I got a message from someone via a Tumblr account I had abandoned long ago asking for some advice on what to do during their current manic episode.  Since my last blog post advising someone about mental health issues got such a good response, I thought I’d post this one too.:

I have bipolar disorder and I’m on seroquel 200 mg currently. It was working perfectly, but then I experienced a lot of financial stress, a death in the family, and then started smoking weed and drinking a lot. So ultimately, I triggered a mania episode (which I’m still in).


My question is, is it possible to still be triggered into episodes even if you’re on medication that has been working otherwise? What do you recommend I do?





Sorry I didn’t get to this sooner.  I don’t spend a lot of time on Tumblr, but fortunately I got an email notification about this. I saw a couple people responded to you and said, ‘go see your doctor’.  That’s good advice but it felt a little lazy on their part.  So here is something that is a big more elaborate.  I hope it is helpful.


First off – I hope you are safe.  If you are self-aware enough to recognize you are feeling manic, that is a good sign that you’ve still got your feet planted in the physical reality.  Dipping into the mystical realm is not a bad thing (it’s actually great!), but it can get very dangerous if you slip into it without realizing your in it.


If there is any immediate thing I can advise you on: get some sleep. In my own experiences, sleep seems to be the biggest trigger or indicator of trouble.  Getting less sleep initially makes me tired but after a couple nights of low-sleep, my body starts overcompensating and giving me more energy… which then can make it harder to sleep, which results in less sleep…. and the cycle continues.


From an evolutionary perspective, this makes a lot of sense.  If things get really intense, your body needs that extra energy to address the problem and pumps you up.  This is useful when there is a physical threat – you can’t find food or you’re running from a pack of wolves.  It’s a lot more troublesome when the threat is something not quite tangible like a stressful job or a death of someone close to you.


Now to get more to your question of whether you can get triggered even if you’re on a medication that seems to be working…. it seems like you already know the answer to this question.  You said it yourself, right?  Your current mood has been triggered by financial stress… family death… drugs…. these can all contribute to altering the mood of “normal” people, so it will definitely effective someone like yourself who may have a more emotionally sensitive system.


Can you get triggered even if you are on medication?  Sure.  (By the way, I don’t want this to sound like I am approving or disapproving of medications, just trying to give something as a reference.  I have very complex views on the whole concept of psych.)  Think of this… imagine if your mental conditions were a physical pain.  Maybe you’d get a dosage of Tylenol that you’d take.  And the same dosage would help address the same amount of pain.  Then all of a sudden, you end up in more pain.  Would the same dosage address that pain? It’s very likely that it would not.  I know I’m grossly oversimplifying.


This may come to a surprise since medication is something referred to as the magic solution… the “cure” for a “disorder.” Medication is probably better described as the pharmaceutical community’s best effort to reduce a set of symptoms that people are reporting to be undesirable.


One options for you would be to go to your doctor and they could prescribe you more medication.  That might help.  And when things calm down for you, you could reduce the medication. I’m not going to act like that isn’t an option for you. If that was the only recommendation I was going to give you, I would have just left you one sentence as a reply rather than writing you an essay 🙂


Some other things you can do, and I would really recommend.  Firstly – try to get away from alcohol and marijuana.  You already acknowledge in your message that marijuana and alcohol are playing a role.  You cannot instantly fix your finacial situation or bring a family members back to life, but it is physically possible to stop drinking and smoking.


Alcohol can cause a lot of issues, ESPECIALLY when it is combined with psychiatric drugs.  Marijuana is considered by a lot of people to not be a big deal, especially with all the pro-legalization media coverage out there.  But it is still a mood-altering drug.  I personally used to be a big lover of cannabis. (And alcohol too.) And through time I eventually came to realize that it was having a big influence in my having manic episodes.  I am not claiming it has no medical benefit to those who use it for that reason… and hell, it may even bring benefit to that majority of users.  But it is still a legitimate possibility that the drug can exaggerate certain problems, particularly if you have had a history of mania/psychosis.  I do miss it at times, and I occasionally doubt my decision to quit, but I’ve also had no hospitalizations or wild episodes in the two years since I stopped smoking.  So it could be a good sign. But keep in mind I was also a daily user (and nightly and morningly) – which is probably not advisable for any drug.  Using something in a controlled setting could still have some possible benefit, like taking mushrooms in a national park on a beautiful day… but taking bong hits morning, noon, and night while carrying out all my regular life activities does seem a bit impractical.  And since I just don’t seem to be a person who can just occasionally smoke weed, I eliminated it altogether.


I harped on smoking and drinking enough.  So let me get to some things you can DO as opposed to things you can AVOID.  (Notice how the drug/alcohol isn’t something I’m recommending you do but instead something I recommend avoiding?  It’s interesting…. sometimes I find it easier to quit bad habits than to create good ones.)

#1: DO focus on getting really good, restful sleep.  Some people I talk to who are researchers in the area of bipolar/schizophrenia/schizoaffective are telling me it is seeming more and more likely that these “psychiatric disorders” are really all “sleep disorders.”


To get better sleep, try a few things.  This year I began meditating for 20 minutes after I wake up and 20 minutes before I go to sleep.  This seems to help me get to sleep better and start my day a little more balanced.  I also began reading a chapter or two from a book right before bed. I read first, then do the meditating I am not some kind of meditation expert, I might be doing it wrong, but people tell me there’s no right or wrong way to do it.  Sometimes I sit in a chair or on my bedside, sometimes I sit on the floor, and sometimes I do it lying down. I breath really slowly in through my nose and out through my mouth.  Sometimes it helps to count how long the breaths take. I think it helps me to do that to focus on my breath and also ensure that I am doing it very slowly.  I try not to think of anything in particular, but when I do have thoughts I do my best not to focus on them but instead just to kind of notice them and observe what is consuming my mind.  Usually my mind is racing anyways, it can be tough to turn off altogether. But you’re not necessarily supposed to.  And try to come back to counting my breaths.  It’s never perfect, I promise you that, but it seems to help.  And avoid blue light an hour before bed.  Studies over the last 15 years have showing that receptors in your eye use blue light as a way of telling your body what time it is.  It’s very useful in the morning and really bad at night.  That means no smart phones.  And computer screens.  There are some apps you can get to reduce the blue coming out of your computer and cell phone (Google “f.lux app”), but I highly recommend turning them off altogether.  Even without the blue light, it still increases your brain activity at a time when you want to wind down.


While on topic of sleep – another thing to avoid – caffeine.  I switched to decaf coffee first thing in the morning and no more coffee or caffeine at any time during the day.  There is some tea which is really good – rooibus tea.  It has no caffeine and very good for stimulating alpha brain waves.   When I’ve been manic, I’ll find myself having lots of coffee and Sunkist orange soda… I still occasionally have Sunkist cause it’s so fucking delicious, but I really try to eliminate this.


Some more thing to DO:


DO be around people to avoid being isolated.  Isolation can cause some loneliness and depression but also can get things to ramp up uncontrolled if you are manic.  Try and join clubs or groups even if they only meet occasionally.  (MeetUp.com is a good place for this).  It’s just good to be around people as it helps to reduce ideas and thoughts building up too much in your brain because you get to converse and share with people.  And also distract you a little from your pains.  Being around people will also help you to avoid locking yourself up and trying to create metaphysical transportation devices to bring you to another realm.  Or whatever other kinds of psychosis-induced science experiments you may work up.   I kinda of hate that I just wrote telling you to avoid doing these types of experiments because I definitely think there is a place for them.  I personally haven’t figured out the best way to do them without inevitably getting myself in some kind of trouble.


Do get outside at least for 30 minutes a day.  Preferably much more.  But don’t spend a whole day inside.  Getting outside in the morning is best because there is more blue light in the sky at that time.


Do exercise at least 30 minutes a day.  If you don’t have the energy, go for a walk.  If you’re wicked manic, that’s fine, go for 2 hours. It may be a good idea to do sports that are considered “extreme” – dirt biking, surfing, skiing, skateboarding, rock climbing, sky diving… these kinds of activities may give you that adrenaline feed you’re looking for without actually putting yourself at serious risk.


Do accept that fact that it is normal to get stressed and depressed and manic when someone you know dies.  Don’t think to yourself that you should magically feel good and normal.  It’s normally to feel emotions.


Do get a massage.  Not only is it good for relaxing you if you are manic, but it’s good in general for overall health and wellness.  It’s not just something for athletes, injured people, or the rich.  If you do some Googling, you can hopefully find something affordable.  I’ve lived in a lot of different places and always seem to find something somewhere for under $50/hour.  It’s a good once-a-month thing.


Do consider acupuncture.  I don’t know if I can give a strong claim of it’s effectiveness.  But I started doing it.  If you’re manic, you may have had some psychosis, which means you may have dipped into the mystical realm a bit.  I like to think acupuncture is somehow balancing my physical and mystical selves… who the hell knows what it’s really doing though.  Maybe it’s inflicting small pain in places to send neurotransmitters to those locations to focus your body’s reparation on them.  I wish I had a better answer here.  If you are looking for a deal, look up “community acupuncture.”  You can usually get in for $20-30 instead of a traditional $70-100 from a regular practitioner.  Something to try doing once-a-month.


DO consider Omega-3 supplements.  Maybe even vitamin-D if it’s the winter.  That will help compensate for the lack of sun.  I am absolutely not an advocate of medication and  I often feel like supplements are some kind of medication.  It’d be nice to not require any meds.  I think it is an irrational thought to believe someone requires psychiatric medications to survive in the world.  (I guess I let me opinions creep in.  Meds may be useful in an emergency situation, but as far as planning on taking them everyday for life…. I don’t think I agree with that but to each his own). I think I can give Omega-3′s a pass due to some evolutionary reasons.  Again, it seems irrational to believe we need to take a pill everyday, right?  But… I discovered something about this particular supplement since I’m a vegetarian.  The normal source for Omega-3 people recommend is fish oil.  If you are a veggie, then you’ve got to get an algae-derived version of Omega-3.  Which means you’re basically taking an algae-supplement.  This might make a lot of sense given that we evolved from ocean-based creatures.  Most organisms (bacteria, mammals, fungi, etc) have an outer-membrane and some type of salt-based water on the inside.  It’s basically all life on earth.  Keep in mind that humans have this system too, we are basically just bags of salt water.  We were badass enough that we evolved to carry around the ocean inside of us. So it’s not such a bad thing to take a supplement that is derived from the ocean, it looks like it may be something everyone could benefit from.


Just like I said Omega3 supplements may be something everyone could benefit from… you’ll probably notice that all the things I’ve listed here are things everyone can benefit from.  That’s kind of the point.  When I got convinced I had some kind of brain disorder and didn’t agree with the medication approach, I figured “there must be an alternative treatment.”  I didn’t know what I was expecting.  I probably wanted a magic bullet of my own, just like the doctors were claiming to have.  But the reality is, all the “alternative treatments” are just doing shit that basically everyone can benefit from.  Eating better, exercising, sleeping better, getting outdoors, massages, etc… these are all just recommendations for better quality living overall.


And that’s kind of the point – you’ve got to live better overall.  It may be the case that you/we have a brain disorder that makes us incapable of living in society…. that seems pretty fucked up.  And we can’t just change society.  But we can go after things which society may not have presented to us as “normal” behavior and acknowledge it’s value.  Society doesn’t really recommend massage, doesn’t advocate against caffeine/alcohol/marijuana, doesn’t emphasize sleep enough, doesn’t promote meditation… but you can do all these things without society’s permission.


Ahh… society.  Maybe they were wrong about some other things too… like the idea that you have a “disorder” to begin with.  I noticed in your Tumblr feed that you are a graduate student.  You suggested that is playing a role in you feeling the way you do.  Maybe you don’t have a problem but the system you are in does?  I’ve been studying the education system a lot lately and it appears to be just as toxic as any drug I’ve done or read about.  Maybe you feel you “have” to continue your schooling and quitting makes you a “quitter.”  That’s possible… but maybe you’re also complying with a pre-defined path which is destined to make you (and many people) ill.  Maybe you need to reconsider the roles that your education and profession are playing in your life.  Again… society has certain structures and expectations laid out for you but you are actually allowed to choose your own path if you want.  I’m kind of beating around the bush to getting to the point that maybe school makes people (and you) sick.  And maybe the “traditional” career paths people envy making them (and you) sick.  Maybe the answer is to actually quit.  It’s got such a negative feeling attached to it… but maybe people are wrong.  Having a job or school that requires you to lose sleep?  For what?  For who?  If you begin making compromises now for the sake of fullfilling other people’s expectations, then when you that stop?  It’s good practice to begin immediately doing things that fullfill you and not necessarily outsider’s expectations.  You have much more control of our life than you realize if you begin rejecting some of society’s expectations. It may also be helpful to open your mind to the idea that the medical interpretation of mania is wrong to begin with. (I would recommend consider lots of the other things suggested in this article before doing something as “permanent” as quitting school… but keep an open mind to the possibility it may be a good decision and also set a precedent for future good decisions)


What else can you do in a mania instance? If you’ve got a taste of the mystical/psychosis stuff, look for “Hearing Voices” groups in your area and check out the NewLightBeings.com community.  Look for some peer support in your area.  I prefer the Hearing Voices groups since some of them seem to get the psychosis/mystical stuff, but there may be other support groups to meet with.  You may be fortunate enough to live in an area where there is respite housing.  Find one close to you here. An example of this is Afiya, which is only in Western Massachusetts.  If you’re in crisis, they’ll let you come stay at their facility for free for up to a week.  Unfortunately there is usually a waiting list, so it’s hard to get in in an immediate emergency.  But there may be something closer to you.  And Afiya isn’t a psychiatric hospital, there are no doctors and they don’t lock you in.  It’s just a place you get to stay and sleep and they have staff to talk with you and help you prepare food.  I think the food is provided.


I’m trying to think of more about what to do in a crisis.  If you can find someone willing to sit down and talk with you for hours in a real conversation that is non-judgmental and very open, that could be really helpful.  I’ve found that has calmed me down tremendously in a few rough situations.  It’s really hard to find the right people to talk to in that mode though.


I think that’s enough ranting from me.  Be safe but never careful.


P.S. – I’d be doing you an injustice if I didn’t share this with you. AFTER you’ve made it through this episode, take some time and watch through Sean Blackwell’s work re-analyzing the bipolar diagnosis. If you are currently feeling manic, it may trigger you into something more manic which probably isn’t the best in that moment. But when you’re calmer and looking to reflect back on the experience, it’ll be really useful to you. I don’t necessarily agree with 100% of his position, but it’s still really solid stuff and I accept about 90% of it…. which is much higher than my acceptance of the medical community’s perspective.