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how to stop or slow down a manic attack in progress, in bi-polar disorder so it doesn't get out of hand as in a hospital stay

Posted by mithrasb

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I myself am trying to keep the mania monster from rearing it’s evil head, so please forgive me if I ramble in this answer or otherwise sound disorganized ;)

There isn't one solution that will fit best for everyone in this situation, as bipolar disorder presents in everyone differently and is influenced by both genetic predisposition and environment. Granted compared to depression bipolar has a significantly larger generic component, there is still an element of environment in the equation of controlling symptoms. I suggest a two step counterattack to the mania:

1. ENVORONMENT: The most immediate thing you can control is your environment. Many bipolar patients are adversely affected by stress (see: kindling effect, stress-diathesis model). Take steps to reduce as much immediate stress in your life as possible. Hopefully you have supportive persons in your life who you can turn to in this case and let them know where you are mentally and that you need help in reducing your stressors temporarily.

I am fortunate enough to have family and friends who are understanding and able to work with me when things begin to get out of control. I temporarily postpone any social obligations I may have in the upcoming week, as for me, the pressure of having to be somewhere and some specified time for a particular reason can additionally set me off and cause me to fly off the handle. If there are things weighing on my mind that I have to do, I write them all down on paper to get them out of my head to help reduce the pressure and stress. Sometimes I will spend an entire day not doing anything because for me, if I don't *do* anything, then I can keep a lid on things, and as soon as I start to do something and my mind gets engaged and running then I cannot control it any longer. If I block out all stimulations and keep everything minimal I can manage okay. This means sometimes that I will be functioning at the speed of a snail or wearing sweats al day (because trying to get dressed is too much stimulation and will send me over the edge and I will lose control), but I must do this to prevent things from going too fast.

I also suggested, if you are able to sit still long enough, to try to write a journal and jot down everything you are thinking and feeling and seeing in your mind. Journaling is a very therapeutic activity whether you are depressed or manic. It serves as an outlet for all of the rapid wackadoodle thoughts in your head. If you can get some of what is in your head out on paper, it can help relieve some of the pressure inside of your mind. Again, I know it is very difficult for a manic person to sit and type/write, but try to force you to do it, just a little bit at a time. I write in my blog, I come to the bipolar support communities where I answer questions other members have (as I am doing now while I am trying to control manic symptoms myself a this moment), and I try to connect with other people who are sharing this experience and going through these things as well. Group therapy, being able to connect with other people who intuitively understand what you are going through and relate and help you not feel so alone, is something I have found to be EXTREMELY helpful. If you ever need addition support, please do not hesitate to send me an email.

There are also many meditation type of breathing exercises that can help temporarily slow the mania down. It has taken a lot of practice for me, but I can now, for maybe a few minutes at a time, slow my brain down whiles I am focusing all of my energy and attention to one central place while breathing deep and mentally forcing everything in my head to slow down. Granted as soon as I stop this and open my eyes my mind goes haywire again, but I consider the ability to stop the madness for just a little bit of time a success.

2. MEDICACTION: I should have listed this first, as I think the very first thing you should do when you believe the mania is becoming out of control is to phone your psych doc. If you can't reach them, try your family doc. Let the pdoc know what is going on and that you need an immediate medication adjustment. For prevention of acute mania, I have found that reducing the amount of antidepressant I am on along with increasing the mood stabilizer (Lamictal and Lithium) can have positive effects. When increasing these medications, I experience a combination of lethargy, confusion, upset stomach, and other common side effects of these drugs. It is a lifesaver for me to have people in my life that I can share this with and they understand of the effects of these drugs as I make the adjustments. Their support means so much to me.

Since these adjustments usually take at least a couple days for the effects to be noticeable, I also have a supply or PRN Ativan. The Ativan begins to work in less than 30 minutes and I consider it a lifesaver. The danger with the benzos (and why many docs do not prescribe them) is that they can be addictive for some people. I am lucky, and do not have the addictive trait, so I am not in danger of forming a habit with the benzos and can use the to prevent acute mania onset.

Do not let your pdoc put your concerns on the back burner. My old pdoc did that with me during my last two manic episodes. I saw the signs that things were getting out of control and she did nothing but make an appointment for me in two weeks. Both times I ended up in the hospital. After the second time, I essentially *fired* her as my pdoc and have found another doc who is more active and concerned about my care.

NOTICE: The information provided on this site is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your physician or other qualified health provider because of something you have read on Wellsphere. If you have a medical emergency, call your doctor or 911 immediately.
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