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Sleep. Sleep sleep sleep sleep sleep is the key. I cannot stress that enough. Sleep and schedule. Wake up at the same time every day, no. matter. what. Don't stay out late just cause it's the weekend, don't go out partying just cause your friends are. Don't pull an all-nighter just to get an A on a test or meet a deadline. Once your sleep gets out of whack, a manic bout is not far behind, and that's 6+ months of your life turned into chaos. If you find yourself staying up all night, unable to sleep, that should be a huge warning sign.

I speak from experience. Lots of it.

Amen, and well said. I'm a psychiatrist and I worry the most about sleep, full stop. In a disease (or set of diseases, or whatever) that can make people feel so out of control, sleep is one of the best ways to take back control.

yes! i agree. i have lots of sleep issues. now i go to sleep early in the evening (nearly right after the sun goes down) and i wake up between 3 and 5am.

my biggest problem right now is work: i have had issues holding a job throughout my life. there was a 6 year stint that i was able to keep 2 jobs, but beyond that i usually quit due to what amounts to nothing in the end. have been trying to get a fully remote position as seclusion seems to help.

Radiolab had a very compelling depiction of the manic phase of bipolar disorder:

https://www.podtrac.com/pts/redirect.mp3/audio.wnyc.org/radi... (starting at 3 minutes 30 seconds)

The defining factor between Bipolar I and Bipolar II is that you have been essentially never been hospitalized(and never had a completely documented manic episode). Ignoring psychosis the defining characteristic of a mental illness is often abnormal behavior which is slightly subjective. It is essentially the scale of the issue(mania typically) when it becomes a mental illness.

I'm not sure what you're saying. i was hospitalized last year during the election while thinking that the gov. was after me, reporting a coworker as a terrorist (def not a terrorist) etc. i could go on.

actually i will go on:

reported the nicest guy to HR (he's fine) was on the verge of suicide, then thought "people" were after me and just completely flipped shit. family member kindly allowed me to stay at their home and then took me to the hospital the following day where i checked myself in.

Psychosis is not required to have a diagnosis of bipolar and frankly I do not personally believe that it should be included in bipolar(it should be a separate diagnosis). IMO and many other psychologists opinions is that bipolar by the general public is often viewed as a mood disorder(not the psychosis part).

regardless, i had some sort of psychotic attack which lasted for several days along with a list of other symptoms which are fully documented, observed and on record. i have hardly been able to hold a job since that event and am stumbling through life.

The genetics would argue otherwise. Here's an interesting recent illustration: https://www.ncbi.nlm.nih.gov/pubmed/29167880

No. That article proves my point exactly. Bipolar by definition currently may or may not include psychosis(there is no way for the medical provider to distinguish between the 2.) If you did not include psychosis(as the DSM does now), most people with bipolar diagnosis would actually have Schizophrenia because that is the next closest mental illness(which is why there are genetic similarities.) Bundling an angry disorder with hallucinations should not be done and was an afterthought. Actually psychologists agree with me. "psychotic features – is included almost as an afterthought. It is not one of the defining features of a manic episode. Rather, it is something that may be present.[1]"

[1]: http://behaviorismandmentalhealth.com/2009/09/06/bipolar-dis...

Let me suggest you start a food diary as a useful tool. I have been successful in mitigating certain somatopsychic symptoms largely using diet.

I probably should. just started looking through the list again:

many people have bipolar disorder along with another illness such as:

anxiety disorder substance abuse eating disorder delusions runs in family Feel very “up,” “high,” or elated Have a lot of energy Have increased activity levels Feel “jumpy” or “wired” Have trouble sleeping Become more active than usual Talk really fast about a lot of different things Be agitated irritable or “touchy” Feel like their thoughts are going very fast Think they can do a lot of things at once Do risky things like spend a lot of money or have reckless sex Feel very sad, down, empty, or hopeless Have very little energy Have decreased activity levels Have trouble sleeping, they may sleep too little or too much Feel like they can’t enjoy anything Feel worried and empty Have trouble concentrating Forget things a lot Eat too much or too little Feel tired or “slowed down” Think about death or suicide

literally everything... and i've been denying it until like 2 days ago and am heading to the dr on monday after being talked out of killing myself for the 5th time by my wife ¯\_(ツ)_/¯

I'm not going to post a link to it on HN, but I have a discontinued food blog with some information potentially relevant to you.

The tldr: I am often suddenly suicidal. I have essentially a salt wasting condition. There is a salt and lithium connection and I have found it really helpful at times to eat a meat and potatoes meal to mediate the salt-lithium connection when I am under stress and expecting to soon fall off the deep end suddenly.

i am supposed to be taking lithium but have refused medication for a few reasons.

mainly everything i have been prescribed has screwed me up further -- lithium specifically felt absolutely amazing to be on, i felt "content" and started feeling more balanced and creative etc... however i was sleeping until noon and felt a weird fog and felt like i couldn't program well (which is pretty much the only thing i do).

edit: the above fogginess may have been from the seroquel actually i can't remember.

I tried other medications but has other weird effects (i'm not good with drugs).

secondly, the suicidal thoughts weren't fading and I was very focused on the drugs as a means to my end (they were hidden from me by my wife because of this and she would give me my dosage when it was time).

i have to use a number of techniques to keep me grounded and most of the time I'm fine (i meditate, read, listen to specific types of music, exercise, etc) however there are triggers in my life which i have no control over and i lose control (ex wife making my life a nightmare via legal system, lack of funds etc).

to be honest i'm sort of fucked. i'm an aging dev with mental health issues, little to no support from family, can't really do meds because it fucks up my ability to work. sucks

I'm talking about a much gentler approach than taking drugs.

Best.

I feel for you. I understand your concerns about the medications. Some of the treatments I have taken have basically prevented me from functioning normally. It is hard at times, because I haven't been able to find a solution. I think best hope is an improved ability to cope with the symptoms as they become more recognizable

yeah i'm not really sure what the solution with this one is. without insurance or support i'm basically out of options. I was going to live in my car last year but a family member let me stay at their home for 3 months (happened to get a job just as they were on the verge of kicking me out). wife is looking for work but won't make enough to cover rent let alone everything else. we have a couple more months to figure it out so i'm sure something will pan out.

FWIW, I went 30 years without being diagnosed as or medicated for Bipolar 2. Life was hell, physically tortuous even, and socially and financially devastating. Wrecked my life good. I was around 43, when I found out.

I completely understand getting set off. I don't know how many thousands of hours I've lost to excessive anger and irritation. The bitch of it is that there's usually a good reason to be angry, just not _that_ angry.

With the proper meds, life isn't perfect, but I have the kind of peace of which I dreamt for decades...and without being zombified. I can actually hold down a job.

Friends, roommates, and noise generated by other people, still a big no. I live alone up in the hills and wfh. I like it that way.

As for meds, should you try any again,

Forget lithium. The best mood stabilizer I know is Lamotragine. If you are in the US, fill your prescription through canadadrugs.com. It's too expensive in the US.

As for anti-depressants, the Serotonin-based drugs never worked for me, but I take Viibryd now, which isn't Serotonin-based.

As for ensuring that you sleep (I was an insomniac for much of 20 years), Trazadone is an old, cheap, and non-addictive sleeping pill. It has nothing to do with ephedrine or melatonin, and won't mess you up at all.

> around 43

late 30s here.

> there's usually a good reason to be angry, just not _that_ angry

i experience extreme anxiety more than rage

> Friends, roommates, and noise generated by other people

i am similar. thankfully my wife is a very quiet person.

> Viibryd

was on it for over a year -- didn't end well (weaned myself off after running out of insurance)