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Has anyone managed without meds?

I am 14 months off methadone, it can take 2 years to physically recover. I want to wait 2 yrs before I try any meds for bipolar, I want to start with a base me. I can control my behavior during most episodes, but this last cycle hit me hard. As my brain has been healing from opiates, the bipolar is returning to pre-opiate levels of intensity. I am stable again, but I look back on the last weeks and feel sad, I can't keep starting over like this. I have my wife and kids watching me and they will tell me if I start to get intense. I am trying to arrange my life so I can withdraw if needed. I'm scared of meds, which is good for an addict. I haven't done anything really crazy yet, but I fear I will wake up in another country if I don't work this out. I have 10 months before I plan to start trying meds, Lamictal is where I think I want to start. i am trying Tryptophan and Tyrosine when I get some money. I am trying all the natural routes until I heal from methadone. Is there any natural remedies or aids that anyone could suggest? Has anyone learned to set up damage control successfully, making meds unnecessary? I feel I am at a road block, my addiction recovery has reached it's limit, until the bipolar is under control. Any and all ideas are welcome.
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Avatar universal
I'm looking for psychiatrists, but most I have found aren't taking new clients. There are a lot more calls to make, but the Skype/phone meetings sound are a great idea. Most times, I can control myself, using the tools from addiction recovery. This last cycle scared me, I'd love to deal without meds, but I'm not sure anymore. I'll keep looking for a doctor to broaden my choices.
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Avatar universal
Do some research regarding *what* it is in the energy drinks that is believed to cause mania in many with bipolar disorder.  Taurine is in a lot of them, so make sure it has nothing to do with that before you take it.

Is there any way you can find someone you visit once or twice in the four hour away range, maybe see a couple times, then have phone appointments?  I know I can have phone appointments with my therapist and psychiatrist through Kaiser.  Maybe other places offer this service as well?  That in combination with setting it up so the prescribed medications are filled at a local pharmacy will save some miles but also enable some help to be found.  You'd have to do some research/make some calls to find out, but hey, your mental health would be worth it.

I will be honest that I haven't been on medication for about 3 years, but that was following four years of therapy and medication.  My second psychiatrist was afraid to try new meds with me and lithium alone wasn't helpful, so I kept in therapy and used my support group (boyfriend, friends, family) when needed.  However, I do feel those four years on medication while in regular, frequent therapy to learn my triggers and early symptoms were necessary to get where I am today.  Without the meds in those early years, I don't think I would have made it through those four years without some major lapses in judgement and/or even alive.
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Avatar universal
Try checking out telehealth things.  I know that Medicare will reimburse psychiatrists for doing consultations via skype (or anything that has real time audio and video) as part of a rural health initiative.  I don't have time to look for providers who do it right now, but it's definitely something to look into.
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Avatar universal
I checked all the resources in the County. Unless I drive 4hrs, I have few options. I was told to go to the clinic and get whatever meds i want, they will recommend some, but there are no good psychiatrists here. I'm kinda on my own. I did more research, I'm going to do 500mgs of Tryptophan an hour after dinner and 1000mgs Taurine before breakfast. I will try this as I research all the drugs and techniques you have mentioned. I will up the Taurine if necessary. I have a few books by D. David D. Burns and Dr. Julia Ross. If I want help from the county, there is a 700 person waiting list for 2 doctors, and I was told by Behavioral Health, they will basically do the same thing as a GP at my local clinic, offer me drugs to try.

Thank you folks so much for your support. I will keep trying something new until I find some level of balance or damage control, at the least. I expect this to take some time, luckily my family is on board. I took a semester of Addiction Counseling classes at the local college, that has helped a lot. The classes are taught by therapists, and a lot of it has to do with personal healing and growth. I also get free counseling, I can talk to the teachers/therapists one on one. So far, I think I am utilizing the best resources available here. I don't know what to do next, if this doesn't work. I can't drive 4hrs and spend money on psychiatry, but I will move for awhile, if that's what it takes.

I really relate to all that you have said, all of you. This is harder than getting off opiates, there's no 12 steps to freedom. Thanks for being here, it really helps to have people who relate.
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Avatar universal
Sorry, looks like I misread some of the content you posted earlier.  I'm a bit short on sleep right now, in the middle of moving to another country for school.

Did some posts get deleted while I didn't have internet?  It seems I'm missing part of a conversation.  I'm posting this before I lose internet again and it gets even longer.

Re addictions: As I said above, I'm not a healthcare provider (well, I have an EMT-B cert, but they don't really cover this stuff at all), but I do spend a lot of time around them, and they absolutely consider issues like previous addiction or any adverse effects when it comes to choosing drugs (or they should).  Of course a need can override contraindications if the need is strong enough, but I think you'd agree you'd try other things besides opiates in a recovering opiate addict first if you had the option, to avoid the complications for them.  That's obviously not always an option, but again, it's a consideration.  Withholding opiates from everyone because they *could* become addicted would be silly, as would refusing to prescribe benzos at all (which apparently some psychiatrists do, as per individual reports from other people).

For benzos, they can be great drugs when used properly, but they can produce addiction (or more commonly, dependence), although that's mostly a risk from long term regular use and not PRN use.  I don't want to get anywhere near benzos myself (I take buspar for anxiety), and I don't have a tendency to get addicted to things (and an apparent LACK of addictive personality seems to run through at least one side of the family--several members quitting smoking without much difficulty when they decided it was bad for them).  My personal view on benzos and anxiety (which I'm sure some psychiatrists would agree with and some would disagree with) is that they should not be first line anxiety control drugs, i.e. they should be for PRN use and you should try the SSRIs and buspar first, if possible.  

On antipsychotics:  My point was that you can load antipsychotics very quickly, both orally or by injection, if necessary.  You can't do that with most other mood stabilizers.  Lamictal is approved for BP I, but it takes several months to get up to the right dose if you're doing the titration properly.  Zyprexa can be started at the target dose (10-15mg, as per the PI sheet).  It's not magic that makes it go away instantly, but it is very fast compared to the length an untreated episode would be and is much faster than "this medication may take 4-6 weeks to have an effect".  And you still need something for maintenance, naturally.  I have not seen antipsychotics given IM or IV, but I have seen IM ativan given (and apparently, IM benzos are sometimes used in acute mania).  In that case, the person was catatonic, and had mistakenly ended up on the neuro service (where I was shadowing) instead of the psych service.  Gentleman with schizophrenia who had stopped taking his meds.  In under a minute, he went from lying unresponsive to moving and answering questions.

I know haldol isn't as popular now; my point was that it was an antipsychotic, and that he was taking it with weekly drug holidays.  Haldol is still used in tourettes, by the way, as are other antipsychotics.

As for PRN use in bipolar, again, I have other people's reports of having permission from their psychiatrists to do that.  If they feel a manic episode coming on, they start taking it.  I think especially for some people with ultra rapid cycles that occur intermittently (i.e. not very often, and the episode is short) it's particularly useful, assuming they are able to tell that it's coming.  I am not saying that antipsychotics are only for psychotic episodes.

What exactly is it that you do?  Orderly, tech, LPN, RN, NP, MD, DO, something else?  There's no need to be so sarcastic with me, as I have never claimed to be a doctor (or to have been admitted to a psych ward); just a well read mentally ill citizen who has spent a LOT of time around doctors (though not psychiatrists), and listened to other people's stories of their inpatient experiences.  In the end, this is the internet: the advice you get is worth every penny you paid for it.  I think you are reading a lot of things into what I'm saying that are not there, and I'm sorry that I seem to have offended you.  I am not a brick wall, but I do know how to argue (and by that I mean engage in reasoned debate, not a shouting match) and will defend my points with research available.  Kindly remember that I have the same thing you do, and I'm not sure I'll ever see myself as completely well.  I speak from personal experiences on some things, not just books.  

Arguments aside, are you ok?  Your writing has gotten increasingly hurried looking and I feel like it would sound like pressured speech if I could hear you talking.  It could be nothing, and you certainly don't need to say anything to me if you don't want to—I just worry a bit.

@WEAVER71 (capitalized so you'll be able to pick it out from the previous text):

Mood changes can absolutely be seasonal.  Seasonal affective disorder is depression that sets in (usually) in the winter, when there is less sunlight.  I tend to get more depressed in the winter, although I don't always notice that's the case (I have trouble telling what's normal if I'm not horrifically depressed).  Some bipolar people get mania that sets in reliably at the same time every year.  The psycheducation.org website has a lot of interesting info on it, mostly focused on BP II, including a section on light and how it affects mood.  It's something you could look into as an adjunct treatment for depression—they sell light boxes that put out full spectrum light, which you sit under for 20-30 minutes in the morning to help regulate your circadian rhythms and elevate mood.  Getting outside and getting early morning sunshine is also good.

If you do need an antidepressant added on, and you don't have anxiety problems, Wellbutrin is probably the best place to start, as it is less likely to cause mania in people with bipolar, but it can worsen anxiety.  Just something to bring up with your doctor if you want.  It wasn't a good drug for me, although I can probably credit it with helping the depression quickly while we got the Lamictal on board (I seem to be a super fast responder to meds—within 2-3 days of starting Prozac at 10 mg, back when my dx was major depression, I started to feel noticeably better, and the same thing happened this last time around).  If you need an antidepressant after you've got a mood stabilizer on board, just go with whatever your doctor recommends or, if you feel like doing some research, ask about the drug that looks like it has the best side effect profile for you (although there are never any guarantees), and go from there.
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Avatar universal
Also, you can probably relate to this because I know  you like  humor.  I just bought a mug with a cartoon on it. There's a guy in a psychiatrist office lying on a chaisse, and the doctor is sitting and writing down in a notebook behind the head of the chaisee. The patient says, "It's time to up my dosages because I'm having feelings agan." That is what it's lke for me since I've been in recovery and stable for 4 months now...which Inhadn't felt for a lng tim. Everythng either feels raw, new, remembering events and thoughts that happened during in my illness that are now impacting me are comng through. Even feeling again. It makes me introspective. It also caused me to go back and thank people or apologize to them for things that happened durong my illness. I will get sad, happy, tearful, obviously perturbed, but I can feel again. There are times when it feels scary because I'm just more aware, and when I would think that I was better off not feeling anything or even being psychotic or too involved in the midst of illness. However, I learned the art of stepping back, letting it go for now to ponder later when I feel less vulnerable. I'm also re-charging my "second skin" to buffer the harshness and "unpredictability"of people. I also found that my "feelers" and ability to assess a sotuation wasn't off the mark, and that I can read well.

Recovery from anything is a process. I choose to process it even if it's painful. I did tell my pdoc that there are times I am tempted tonget off my medicaton just so I don't have to feel too much, but I did work hard for this and so did he as well as everyone else. I'll see it through, because It's interesting for one, andI'm hoping, like you mentioned for ourself, that I will be a better person. I'm not there yet. No one's going to put up an altar for me, but the act of getting to where you want to go is well worth it. I always did like challenges. It's just nice to feel the goodness of being and breathe fresh air in my head. It's good to feel lght and centered. I also love the mug.
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Avatar universal
You are absolutely right Weaver77. I got  triggered, and I take responsibility for my own input. I also try to keep an open mind, but this was more on other issues, and I got carried away. I'm sorry to disrespect you. This is my very last posting but I will still message you and finish my task. I'm just waiting for the last answer from my contact on dual diagnosis groups.

Journalng is fine, but what I found helpful was Dialetical Behavior Therapy and Cognitive Behavioral Therapy. Look up David Burns because he has some pretty nice worksheets that are eay. It helps if you can sound out  the worksheet out to someone when you plug in the answers...like your wife, because (I'm envious.) she sounds supportive and sensible. For some reason, when I say the words out loud to someone, I get further insight and the other person usually has some great feedback or catches nuances I haven't caught. I don't know about you, but  when my thoughts start going, II either get lost on them or can't get an end point or just keep reprating. Writing down with a worksheet  helps me with giving me relief and keeping my head up above depression. I have a hard tme doing it myself prior to hypomania.

You weren't rude. I was. You're a good man and it comes across to me with all your post. Even if you quoted pages of Aldous Huxley.  You can repeat it in Spanish if it soothes ou more:) Adios.

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Avatar universal
Yes, I suspected from my first encounter with you what your expertise was. No need to reply further. I already got the drift from your previous posts that I just let go. I will leave Medhelp with this my final postng. I don't particular like talking to brick walls or wasting my time, since I'll be sick forever with bipolar disorder as you so kndly pointed out in another posting, even though I feel well now and have finally achieved remission. Oh, btw, people with HIV who are living healthy lives don't consider themselves sick. I think I would know something about that since I was working in a hospital that led the charge in the AIDS epidemic and now. I also work and have friends with HIV for decades who I feel are lighthouses for me. But, I don't know nothing because I don't have a doctor in the family. Well, that's not true...I do, besides a car mechanic, which is a skill I would love to have by virtue of famly osmosis.


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Avatar universal
Thanks Catbeard, I like your suggestion. I am journaling, but I like the spread sheet idea, less sifting through random thoughts. I think I'll start a ledger that goes with my journal. Thanks. I am mostly concerned about damage control. I don't mind the mood swings, if I don't hurt anyone or anything. It seems like few people find a perfect balance, it bums me out. I thought getting sober would do the trick. Nope, it's getting worse, the longer I'm off opiates.

As for the debate about people's opinion, this reminds me of the addiction forum. I am not really manic right now, so it's okay, but I think a personal debate on a public forum, on someone's thread, is counter productive a lot of times. I want all opinions, I can decide what I think is right for me. Anyway, just trying to help. Private message is a good place to debate, if helping others is the goal, rather than being right. Hope I'm not coming off rude, thank you all for your responses and time.
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Avatar universal
I don't have time for a long reply right now, but I would like to dispel the notion that I am a doctor.  I'm related to several, I read a lot, and will be one one day (!), but not yet.  I have not been inpatient on psych, from either end of the spectrum.  They make IM injections of certain antipsychotics that can be used acutely.  I've gotten info about titrations on antipsychotics from the crazymeds wikis, and the guy there really does his research.  

I would say avoid addicting drugs IF POSSIBLE for recovering addicts, not completely avoid.  Everything has its uses (including benzos in alcohol withdrawal, where they can be acutely life saving, oddly enough).  

Gotta go, will post more later.
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Avatar universal
continuing previous conversation

Medications because their conditions warrant it and keep in mind their history and how they present. If I followed what you are saying, I would ask for no ativan to be given with propofol or any potentially addictive medication for pain medication during and after surgery. In the hospital I worked in, a good many of the patients come in with some sort of drug dependency and a whole lot with some form of mental illness.

In a perfect world, it would be great to avoid all the potentially addicted medications for addicts and recovering addicts. It would also be incrediblyloveloy that haldol and zyprexa puts everyone down like a light. Your hospital and experiences must be very perfect indeed.

Maybe in a book world, haldol and zyprexa injections (zyprexa rarely given, haldol more often), it doesn't have the magic rapid onset that you speak of..and more often than not, doctors love to give the tiniest dose, so it usually takes hours before it ever hits.As a result, Haldol and zyprexa are usually given a second dosing or even a third. These patients are usually in "quiet rooms" or in 4 to 5 point restraints for hours, and it doesn't happen often. Not even in ICUs.  How does your hospital manage to get control of most of your patients with a single dose or in your experience? I've titrated on haldol and only once with zypreza in 25 years. I've given Haldol as a drip by the way on quite a few patients when other hospitals didn't do it. I've never seen people gomdown in minutes and I just checked, neither have my friends, colleagues or doctors here, in other countries or in other states.Tell us what we are doing wrong? How would you suggest be administered and when and should it be a one to one or one ton2 or whatever nurse tonpatient ratio?

As for Oliver Sacks I have great respect for his workand I am very aware of Witty Ticcy Ray. I suggest you talk to your psychiatrist or other medical colleagues and find out how many people out there with bipolar idisorder or even schizophrenia have a maintenance dose of haldol. It's not the flavor of the day for decades now. When exactly did Witty Ticcy Ray get his maintenance haldol medications?
  
As far as titration goes in hospitals, it's not given that often...haldol and zyprexa injections. You must be in a high intensity psych ward, because I don't know any psych ward or regular med surg floor with haldol or zyprexa drips for titrating doses, and I've only seen anyone be given a zyprexa injection or a haldol injection as often as you say.

In fact, I,  my colleagues in the psych field nor my pdoc has never seen a haldol drip on the  psych floor. In fact, I've never seen an iv in the psych floor. I don't even know any psych ICU intensive care units. I would be very interested in visiting one.  There is no one in their right mind going to give dosages of haldol in 5, 10, 15 minute intervals without some kind of cardiac monitoring being given...often.  i don't  know if you've ever seen a regular floor, psych floor, or clinic perform BLS, let alone  know proficiently how to use a crash cart or even know where to put on the cardiac leads. There really isn't much occurences of ARD, ACS, PE, OD, or whatever out there. Theynusually call us to come and "help out," but it often happens thatbwe domall the work out in the regular floors.

.I'm sorry. I forgot that you've been admitted and know hospitals and psychiatry and drugs so well and as you enlightened me on your last post, I  willmstay in my place as a  "lower level" staff as you so quaintly put it on a previous post, doctor.







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5887485 tn?1376142924
I'm only on an SSRI... and a very low dose (7.5 mg of cipralex).
I track my mood daily, in a journal and numerically in an excel file to see my mood changes over time. I also track my sleep, irritability and any social/ character changes. I'm BDII, and I used to spend most of my time in depression... so now its usually euthymia or very mild hypomania (although I can feel it creeping up on me ... damn). I wouldn't suggest taking just an antidepressant though, as it's easy to end up kicking yourself into hypomania/mania. But perhaps adding a lot of mood ( sleep...etc) tracking to your regimen will help keep things controlled! =) Good luck!
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Avatar universal
Thank you for replying.

While I understand your concern for a potential of addiction, when medications are used and monitored by a health care provider or a health care professional, which I'm sure you inow since you must  be one, we don't even think about the effects of a potentially addicting medication when medical condotion warrants it. I'm sure in your practice, you gave morphine to a drug addict experiencing an onset of acute MI. I'm also sure that if a patient came in with major alcohol withdrawal, you wouldn't withhold giving an ativan drip for an alcoholic, because benzodiazepines are so potentially addictive.

Geez, I've put addicts and recovering addicts patients on potentially addictive
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Avatar universal
Just a quick reply for now:

I say he should stay away from benzos because of the addiction potential.  If you have a tendency to get addicted to things, best to avoid things that have a high potential for addiction if possible.  That's all.

It is possible to start someone on an effective dose of many antipsychotics if necessary, which is why they're so often used for inpatient (an injection of haldol will put someone down fast, as will zyprexa).  While it's always preferable to titrate, you can certainly start them quickly, and at least some people can tolerate coming back off them quickly (for a case study, see Oliver Sacks' account of Witty Ticcy Ray, who took haldol during the week for his tourettes and took breaks on weekends).  And some people do get zyprexa as a prn for when they start cycling.  The folks over at crazymeds have a pretty good handle on it, and can explain the pharmacodynamics if you care to take a look.
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Avatar universal
Why would he have to stay away from benzodiazepines? Why do you feel that  "youthink some people get away with having antipsychotics (which work quickly, with no titration if necessary) for when they feel an episode coming on, but most people take a maintenance drug. " and how donyou know titration is not necessary. Are you saying that antipsychotics are for psychotic episodes. It's a pretty vague statement. Are you referring to all antipsychotics.

I ask about  the "benzos"  because I take them. if it's because of the methadone, weaver71 is 14 months abstained from metadone. I respect his preference not to take  them.

I understand about AD's, but I'm confused about the antipsychotics, including not titrating them for episodes or otherwise. You don't titrate at all, even if the first dose doesn't work? Is that standard?
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Avatar universal
Yeah, I guess I'm getting impatient. I want to wait 2 yrs before adding new meds, but at 14 months clean, I'm getting convinced the base me was off to beggin with. I don't know if I can go another year and not do something crazy. I am trying the amino acid therapy while I look for a doctor. I can't sit and wait, I have to feel like I'm doing SOMETHING to grow, all the time. I don't crave opiates at all, which apparently is odd at early recovery. I think it's because I am puting 110% of myself into being as good a person as I can. Knowing that is all that is holding me together at times.

I have my ups and downs that are normal life events, then there are those times that I lose myself. Do you think cycles could happen on a seasonal basis? I seem to have worse episodes around solstice, equinox too, but usually not as intense. My wife keeps a journal that spans our 13 years together. She pointed out a general pattern that seems to have developed. Is that normal?
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Avatar universal
Thanks, you sound like a voice of reason. I haven't gotten to severe manic states, since coming of methadone. I just stabilized a few days ago from one of the worst cycles yet. I called Behavioral Health today, and am trying Pharmacuetical grade Tryptophan and Tyrosine, so I can gauge my dose. I think I'm still holding onto the idea that I just need to fix what is broken. I have hoped that I am not truly bipolar. If I heal, then I wasn't born this way. I am surrendering to the idea slowly. It's just like addiction, once you accept it, then the healing begins.

I will never take benzos or AD's. I'd rather wake up in another country, to be honest. I do think I should have a maintainance drug, rather than an Emergeny pill. I don't think you could make me take it, if I got to far gone too fast. My wife is on board, I have had some cog therapy, and we see patterns. I am journaling daily to observe myself, the act of writing helps me stand back and see my thoughts better. I have my kids watching me too, they like the manic me, at first. They are 9 and 11, I think they tune into my feelings way more than I do, so I'm trying it natural, but I'm looking for a psychiatrist or someone to broaden my choices.

Thank you so much for your input. It means a lot to me, everything means a lot to me right now, that's why I have to get stable, one way or another. After methadone detox, I learned a whole new kind of patience in misery. I know it will take time, but it will be worth it. Thanks again.
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Avatar universal
"If you decide to use supplements, IF they work, then they will have been doing something (good) to your brain chemistry, so you won't have a true baseline to go off of.  If it works, it's doing something to you, and if it works, it's going to create side effects (although you might get lucky).  Personally, I avoid the herbal things because the regulation on them in the US is terrible, and also because plants can vary the amount of active ingredient they produce based on growing conditions, making it hard to standardize a dose."

This and a lot of the natural supplements currently have no standard %DV established.  Not to mention, acetaminophen, aspirin, and other things can be snuck in if you don't read the labeling carefully, which can affect things if you don't realize and take one of them alone.

I, too, believe you need to get into therapy and get onto medications.  It's better to control your symptoms so you don't wake up in that foreign country or in deep debt or anything of the sort than to have this "alleged" baseline.  You are off methadone and other things, so you're finding your symptoms are already to come out.  It's better to start meds while the symptoms are still manageable.  You've made it clear to yourself that it's really hard to manage without meds at this point if you're scared you might wake up in another country and are experiencing more intense symptoms already.

You at least need to be on them until you've established a strong support system, learned your triggers, learned your symptoms, and other things.  Then, and only then, can you even consider no medications.  Even then, you have to keep in mind if you have a "med cocktail" that works without too many side effects, the meds may not work the second time around and you'll possibly have to start over finding that right mix of medications to keep your symptoms at bay.
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Avatar universal
If you decide to use supplements, IF they work, then they will have been doing something (good) to your brain chemistry, so you won't have a true baseline to go off of.  If it works, it's doing something to you, and if it works, it's going to create side effects (although you might get lucky).  Personally, I avoid the herbal things because the regulation on them in the US is terrible, and also because plants can vary the amount of active ingredient they produce based on growing conditions, making it hard to standardize a dose.  

Luckily, most of the meds for bipolar are not addictive, although some can be hard to get back off of (not the same thing).  I'd stay the hell away from benzos if I were you, though.  If you want to start Lamictal, it takes several months to get to a proper level, so keep that in mind.  I love it, but it takes a while.  You should not be taking any SSRIs without a mood stabilizer on board.  Lamictal is probably the best for BP II (works better with depression), but it is approved for BP I.  It's not much help if you start in the middle of a really severe episode, though, and it can make some people hypomanic on the lower doses.

If it's at the level of maybe waking up in another country, then you do need meds.  Therapy is also a good idea.  CBT can work with controlling episodes and learning how to tell when one is coming, and help you work out plans for what to do (like someone taking control of your credit cards if you start getting manic).  But these are more stop gap measures in my opinion, especially for mania.  I think some people get away with having antipsychotics (which work quickly, with no titration if necessary) for when they feel an episode coming on, but most people take a maintenance drug.

I think you should go see a psychiatrist and have a good discussion about your options, and let them give you their advice.  You don't have to take it, but they generally know what they're doing.  And get into therapy.  Consider bringing your wife with you to a couple of sessions to help work out plans for episodes so she's on board.
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