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Expert Q&A

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How can I manage bipolar disorder if I can't afford meds?

Asked by Cassandra, New Mexico

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I have phase II bipolar and cannot afford the necessary drugs. I'm dealing with this alone, which as you may know is tough. Are there any tips you can give in management of my disorder?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Cassandra,

You are in a rough spot, and I can only hope that changes in our health care will make problems like yours a thing of the past within a couple of years. In the meantime, we need to deal with actualities, so let's talk about how to improve your situation.

First, for readers who might not be familiar with bipolar II disorder, it is a very painful condition characterized by repeated depressions and episodes called hypomanias, which are characterized by increased energy and either an emotional high or irritability, or both. Although patients often enjoy the brief hypomanias, they come at a terrible price, because they very powerfully trigger new depressive episodes.

Bipolar disorder and "regular old depression" share many things in common, including the fact that they are strongly affected by environmental conditions. However, whereas regular depression is mostly caused by stress or physical illness, patients with bipolar disorder are also extremely sensitive to the physical stresses that come from the flow of time itself. It is ironic that an illness characterized by constant change -- moods up, moods down, moods up, moods down -- is itself so sensitive to all types of change. So in bipolar patients, the change from day to night and night to day, the swing of the seasons, a simple airline flight to a new time zone can all set off episodes of either depression or mania.

I am telling you all this to make a simple and important point: Bipolar disorder is more "biological" than regular depression -- you can see it in the fact that it is so affected by biological stressors such as those I've described. For this reason, it is especially important to get medical treatment for the condition. Without appropriate medications, most people find it very difficult to make appreciable headway against the illness.

So my first piece of advice is to try harder to get help obtaining the medications you need. I don't know where you live, but many counties have mental health services that will provide treatment free of cost, or nearly so. Counties that don't have such services often have contracts with neighboring counties that do. You pay your taxes, so you should make the government work for you on this issue.

Now let me make a series of recommendations for things you can do on your own that are known to help the condition. Many of them are not easy, but as you yourself said, you are struggling with a tough disorder. First, if you are drinking too much alcohol (more than one drink per day) or using drugs, you need to quit. Almost half of everyone with bipolar disorder struggles with drugs or alcohol, so if this is a problem for you, you are not alone. People often do much better if they can just get ahold of their substance abuse.

Second, as you might imagine from what I wrote about biological stressors, it is very important that you maintain a very stable sleep-wake schedule -- there's an entire school of bipolar therapy based on this. Even minor changes in sleep can induce mood episodes. I treated a patient once who went from completely psychotic to working as a university professor because she took her meds and was willing to live a very clean life in terms of her daily rhythms. (You can read about her in the final chapter of a book titled "Detour: My Bipolar Road Trip in 4-D" by Lizzie Simon.)

Third, try to get to an internist or family doctor (if you can't get to a psychiatrist) and have your thyroid checked. Many people with bipolar disorder have too little thyroid hormone, which can make their mood episodes come on more rapidly and more often. If your thyroid is a little low, it's an easy thing to take a daily supplement.

Finally -- and God knows this is easier said than done -- try to reduce the stress in your life. Stress makes everything worse.

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