insurance company.

Hell, play your cards right and the nice office manager may have some tips for you as to a competent person to talk to at CigAetBluCrosMark.

Also, would it smooth things out with your insurance if a GP made the referral? It's amazing how often that just knocks down barriers.

The other thing is to just CALL a damn psychiatrist's office - one your GP recommends, one someone else recommends, whatever - and ask if they take Insurance X, and explain that you're having a hell of a time with them on the phone. Be charmingly frustrated. Emphasis on charm.

Seriously, though, you should be able to look this up online with your policy information... or ask your HR person, if you don't know how to do this (you don't have to specify psychiatry, if you don't want to.)

And, with all respect... even if you did have to go to OC/KC.... you can't afford NOT to drive there. The structure/rhythm thing is vital to management, but it just isn't enough. I wish it were.

Sorry.

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I am trying to get through to the insurance. I live in Wichita, KS and for some reason, every time I call I get some stupid person who says that Wichita doesn't exist. They keep telling me there aren't any doctors in the area that they cover and I'd have to drive 3 hours to either Kansas City or Oklahoma City. I can't afford that.

I didn't know about the patient advocate thing though. I might ask about that. Also, mentioning the emergency thing is a good idea too. Thanks!

It sounds as if you could possibly have a non-local insurance company, hence the no coverage in wichita. Try looking up the company's website. Most insurance companies have provider directories on their website, which would cut out the annoying calls to customer service. Keep trying the patient advocate, though.

BTW, I grew up in Kansas about 1 1/2 hours north of Wichita. I definitely know where it is, because I fly there a couple of times a year to visit my family.

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What I was wondering is this: What do you guys do when you get depressed or manic? Aside from medication, I mean.

Aside from medication ... how about in addition to it? Most of the positive coping strategies anyone can teach you are going to still be useful even on the best med regime.

1. Good sleep habits - abso-freaking-lutely important for bipolars (and just about avery other kind of crazy there is, including epileptics)

2. A balanced diet - look carefully at what you eat. If you suspect it's not as healthy as it should be, supplement for the things you are missing (I'm almost completely lactose intolerant so I avoid dairy products ... Vitamin D and calcium aren't going to teleport themselves into my body) and take an appropriate multivitamin daily. Eat more healthy things.

3. Moderate exercise. Especially if you do not want to, but set reasonable goals and limits. Remember that too much of a good thing in this area can fuck you up.

4. Have a backup. When the rollercoaster tries to jump the tracks - and it will - you may need someone to visit when you just cannot be alone. You may also need to call in sick when you cannot be around others. (Been there, done that, both cases)

5. Give yourself permission to hide under the covers and refuse to leave the bedroom. That may require advance arrangements to take care of children, spouses, and other pets, but sometimes it's a lifesaver.

Of course you should work towards getting the correct medications and support, starting right now, even if it's the only thing you can get done. The other stuff should help support you in getting that done.

Absolutely. All helped me. Going to the bed at the same time and getting up at the same time helps too, otherwise I find I can tumble into terrible habits that make me worse. Clearly this isn't always possible when you're manic and/or depressed.

I would also add something that I find incredibly difficult and that is to really cut down on computer usage as I find it over-stimulates me mentally and makes it harder to sleep if I have been using it all evening.

DVDs, chats with friends and reading (doesn't have to be books if you can't focus, can be lightweight magazines) make me more chilled out than random web surfing.

Null0trooper - Why do you think too much exercise can make you worse?

I can do an hour of intense cardio a day for six days and then leave it for a few days and start again. It helps if I am stabilising on meds but does seem over-stimulating mentally if I am ill, in spite of feeling more physically relaxed. Is this what you mean?

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Therapy-wise... Wichita, eh? I think Zettle teaches at the university there, and he's a kickass cognitive therapist/researcher, so if the university offers therapy, I'd see if you can get into the university's program that the grad students work in.

As an adjunct to the meds, that is.

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Therapy-wise... Wichita, eh? I think Zettle teaches at the university there, and he's a kickass cognitive therapist/researcher, so if the university offers therapy, I'd see if you can get into the university's program that the grad students work in.

As an adjunct to the meds, that is.

Wichita State? I go there! I'll look him up.

Thanks for the name drop. ;)

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