I had my robotic laparoscopic partial hysterectomy May 9, they took everything except ovaries. Im 44 and learned of my fibroid diagnosis bc of heavy break through bleeding on bcp earlier this year. Apparently I was anemic and didn’t know it, I thought my headaches and fatigue and eating garlic pretzels by the bag was stress from middle schooler lol my doc put me on iron 100 tablet bc hemoglobin one point away from iron transfusion. I also supplemented with liquid iron. She even suggested myfreebee but I declined taking that! So when my iron numbers were up she said let’s do the surgery and I did may 9! I will add that I was highly active exercise wise prior to surgery and after bowel prep down to 124 lbs 5’4 so the gas filled my entire cavity. My only bothersome symptom was shortness of breath walking and to relieve it I had to burp a thousand times bc my belly was blown full of gas. This caused anxiety and my short breathing continued but was not bothersome when sleeping. My resting heart rate actually was low so doc ruled out embolism. So I restarted iron tablet, took gas tablets, drank ginger ale to burp and took half a klonopin for anxiety and the breathing resumed normal. I plan to return to work day 8! This has been a bizarre experience but I feel it will change my life for the best. I’ve bought a white bikini and plan on wearing it this summer!

F, 20yo, 5’4, 110 lbs, on microgestin and supplements with occasional klonopin
Dx: GERD/ulcers, EOE, PPPD, PCOS, dysautonomia, POTS (almost dx), MCAS, GAD/panic disorder
The past 1.5 weeks I have been unable to get restful sleep. the nature of the insomnia keeps changing. in the beginning i couldn’t get myself to fall asleep - every single time i got on the brink of falling asleep i would feel super weird and jolt awake in an altered state that left me shaking, nauseous, confused, etc. this went on all night for 4 nights straight. the next few nights, i could fall asleep relatively easily but i would wake up insanely early around 6am (i don’t get up till 8:30-9:30) but the catch is, i am still extremely tired and try to go back to sleep but despite how exhausted i am, i cant. i get into this SUPER weird state where i am conscious but i am sleeping/dreaming at the same exact time.
i am aware of sounds and things around me but can vividly see dreams and this goes on for hours. i go in and out of this state for hours and finally end up jolting awake in panic, with a wicked headache and feeling like nothings real and im super groggy. because of this, i haven’t gotten more than 4 consecutive hours of sleep in 1.5-2 weeks and i am feeling the repercussions.
i woke up this morning at 5:43 still extremely exhausted (i couldn’t even keep my eyes open) but every time i got back to being asleep i shot up and would be in a terror state. i feel like im on drugs or drunk and i haven’t even taken anything. i’ve tried klonopin from my doctor, benadryl, hydroxyzine, getting a nightime routine down, breathing exercises, etc. but nothing is working and its just getting worse.
my doctor referred me to a sleep clinic but they can’t see for another 3.5 months and i will literally be dead from sleep deprivation by then. what do i do? what is this called? why do i keep jolting up with panic and derealization every time? is that what’s causing me to feel so out of it? i can’t take naps because i wake up with AWFUL sleep inertia and it triggers my anxiety badly.
TLDR: haven’t slept normally in weeks i keep jolting awake in panic and severe confusion. nothing is helping and i am severely sleep deprived so much that i feel psychotic.

Age: 29
Sex: Male
Height: 5’8
Weight: 160
Race: Asian
Duration of complaint: 1 day
Location: United States
Non smoker, non drinker of Alcohol
Any existing relevant medical issues: asthma, positive ANA potential autoimmune issues such as Behcets, anxiety
Current medications: albuterol, QVAR, klonopin as needed
Took some klonopin last night because of my anxiety (1.25 mg) and then this morning I took 1 Tylenol extra strength for a migraine. I went to check the drug interaction checker and it says the following “acetaminophen iv decreases levels of clonazepam oral by speeding up drug metabolism. May cause liver problems.”
I have some slight discomfort in my right rib cage now, could this be indicative of a liver issue? I have also recently been working out in the gym and doing new exercises but I think I’m a little concerned about the klonopin and Tylenol affecting my liver. Thanks for your help

Age: 29
Sex: Male
Height: 5’8
Weight: 160
Race: Asian
Duration of complaint: 1 day
Location: United States
Non smoker, non drinker of Alcohol
Any existing relevant medical issues: asthma, positive ANA potential autoimmune issues such as Behcets, anxiety
Current medications: albuterol, QVAR, klonopin as needed
Took some klonopin last night because of my anxiety (1.25 mg) and then this morning I took 1 Tylenol extra strength for a migraine. I went to check the drug interaction checker and it says the following “acetaminophen iv decreases levels of clonazepam oral by speeding up drug metabolism. May cause liver problems.”
I have some slight discomfort in my right rib cage now, could this be indicative of a liver issue? I have also recently been working out in the gym and doing new exercises but I think I’m a little concerned about the klonopin and Tylenol affecting my liver. Kind of worried I have inadvertently caused severe liver damage? Thanks for your help

Age: 29
Sex: Male
Height: 5’8
Weight: 160
Race: Asian
Duration of complaint: 1 day
Location: United States
Non smoker, non drinker of Alcohol
Any existing relevant medical issues: asthma, positive ANA potential autoimmune issues such as Behcets, anxiety
Current medications: albuterol, QVAR, klonopin as needed
Took some klonopin last night because of my anxiety (1.25 mg) and then this morning I took 1 Tylenol extra strength for a migraine. I went to check the drug interaction checker and it says the following “acetaminophen iv decreases levels of clonazepam oral by speeding up drug metabolism. May cause liver problems.”
I have some slight discomfort in my right rib cage now, could this be indicative of a liver issue? I have also recently been working out in the gym and doing new exercises but I think I’m a little concerned about the klonopin and Tylenol affecting my liver. Kind of worried I have inadvertently caused severe liver damage? Thanks for your help

I've had chronic insomnia for many years now, most of my life. Some things have worked temporarily in the past, but this past year has been hell and nothing is working. I've done sleep studies, practiced good sleep hygiene, sleep meditations, exercise, bath before bed, everything else that is usually recommended. I have pretty severe PTSD, and the past few years have been the most traumatic and I'm sure that's a big part of it. I recently did SGB and it the benefits only seemed to last about a week. I've tried EMDR also. Been in therapy 25+ years. It usually takes at least 5 hours for me to fall asleep, sometimes longer, and even after I've finally fallen asleep I usually wake up at least once an hour and then it takes a while to fall back asleep again. Here's some of the meds I've tried (with all of these I've tried up to the highest dose possible, even sometimes tried doubling and have also tried various combinations of many of these):
Seroquel: used to work years ago but now doesn't seem to have any effect
Benadryl (even up to 200mg): no effect
Unisom: no effect
Ambien: no effect
Lunesta: no effect
Melatonin: no effect
Ativan: no effect
Clonazepam: no effect
Vistaril: no effect
Doxepin, no effect
DSIP: no effect
Phenibut: no effect
Trazadone: no effect
Gabapentin: no effect
Promethazine: no effect
Belsomra: no effect
Remeron: no effect
Risperdal: no effect
Geodon: no effect
Sonata: no effect
Restoril: no effect
Clonidine: no effect
Propranolol: no effect
Selank: no effect
CBD and CBN: no effect
Many herbal supplements (ashwaghanda, magnesium, passionflower, 5-htp, etc.): no effect
There's probably more I just can't think of at the moment, but basically it seems like medications just don't work for me for some reason. The only combinations that have had minimal effect (I fall asleep within 2 hours instead of 5) are not sustainable because of tolerance build up or risk of addiction or things like that. Many of these aren't supposed to be taken together but when I'm super desperate for sleep I'll try anything. For example, when I take these all together it only takes about 2 hours to fall asleep instead of 5 or more: 300mg seroquel, 200mg trazadone, 12.5mg Ambien, 1mg klonopin, 250mg phenibut, 10mg melatonin and 20mg propranolol. When I take that combination I barely feel anything and it does take a while to fall asleep still, but I'll take anything I can get. I've been trying to function on an average of 2-3 hours of sleep a night, some nights I end up getting zero sleep, and I'm just not functional in the world.
I've literally gone to the emergency room a handful of times in tears begging for something that actually helps, but they usually just tell me to take melatonin or something and send me away.
oh also, cannabis, along with a few of the meds mentioned above is usually helpful, but I end up having horrible hangovers with cannabis and am barely functional the next day... although I'm barely functional as it is bc of my sleep issues.
Does anyone else suffer from insomnia to this high of a degree? Have you found anything sustainable that works for insomnia this severe?

51yo male, 218lbs, 6'3". No alcohol no smoking. Moderate exercise 5x week. BP 127/77 but heart rate at approx 100bpm for approx 2 weeks. Dizzy, fatigued, short of breath. Heart palpitations at night and morning. Was taking tramadol long-term for pain, 12.5mg. Also .25mg klonopin as needed for anxiety, not taken concurrent w tramadol. Stopped both. Very tired, faint of breath, dizzy and headaches. Conditioned not worsened by exercise. Very new blood panel very normal, only AST a bit high at 39 and glucose at 114. Everything else good. Have appt w GP tomorrow to pursue.

Hi everyone,
I am three days away from being six months sober after a TERRIBLE last year, and the anxiety I’m feeling on a daily basis is so severe I can barely stand it.
Anxiety was always the major reason I drank… I seriously haven’t drank for fun in years and years. When my mental health gets bad I drink to self medicate and calm down… it got really out of control when I started working from home and would feel like I needed a few dinks in the morning just to calm down and be able to function enough to work.
I’ve been like this my entire life. The first time I got drunk was at 18, and after 18 years of physically painful anxiety as a near constant, those first couple shots felt like this unbelievable peace and calm that I truly had never experienced up until I got drunk for the first time.
I’m trying so hard. I have a job interview in half an hour and I am absolutely sick with anxiety right now. I get five Klonopins each month for panic attacks, and I always take a couple right when I’m able to refill the prescription just to get a small break from the inside of my own mind. I feel like all month my anxiety ramps higher and higher until I can refill them, and today it’s literally at an unbearable level and I have two more days before I can fill my meds.
I know Klonopin isn’t a good answer, but if I didn’t have that light at the end of the tunnel each month I think I would have already snapped and drank by now.
How do you all deal with crushing levels of anxiety?? Mine never goes away. I’ve tried all kinds of breathing exercises, meditations, reading, etc. And it Just. Never. Stops.
I really want to drink right now. ☹️
EDIT: I need to update my flair.

Hello. Tomorrow I have a new app with another doctor. The current regimen which my doctor did not want to change or did not know how to change is :200 seroquel. 600 gabapentin. 0.5 klonopin and 50 lamotrigine. Despite these I started to have panic attacks daily a month ago. Caused by some intrusive images. Its Something like ocd but some resamble psychotic features like some hallucinations I am not sure but mostly they are vivid images and these almost feel real but I know of course they are not so its mostly ocd. Anyway despite these meds I have panic attacks daily. And a state of anxiety almost from the morning . I have no explanation. Usually even with 50 seroquel I had no anxiety I was peaceful all day. Now I take 200 seroquel and it does not even touch anxiety anymore. I need advice what could I Tell the new doctor how can he help me. What helped you, with anxiety. I am trying grounding breathing exercises its not working the tension îs a lot to deal with and even at night I feel worse cannot go to sleep. I cannot tolerate Ssri. They lead me to more agitation. I tried also propranolol which I did take long ago also for anxiety its not working anymore. I do not have other health issues all blood work is fine. Please I really want to lower this anxiety any hints?

Had a massive panic attack 15 years ago. The next morning I started experiencing derealization. It was awful, and wouldn’t stop. it was if a switch was turned on and there was no way to turn it off. It affected my life so much so that I had to take away from work. Finally I had to see a doctor who referred me to a psychiatrist. I had every type of test done - blood work, a brain MRI, heart monitor, etc- and all came back normal. I was diagnosed with an anxiety disorder, and prescribed Prozac, a ssri, and Klonopin, a benzodiazepine. Within an hour of taking the klonopin, the derealization was gone, and I finally had relief. I kept the ssri/benzo medication for 9 months and slowly tapered off both. During the 9 months, I ate exceptionally well, made sure I got 8 hours of sleep every night, and exercised everyday. I even listened to meditative music as I fell asleep. After the 9 month period, I was 100% back to normal without the need for medication. I kept up my exercise and wellness routine and had been great…. Until I smoked weed several years later, which kicked me right back into DR. Another appointment with the psychiatrist and I was back on the benzo and ssri. Went through another 9 months of that and came out fine again.
I don’t smoke, drink caffeine, or do anything that would put me at risk of getting DR again. My brain has been sensitized to the point that any type of stimulant triggers DR for me. It sucks to not enjoy those vices, but my life is better for it.
I think DR is one type of manifestation of anxiety; a physical expression of an overstimulated brain. Calm the brain down, and it went away (at least for me).
DR is truly awful, but at least in my experience I find a way out, and am convinced other people can too.

I have a six hour flight on Monday, and my anxiety is specifically to having some sort of medical event or emergency on a plane and being “stuck.” Takeoff and landing doesn’t bother me, and turbulence is not fun but doesn’t trigger me.
However, I have panic disorder, GAD, OCD, etc etc which means I am in fight or flight in any “stressful” situation aka flying.
Since my heart rate is already elevated, when I get up to go to the bathroom the normal heart rate increase that happens with going from sitting to standing and moving around and navigating the tiny restroom feels like exercise. By the time I get back to my seat my heart is pounding as if I’d just run up a flight of stairs.
I also get heart palpitations when nervous/panicky (had a full cardio work up, all normal) and they go into overdrive on flights which is VERY freaky.
Basically I am dreading this flight next week because I HATE the feelings that come along with those two things and nothing ever seems to work (I have a script for klonopin but it makes me super drowsy). Want to know if anyone else has this specific issue and how you deal with it. TY!

37 (F) So long story short I have an intrinsic sleep disorder, spontaneous cortical arousal. I have tried Klonopin and currently, I am taking Ativan because it is shorter acting. I just repeating my sleep study with MSLT because I have daytime sleepiness. I can nap every day for several hours and I still sleep a good 10 hours every night. PSG showed I still have the intrinsic sleep disorder. My median sleep latency was above 8 min (right at 10 minutes) so I don't meet the definition for idiopathic hypersomnia. I also had actigraphy done and all show I am sleeping adequate amounts with high 91-94% efficiency but I am so tired every day, all day. So what more can I do to help myself get some energy back so I don't feel the need to nap every day? Note: I am not napping daily, maybe on a weekend but I avoid it as much as I can. I have great sleep hygiene, I don't drink caffeine after 12pm... I do all the "right" things except maybe exercise regularly which I want to do but Im exhausted! Please help!

So some back story. I am type 1 diabetic and bi polar and with both of those things i get low energy at times, anxiety at others. And sometimes just the feeling of my sugar dropping, anxiety mixed with caffeine makes me jittery. I use to be able to drink 2 to 3 bangs a day and not get very jittery, but I also use to take 6 to 10 mg of klonopin a day, sometimes with ativan, sometimes with xanax, promethazine, codeine, hydrocodone, dxm. I was a poly drug user for years. Opiates from age 13 to 28 Benzos from 22 to 28.. I started to get clean in the start of the pandemic. Idk if its age, or years of abuse. But im almost always tired, I barely touch caffeine ( only matcha or yerba mate) or else the only effect i get is jitters, stomach pains And my anxiety flares up in certain situations ( like high blood sugar and having to drive a car with my reactions feeling slower) I'm wondering if there is anything safe I can take with my history. I dont like taking kava because it makes my appetite even lower and makes me feel not present. I cant smoke weed anymore, so I use edibles for sleep I sometimes get anxiety relief from lions mane, amanita muscaria , golden teachers I take some adaptogens ( ginseng with ginko, ashwaganda ) I take turmeric, magnesium , creatine , d3, zinc I eat raw honey, I exercise daily.. I dont really know what else I can do to try to feel less anxiety, less pain, more energy.
Sorry if this is hard to read, im unfocused and anxious

. L-tyrosine (2g) . L-theanine (200mg) - arriving soon . Glycine (3-5g) . Magnesium (500mg) . Omega 3 (4-9 grams) . Methyl B complex - arriving soon . Vitamin d (10k IU) . Vitamin c (2-3000mg) . Beef organ multi . Bpc 157 (500mcg) . Nac (600mg twice daily) . Ginkgo biloba (120mg)
Going through benzo withdrawals atm after 2 months on Ativan (1mg for a week then 1.5-2mg for the rest of the month, 1mg and then 0.5 for the second) and just over a month month on Valium and Klonopin (1 week 1-2mg Valium, 2.5 weeks 0.2-0.25mg Klonopin, 1 week 0.150) and am also on 200mg fluvoxamine for ocd (I’ll include dpdr and body dysmorphia under here too)/ptsd, 25mg Seroquel for sleep, and 70mg vyvanse for autism/adhd. I’ve been on the Luvox and Seroquel for the longest and was put on it in the psych ward (as well as the benzos, which I’ve been off completely for about 9 days now).
I also have a lot of addiction problems and have struggled with those since I was like 10-12. Mainly binge eating, porn 2-3 times a day, and video games for 8-12 hours 6 days a week up until I was about 17. Still haven’t completely been able to cut the porn habit, but have cut the others since 17, and the longest I’ve ever gone is 6 months, but I usually fail around the month mark now. I did have a pretty brutal caffeine, social media and exercise addiction from like 17-20 (age I am now) too but I stopped that while I was in the ward from end of January to end of February. So instead I picked up vaping and smoking while I was in there, go figure.
I’m pretty sure I was hypomanic and delusional from mid 2019-early 2023. The hyper-religious and political delusions as well as social media use, hyper-fixations and special interests were fucking peak during that time, and I completely lacked self-awareness and was just in my own bubble. That whole story is for another time though, too long to dive into here.
I’m wondering if it has anything to do with the fact that I was on 250mg of fluvoxamine (which also happens to be a sigma-1 agonist especially at 250-300mg) from 2019 to about April 2022. My caffeine use was through the roof while I was on it too, which concerns me looking back now since Luvox lowers the clearance time of caffeine by about 80% since they’re both primarily metabolised by CYP1A2.
Last thing is that I went through a period where I was using very high doses of ashwaganda without breaks for about a year and quit cold turkey in probs August 2023.
I know my GABA/glutamate, dopamine, and adrenaline is absolutely fucking fried so now that I’m off benzos I’m really trying to find a good stack that will actually help bring me back to baseline neurotransmitter levels.
I’m also unsure whether I should stop the vyvanse whilst taking BPC and NAC or just take them before bed. Seen a lot of mixed things on here and other forums about the relationship between those supps and amphetamines.

English is not my native so sorry in advance Ok so im 28m I have ocd bpd and cptsd I dont have bdd diagnosed But i was always obssesing about my look
Hating it and it got worse
I wanted to transition from male to female (its on hold for now) i grew my hair Nd perm straigthened it And its just turned to a new obsession
I always hated my face and smile I know my face is wierd.. And when i smike it looks extremly ugly And the hair made everything wierder..
I cant get out of the house I shrink and wanna dissapear From about everyone i cross pathes with I look at every surface Touching and rearanging my clothes and hair Looking in the phone while walking I spend hours kn the mirror Trying to find an angle thatl convince me im not that ugly Trying to rearrange my hair like maybe if i move it a bit with my hands ill finnally like it
To to point of shedding ton of hair Im depressed and wanna die I want to feel preety and feminine But i feel monstrous and deformed I see no point in trying to Work,study go out feeling like this And obviously no reason dealing with my gender issues
Cause why go through all this to feel an ugly girl rather than a ugly boy
Like theres no point for anything if i feel like i dont have permission to live And that everyone is better than me
I started to read about bdd and do some cbt exercises Im cureently on the wait list for a program for intensive care And for a therapist from better help
It helps with redirecting my thinking And reduce checking
But nothing ive read is abke to help woth the depression The will to not be like this And how to love myself even if im ugly
I have no friend and live with my parents Ive completly shutted down from the world
My parent will always tell me that im preety Nd that the hair looks good Which make it worse
But i can see Even if i hace bdd It cant distort all my face and body to a point where im preetty but cant see it
If im preety why everyone look at me Wierded out Or gice me judgy looks like theyr better than me
Why pepole dont like me instantly If im not wierd and ugly?
Yes i aware that its possible: 1.the way i act, looking checking,constantly touching and rearranging
2.me trying to be feminine and looking like a guy
But i get looks even if i take a pill and go out Making sure to try act normal
Even if i go out as normal and male as i can look
And all my life pepole looked at me like it
They say apperance dont matter that much And thers ton of "ugly pepole" That love themselves lives their best life Dont care like i do or feel like i do about their looks
But i get looks and pepole treat ne differently
I want to challenge it and go back to life
But how can i when i have no 1 but my biased parents
And when i try to "challange my prediction" My prediction comes true
I cant keep trying to go out Make friebds again and be around pepole Because i feel like everyone looks at ne abd hate me/pitty/laugh to themselves Its not improving with time
So if im wrong why does it happen? I feel in prison I wanna sit at the sun
How can i decide if im ugly abd have bdd Or if its just bdd
How can i decide about ny hair and gender if ny vision is as said distorted
How can i stop caring even if i am ugly
I cant wait here anymore until therapy
Im about to get high go back to shoving klonopins for fake confidence And go "party" as in giving myself for guys attention Shoving substances and alcohol And hate nyself more when ill wake up
I hadnt done it for 2 years But i wanna feel desirable Have fun Forget about this
I just dont know what to do anymore
How to love me ,my smile How to make decisions when im not sure if my perception is ok
How to move forward from this wierd loop
And im just so alone and tired And thinking of shaving my head and throwing everything except hoodies beanies and sseatpant
And hide in my room till the end of this misreable existence

I have chronic pain and seen major improvement, but now am kind of stuck. My dad suggested I post my situation online and maybe my progress and help others or I can compare notes with someone who has a similar exp.
Main issue: Pain in abdominals left side down to left scrotal area.
History:
10 years prior to March 2020: had muscle pain with the upper body with arms/wrist that I treated with trigger point therapy for the last 10 years. Arms, Head, Neck and chest area. On and off for 10+ years. Had pain mostly under control and manageable with trigger point work. Never had any issues below the chest. Mostly healthy for 36 years. No surgeries below the neck.
Nov 2017: Bad breakup. Therapy for a few months. Mentally/emotionally weak
April 2018: Business closed/lost money/off “trajectory”
Feb 2020: Lost job. Mentally strong. Felt stressed/rushed but manageable
March 2020: minor rear end accident someone bumped into my car
For next 3-4 weeks, testicle and perineum area felt tighter every week
WHEN PAIN STARTED
April 5 - went to ER at UCLA due to extreme sharp shooting pain (8/10) in left testicles/scrotum 2:30am
April 2020 - went through all the usual tests Ultrasound, MRI, CT. Took penicillin, hydrocodone and anti-inflammatories, medication doesn't seem to help.
Fast forward to April 2024
MRI of pelvic area clean
Ultrasound of left scrotum and abdominal wall and liver clean
Mostly off meds, don't like taking them when I flare up I use Tylenol and really serious I use Klonopin.
MRI of brain 2020 vs 2024 (due to onset of Tinnitus 6 months after pelvic pain) shows "Small T2/Flair hyperintensities in the deep and periventricular white matter." One neurologist says it's normal, another says it warrants further investigation. My own research I came to this conclusion: probably not serious but needs checkout every 2-3 years to monitor progress. Probably not related to pelvic pain. Even if there are white matter, there's not much you can do in terms of conventional treatment short of stem cell therapy.
All blood test normal, including automimmune issues. My hla-b27 is positive but only 2-8% of positive people develop issues like AS later in life. My RA factor is slightly elevated, but anti-CCP is negative. All other blood tests for autoimmune issues and vitamins and blood counts all normal range. All STDs negative. EMG normal, slight delay on elbow nerves.
Currently:
-Still pain in abdominal area to left scrotum that on some days is 0, with proper TrP work and meditation and pain reprocessing exercises I thought I was back to normal...
...But, lately it's flared up again and my pain is back at 4-5. Masturbating always make it worse. I was able to get to a point where everything was fine for up to 7 months or so but, recently everything got worse.
-More sensitive muscle pain and muscle twitching in arms and legs. Hypnic jerks at night until I started taking Magnesium and B1 and B12 supplements and Chinese medicine. After a week pain in arms got better and no more hypnic jerks, but still sense muscle spasms in arms/legs. I dont feel muscle weakness in terms of strength, but often I do sense muscle pain or fatigue. Possibly due to new exercise routine from PT but I'm not 100%.
Plan forward:
-Chinese Medicine (TCM): seems to be calming and working, needs further calibration with doctor. Probably complimentary to other therapies
-Physical Therapist - I found a very good one, he's helping me with posture and strengthening a weak upper back, which could be adding pressure to other muscles to overwork and cause pain.
-Stem cell therapy - this is a long shot, but I wonder if the muscles are weak or there's' some nerve damage or brain issues ( white matter). It's also expensive.
-LENs therapy - really promising after reading studies on fibro, friend had LENS done and seem major improvement in cognitive issues and his own health problems.
Tension myositis syndrome (TMS) - Dr Darno's work. Alan Gordon The Way Out, Curable App, etc.
TMS: Was thinking of joining Dan Buglios' group, thinking my symptoms are TMS related, which would push me down a path of pain reprocessing. However, deep down I'm not 100% convinced this is the case.
Open to suggestions. My parents don't understand me sometimes... but I refuse to give up. The world is big place and I'm sure there is a solution.

I have chronic pain and seen major improvement, but now am kind of stuck. My dad suggested I post my situation online and maybe my progress and help others or I can compare notes with someone who has a similar exp.
Main issue: Pain in abdominals left side down to left scrotal area.
History:
10 years prior to March 2020: had muscle pain with the upper body with arms/wrist that I treated with trigger point therapy for the last 10 years. Arms, Head, Neck and chest area. On and off for 10+ years. Had pain mostly under control and manageable with trigger point work. Never had any issues below the chest. Mostly healthy for 36 years. No surgeries below the neck.
Nov 2017: Bad breakup. Therapy for a few months. Mentally/emotionally weak
April 2018: Business closed/lost money/off “trajectory”
Feb 2020: Lost job. Mentally strong. Felt stressed/rushed but manageable
March 2020: minor rear end accident someone bumped into my car
For next 3-4 weeks, testicle and perineum area felt tighter every week
WHEN PAIN STARTED April 5 - went to ER at UCLA due to extreme sharp shooting pain (8/10) in left testicles/scrotum 2:30am
April 2020 - went through all the tests above. Took penicillin, hydrocodone and anti-inflammatories, medication doesn't seem to help.
Fast forward to April 2024
MRI of pelvic area clean
Ultrasound of left scrotum and abdominal wall and liver clean
Mostly off meds, don't like taking them when I flare up I use Tylenol and really serious I use Klonopin.
MRI of brain 2020 vs 2024 (due to onset of Tinnitus 6 months after pelvic pain) shows "Small T2/Flair hyperintensities in the deep and periventricular white matter." One neurologist says it's normal, another says it warrants further investigation. My own research I came to this conclusion: probably not serious but needs checkout every 2-3 years to monitor progress. Probably not related to pelvic pain. Even if there are white matter, there's not much you can do in terms of conventional treatment short of stem cell therapy.
All blood test normal, including automimmune issues. My hla-b27 is positive but only 2-8% of positive people develop issues like AS later in life. My RA factor is slightly elevated, but anti-CCP is negative. All other blood tests for autoimmune issues and vitamins and blood counts all normal range. All STDs negative. EMG normal, slight delay on elbow nerves.
Currently: -Still pain in abdominal area to left scrotum that on some days is 0, with proper TrP work and meditation and pain reprocessing exercises I thought I was back to normal...
...But, lately it's flared up again and my pain is back at 4-5. Masturbating always make it worse. I was able to get to a point where everything was fine for up to 7 months or so but, recently everything got worse.
-More sensitive muscle pain and muscle twitching in arms and legs. Hypnic jerks at night until I started taking Magnesium and B1 and B12 supplements and Chinese medicine. After a week pain in arms got better and no more hypnic jerks, but still sense muscle spasms in arms/legs. I dont feel muscle weakness in terms of strength, but often I do sense muscle pain or fatigue. Possibly due to new exercise routine from PT but I'm not 100%.
Plan forward:
-Chinese Medicine (TCM): seems to be calming and working, needs further calibration with doctor. Probably complimentary to other therapies
-Physical Therapist - I found a very good one, he's helping me with posture and strengthening a weak upper back, which could be adding pressure to other muscles to overwork and cause pain.
-Stem cell therapy - this is a long shot, but I wonder if the muscles are weak or there's' some nerve damage or brain issues ( white matter). It's also expensive.
-LENs therapy - really promising after reading studies on fibro, friend had LENS done and seem major improvement in cognitive issues and his own health problems.
Tension myositis syndrome (TMS) - Dr Darno's work. Alan Gordon The Way Out, Curable App, etc.
TMS: Was thinking of joining Dan Buglios' group, thinking my symptoms are TMS related, which would push me down a path of pain reprocessing. However, deep down I'm not 100% convinced this is the case.
Open to suggestions. My parents don't understand me sometimes... but I refuse to give up. The world is big place and I'm sure there is a solution.

Late 40s male. Well into a year of extensive treatment for PTSD, GAD, BPD. Recently tested borderline low out of range free testosterone and barely in range D3 (32ng). Taking carbamazapine er 200mg daily. Quetiapine 50mg at night. Gabapentin 100mg 3 times daily. Escitalopram 20mg daily. 400mg magnesium glycinate at night.
For the past few years I've suffered a lot. Benzo CT, PTSD from childhood abuse plus a severe akathasia event that almost ended in suicide. I've been improving and recently got back to work from 4 years of severe mental health issues. Was bedroom bound.
My GP suggested moderate (5,000-10,000 iu daily) D3, intense exercise (recovering from fairly severe deconditioning), and high protein diet to get on shape and hopefully raise testosterone levels. I've done all 3 one at a time. I am very sensitive to any changes. My Quetiapine had to be adjusted 12.5mg at a time for example. Psychologist said he's had few patients as sensitive to change as myself.
A week ago I increased my D3 from 400 iu daily to 10,000 iu. I had severe disassociation on this night as well a the most vivid nightmares I've had since withdrawing from 3mg klonopin daily 4 years ago. The next 3 days I didn't take the supplement. The disassociation faded over this time and dreams regulated as well. I purchased a higher quality 3rd party tested D3 supplement and tried again. 4 hours later, a rush of euphoria and panic. I spent the next 12 hrs feeling as I had taken speed. It was very similar to the first pill of Adderall I was prescribed years ago. (I'm no longer on Adderall). A day later. 10,000 iu with food this time. 45 minutes later same thing. Iwas also unable to climax with my Wife. It felt very similar to going on Escitalopram. Same reaction all day until I took 400mg magnesium glycinate and my Quetiapine.
Today I took 5,000 iu. This is what I noticed today. This is far from placebo. Not even close. Today I had a huge disappearance of years long gender dysphoria. I normally see myself as female, but have no desire to transition. Today I felt more masculine than I ever have in my life. Confidence was high in an unfamiliar way. Through my disassociation I felt I was watching myself through the day but I wasn't me. I was this very calm but strong and direct man. I felt a heightened body image in contrast to my daily fairly negative one. I didn't recognize myself. My sex drive also returned, but was far more masculine and confident than ever in the past. My Wife commented that it was incredible several times. Through all of this though was still a fairly large level of anxiety. I also went from having a resting hb of 140 bpm 4 years ago after benzo wd to high 40s to 60 on week one of reinstating SSRI. I've had this mild bradycardia for 2 years. Tonight my resting rate is 90 with mild palpitations. Palpitations are common for me. This pulse is not
What is going on with me? Did the vitamin d that quickly up my serotonin, dopamine, testosterone, is this thyroid hormones being boosted? I understand many will likely say this is placebo. I assure it wasn't. I felt like I was in a mixture of going on a high dose SSRI for the first time, on Adderall, or street drugs. I took magnesium glycinate again (200mg) it calmed down, but I still feel like a different person.
Edit to add. Tonight was the first night in a full year that I didn't have to take a nap right after work. I'm so tired every night I can't stay awake. Tonight that never happened, and I also did an extra hour of cardio instead about 4 hours after I normally must nap. +24 hr Update. Mood has stabilized somewhat. Still feel like a different person. Sex drive is still high. Energy still high. Heartrate has settled to high 60s. Long term bradycardia appears to be gone.

Crisis: meaning you are worried about your mental state. (borderline worried = worried)
hypo/mania engine: the mechanisms within your body & mind that induce, perpetuate, and escalate a hypomanic or manic episode.

When you're in crisis, your main goals should be:

1. stay SAFE
2. reduce "brain chemicals" that drive the hypo/mania engine (i.e. the "brain chemicals" that induce, perpetuate, and escalate hypomania and mania. These "brain chemicals" include dopamine, cortisol, serotonin, adrenaline, and noradrenaline/norepinephrine).

The following is a general guide for reducing "brain chemicals" that drive the hypo/manic engine. For ease of reference, I'll list each item with a brief description first. Each item in this list is expanded on below to explain why it's important and offer a few tips on how you might be able to implement it.
​

1. If you have antipsychotics, take them as prescribed. If you don't have antipsychotics, get some ASAP. You're in crisis and APs are a weapon against mania.
   1. If you don't have a psychiatrist, see your general practitioner. They can often get you APs in a pinch.
2. GET SLEEP!
3. REDUCE STRESS. Avoid stress at all costs. Take time off work/school. Fuck around with your favorite hobbies. Stay away from folks who stress you out. Relax.
4. REDUCE STIMULATION. Stimulating your brain by engaging in social interaction or consuming media that evokes specific emotions will rev you up. Staying at home, in a comfortable environment, is recommended. Chill.
   1. Note: 'excitement' is about the same as 'stress' with regard to 'making mania worse'.
5. Create a simple daily routine and stick to it.
6. Take time off work and school. You are in crisis. Your stability is a priority! Some jobs offer Short Term Disability & FMLA (medical leave) which can get you ~3 months off work at ~60% pay. Ask HR or your manager about it.
7. Avoid drugs, alcohol, and stimulants including caffeine & sugar. fr fr, lay off the caffeine.
8. Contact your support network. Let them know you're in crisis and your plan for managing it. If they're willing to help, take them up on it.
9. Consume at least 1500 calories per day. More is better.
10. Stay hydrated.
11. Exercise. Aim to avoid injury, but exhaust yourself most days, but be sure to give your body a rest every few days. Low impact cardio is recommended, like an elliptical or swimming. Lifting weights and running might be a bad idea cuz of injury risk.
12. Stretch. Relax. Treat it as meditation and do some focused breathing. Mania makes you tense, even if you don't notice it...relieving that tension helps to calm your head.
13. Take breaks often to sit and chill. BREATHE. Focusing on a task (or tasks) nonstop ain't healthy bruh.
14. Schedule an appointment with your psychiatrist. They can help you through a crisis by adjusting your meds.

​

PROTIP: a cheat code for "beating" mania is to frame 'specific things that help you to combat mania' as 'enjoyable/pleasurable'. ...mania seeks pleasure and YOU get to choose what is pleasurable for yourself. If you work hard enough at this type of reframing, it's possible to make mania work to beat itself. Ask yourself: is managing this episode of mania well something that could bring you pleasure?

​
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1. Antipsychotics

Why take antipsychotics?
Antipsychotics were designed to wreck mania. The way they work is by blocking some of your dopamine receptors. Dopamine is an essential "brain chemical" in the hypo/manic engine and APs blocking some receptors can often stop an episode cold.
​
Tips on how to take antipsychotics
Take APs per your doctor's recommendation.
It's probably a good idea to see your doctor if they're not aware you're in crisis. They may suggest adjusting the dose.
If you want to stop taking antipsychotics after the episode is over, make sure to taper off safely per your doctor's instruction. Quitting APs too quickly can cause some nasty withdrawal effects that include 'inducing mania'.
It's often the case that APs wont be enough to put an end to an episode by themselves. Don't count on APs being a magic bullet...do everything you can to put an end to your episode.
​
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2. GET SLEEP!

Why SLEEP!?
Sleep deprivation can escalate and perpetuate an episode like none other, because it contributes to elevated levels of "brain chemical" that drive the hypo/manic engine.
Getting some solid sleep can do a world of good when it comes to calming a manic episode.
​
Tips on how to get some sleep
Granted, sleep is not easy to get while manic. Not easy, but not impossible. There are some things you can do to help with the sleep thing:

1. Create a sleep "ritual". The more consistent you are with your "ritual", the stronger your Pavlovian response will be. Something like:
   
   1. Put an end to "screen time" for the day, at least 1 hour before bedtime. No more TV, computer, or phone.
   2. Shower
   3. Orgasm
   4. Get comfy (keep sweats & socks close by if you might get cold, pillow between the legs if that's helpful, box fan or some other white noise to block out background noise, etc.)
   5. Focused/meditative breathing while under the covers.
   6. Programmed dream: make yourself dream the same dream while your conscious mind is still awake. Force the same narrative to go through your head. The active focus can tie up loose thoughts.
2. Set your bedtime in stone. Set an alarm to remind you when it's time to start your sleep "ritual" and strictly adhere to it.
   
3. Set your wake up time in stone. Even if you wake up throughout the night, stay in bed until your 'wake up time' and try to continue sleeping.
   
4. Keep a pen & pad by your bed. When you have thoughts keeping you up, write them out in the notebook. Often, writing something down will let your brain let go of it, because it understands the thought will not be forgotten.
   
5. A 'sleep playlist' or audiobook of something you've already read/heard can be helpful to tie up loose thoughts.
   
6. Make sure to exercise during the day. If you're physically tired, it can help.
   
7. If you can't get sleep using the above, there are meds that can aid with getting sleep. Melatonin is an over the counter med that can help. Ativan or klonopin can be helpful if your doctor will prescribe them, but be careful with those drugs because they're addictive. There are more prescription meds that could help...talk to your doc to see what they can set you up with.
   
8. If your thoughts are keeping you up, give yourself 30 min or an hour to engage in a cathartic/meditative activity. Writing about the thoughts that are keeping you up can be helpful. Stretching can be helpful. Other things can be helpful. Avoid stimulating activities like media or chatting with folks.
   
9. Ensure that you avoid stimulants like caffeine and sugar throughout the day.
   

It is possible to get sleep in the throes of MANIA, but it often takes some effort to get there.
​
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3. REDUCE STRESS

Why REDUCE STRESS?
Cortisol is a big player in the hypo/manic engine. Stress increases your cortisol levels. Avoid stress bruh.
Be aware: events that cause spikes of stress can escalate the severity of an episode instantaneously. If you're managing well, a stressful event can possibly turn an episode into something that is unmanageable.
​
Tips on how you might reduce your level of stress

• Take time off work or school if you can.
  • There's something called the Family and Medical Leave Act (FMLA) in the US. If you file for it, your employer technically can't fire you for taking up to 3 months off work. There's also a decent chance you're eligible for Short Term Disability (STD), which can get you paid ~60% of your paycheck for up to 3 months, while you take time off. Talk to HR or your manager about FMLA and STD and they should point you in the right direction. You'll likely need to get your psychiatrist to sign off on the forms, but it should be relatively simple.
    • WARNING: technically your employer can't fire you for doing the above. However, the vast majority of us are 'at-will' employees, which means that your employer doesn't need a reason to fire you and it's hard af to prove they fired you cuz you took FMLA or whatever. Don't abuse this system.
  • If you're in school, talk to your counselor. It's probably possible for you to withdraw from your courses to give you time to ride out the episode and recover, without damaging your grades.
• Avoid people & situations that stress you out (duh). You are allowed to care for yourself by refusing contact with specific individuals.
• Invest time in as many outlets as you can. Outlets help us relieve stress. Write, draw, dance, exercise, play games, have a good cry, find someone who will let you talk your head off at them without judgement. Do the things you do to reduce stress and do em a lot (not drugs or alcohol tho...those will ramp mania up).
  • It's common that a manic episode will induce a sense of 'Purpose' in you. Working toward that purpose might benefit your stress level, as long as it's safe.
  • Remember to take breaks. Outleting can be helpful, but working on anything continuously without breaks for hours on end is detrimental.
• Organize your habitat and keep it that way. When you're manic and looking for an item, it can be a bit stressful if you can't find it. When you're manic, you might have a tendency to pick items up and discard them mindlessly, causing substantial clutter. ...things will go much more smoothly if you make it a point to keep your habitat organized while you're in episode.
• Nature walks can be helpful.
• BREATHE. Just focus on taking deep breaths. In and out. You'd be surprised how effective that can be for reducing stress, especially right when you're smacked with a big dose of it. Try to take a couple minuites per hour to drop everything you're doing, chill, and BREATHE.
• Reduce your responsibilities if you can
  • If you can afford it, get take-out to eat. Only if you can afford it...watch dat manic spending. If you can't afford take out, find a meal that you mass produce and portion out for the week.
  • Get disposable dishes and silverware
  • Ask loved ones if they can help by taking on some of your responsibilities. Be grateful like a motherfucker and make sure that you return the effort they give you after your episode is over.
• Stretch.
• Make SAFETY a priority. Maniacs have a tendency to get themselves in situations that aren't quite safe...and that's stressful.
• Specific mindsets can help to reduce stress significantly. If you're able to embody these types of mindsets, you'll be much more resistant to the bullshit mania can throw at you. Try to keep these ideals in mind when you find something is stressing you out. Examples of some helpful mindsets:
  • 'don't sweat the small stuff...it's all small stuff.'
  • 'I don't give a fuck'
• If you leave your habitat, have a plan for how you'll manage stress if it happens. Bring an outlet, like a notebook to write your stress out in. Plan to remove yourself and take a walk. If you find that stress is overwhelming you, try sprinting until your legs fail. When stress strikes take a break from everything till you get your head straight.

​
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4. REDUCE STIMULATION

Why REDUCE STIMULATION?
Stimulation stimulates the mind (fucking duh). Stimulation is what triggers the release/absorption of "brain chemicals". If your goal is to manage "brain chemicals" it stands to reason that reducing your stimulation is a viable vector.
Keep in mind that 'stimulation can escalate & perpetuate mania'. When you're planning your activities for the day, aim for reduced stimulation.
Note: 'excitement' is a major culprit in inducing the "brain chemicals" that drive the hypo/manic engine. It probably seems lame, but be wary of 'excitement' as much as you're wary about 'stress'.
​
Tips on how to reduce stimulation (specifically the type that increases "brain chemicals" that feed the hypo/mania engine)

• Avoid social media. Posting is a bad idea. Responding to posts is a bad idea. Reading the posts of others is a bad idea. Social media is poison for a manic mind.
• Avoid media in general. Chilling and watching a movie or something is fine. Reading up on the latest political news or other media that can elicit a strong emotional reaction is not a good idea.
• Reduce phone time to an absolute minimum. Turn your phone on silent, or better yet turn it off.
• Stay in. Don't go out. Grocery shopping is fine if you don't have a friend or family member that is able to do it for you. Going to the gym is fine. Going out to a social event is a bad idea. You shouldn't be going to work or school...you're in crisis, remember?
  • If you must go out, don't drive. Driving in a manic crisis is DANGEROUS.
• Don't allow a group of folks to visit you at home. One or two folks coming over might be fine.
• Don't take on too many tasks at once. Ideally: do a task till completion, then move on to the next. If mania is

​
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5. Create a daily routine and stick to it

Why create a daily routine to stick to?
Decrease day to day variables. Keep life predictable. Lower cortisol levels (and reduce release/absorption of other "brain chemicals").
The more predictable daily life is, the less unexpected bullshit there is to deal with. Remove the guesswork & impulses when thinking 'what should I do right now?'.
​
Tips on how to create a daily routine
Keep it simple. The more you try to cram into your daily routine, the less likely it'll be that your routine sticks.

• Sleep time
• Wake time
• Meal time
• Exercise
• Stretch
• Free time
• Chill time

It would be smart to limit time you spend with others outside your home. Stimulation revs us up, plus there is a higher chance of us getting into trouble outside of our home. Get used to telling folks "no" when they ask if you want to go out with them.
​
Tips on how to stick to a daily routine
Sticking to a daily routine may not be super fun or exciting. Understand that. Understand that minimizing 'excitement' is something you gotta do if you wanna keep your manic crisis from getting out of hand. ...think about what you value more: getting through this episode safely or chasing excitement?
Write your routine down. Set alarms to remind you when it's time for something. If you live with folks, ask them to help you stay on track.
Commit to your routine. If you're thinking "man, this routine thing sucks", the impulses mania pushes into your head will have a greater chance of kicking you off your routine. If you're thinking "I ENJOY doing the things I need to do to stay as stable as possible", mania will have a harder time detracting you.
​
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6. Take time off of work and school

Why take time off work and school?

Important note: remember you can go on 'Short Term Disability' to get paid up to 60% of your current paycheck for up to 3 months

Less stress. Less stimulation. More time to chill. More time to focus on curbing your current episode.
Many of folks have lost their jobs, messed up their grades, or blown up their social lives during a manic crisis due to manic behaviors.
Taking time off school/work will be of tremendous benefit.
​
How to take time off work
Talk to HR. If there's no HR where you work, talk to your manager.

• Tell them you are bipolar.
• Tell them you are in a manic crisis and that you are unable to work.
• Ask them how the place of employment deals with the 'Family and Medical Leave Act', if in the US...if outside the US, there's probably a similar thing in your country that protects the jobs of folks who need time off for medical reasons.
• Ask them how the place of employment deals with 'Short Term Disability' (STD).
• End the conversation. You are not obligated to tell them anything about what's going on with you and it's inappropriate for them to pry.

​
What is the 'Family and Medical Leave Act' (FMLA) and how does it work?
FMLA is the mechanism of the US government that protects the jobs of folks who need to take a leave of absence for family and/or medical reasons, for up to 12 weeks. 'A manic crisis' certainly falls under the umbrella covered by FMLA.
When you enact FMLA to take a leave of absence, your employer is legally not allowed to fire you for taking this leave of absence. ...though almost everyone in the US is an 'at-will' employee, which means that their employer can fire them at any time for 'no reason'. Keep that in mind and don't abuse FMLA.
Your employer might have a specific form on hand that you can fill out to enact FMLA leave. If they don't, you can google "FMLA forms" to find the standardized forms. You will likely need the signature of your psychiatrist on the form to finalize it. Make sure you sign it and make a copy to keep in your own record.
​
What is 'Short Term Disability' (STD) and how does it work?
STD is a type of insurance that most employers have, but not all.
If your employer has this insurance, you are able to receive up to 60% of your current paycheck from the insurance company for up to 12 weeks.
Ask your employer for the forms, fill them out, copy them, and submit them. Your psychiatrist will need to sign off on them.
​
How to take time off school (surefire way)
Talk to your councilor. Tell them you're in bipolar and in a manic crisis. Tell them you need to take time off school.
Your councilor might require a psychiatrist's sign off and they might not. Your councilor will guide you through the process of withdrawing from your courses.
If this happens before your school's deadline to add/drop classes, you can drop all your classes and likely won't have to pay anything for the semester (save room and board). If this happens after the add/drop deadline, you may need to pay for the semester.
​
How to take time off of school (less certain way, if after the add/drop deadline)
(((this section requires some research on my part)))
If it's after your school's add/drop deadline, you might be able to "complete" the semester while taking some time off.
Send your professors an email explaining the situation (bipolamanic crisis/need time off of school). Ask them if you have any options other than withdrawing from the course and being stuck with a bill for the semester that you'll receive no credit on. Possible options:

• ask them what your current grade is and what your final grade would be if you receive a 0 on all future assignments & exams.
• ask them if you can make up assignments/exams that you'll miss during your necessary leave of absence, after you've recovered
• (((IDK, there are probably more options)))

You might find that some of your professors are willing to work with you and others are not. Talk to your counselor to set up a plan of action.
​
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7. Avoid drugs, alcohol, and stimulants including caffeine & sugar

Why avoid drugs, alcohol, and stimulants including caffeine & sugar?
"Brain chemicals" bro...doesn't matter what the drug is, it will fuel the hypo/manic engine.
Notably, pot and psychedelics are known to induce and worsen psychosis if you're manic.
Caffeine & sugar (especially caffeine) increase dopamine & cortisol, which are big sources of fuel for the hypo/manic engine.
​
Tips on avoiding drugs, alcohol, and stimulants including caffeine & sugar.
Just say "no". Keep in mind that these substances will make mania worse.
If you're addicted to the substance, quitting cold turkey probably isn't a good idea. It's hard to say which will impact mania worse: quitting or continuing your use. If you're addicted, aim to keep your usage to an absolute minimum.
​
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8. Contact your support network

Why contact your support network?
To alert some key folks that you're in crisis and inform them of your plan for managing the crisis. If you don't tell them, how can they know? If you don't tell them your plan, they're probably gonna worry...so, be sure you tell them the plan.
Maybe they'll be willing to help out. Maybe they have a specific way of interacting with you while you're in episode. At the least, you'll be warning them that you're manic and they will be able to avoid you if they're not able to deal with that. ...let's face it, while mania may be difficult for us to deal with, it can also be difficult for those around us.
If you have a solid support network, it can be a great source of stress relief, support (duh), and security.
​
Who is in your support network?
Family & friends who you TRUST and who are willing to offer you support during your episode (even if that "support" is leaving you alone).
​
How can a support network help to support you?

• Give you space when you need it. Sometimes the best thing someone can do to support you is to stay away. If you think that's the case with a specific individual, be kind about how you inform them.
• Lend a caring (non-judgmental) ear to let you talk off. Emotional support & validation.
• Help with cleaning & organizing your home.
• Help with preparing food.
• Provide gentle feedback on how well you're managing.
• Give reminders to help you stick to your plan. Help to hold you accountable.
• Provide transportation to the grocery store, gym, psychiatrist, or hospital.
• Be a sounding board to bounce (possibly ridiculous) ideas off.

WARNING:
Don't expect help from your support network. Mania is taxing on those you're around. If they offer, great! If they're not willing, don't hold it against them.
NOTES:
If folks are willing to help, BE GRACIOUS! And make sure to return the love after your episode is over.
Not everyone in your support network will be able to accept you in a manic state without grief/judgement and that's okay...just limit the time you spend around them. It's also important to note that those who can accept you in your manic state do not have unlimited tolerance.

​
What if you don't have a support network?
Don't sweat it bro. Stick to the other tips and make it a point to set up a support network after this episode is over.
If you want someone to provide feedback or to help you stick to your plan, try posting on bipolar1 and asking for help.
​
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9. Consume at least 1500 calories per day. More is better.

Why consume at least 1500 calories per day?
Malnourishment puts a strain on your body & mind and will release some "brain chemicals" that feed the hypo/mania engine.
Your body & mind need at least 1200 calories per day to stay out of "starvation mode". I recommend at least 1500 calories per day cuz us maniacs likely burn more calories per day than an average person.
At minimum 1500 calories per day bro. Try to get more.
​
What kind of calories should you consume?
Protein. Fatty protein is best. Don't neglect your macronutrients (protein/fats/carbs) tho...get some healthy fats and carbs too.
Try to stay away from sugar. Sugar is a simulant and will increase the level of "brain chemicals" you're trying to stay away from.
​
Tips on how to consume at least 1500 calories per day while manic
Choke it down bro. I know you think you got better things to do than eat and food isn't too appetizing, but you need these calories for the sake of stability.
If you absolutely can't stomach much but find you can eat a whole-ass pizza, then pizza it is. Hitting the recommended levels of macronutrients is ideal, but you gotta do whatchu gotta do to get those calories, ya know?
Have dedicated mealtimes. When you wake up, make sure you eat your whole breakfast. When your alarm goes off to remind you it's lunchtime, eat your whole lunch. Same for dinner. Snack as much as you can.
Prepping food in advance can be helpful, cuz making food fresh for each meal can be a chore. I like to bake 3 lbs of chicken on Sunday, then heat it up throughout the week with some rice & broccoli on the side. ezpz. Def gotta choke it down, but that's just a minor effort of will.
Don't go crazy with takeout. If you can afford it, cool. But most of us can't afford to live off takeout. I know it seems like a simple solution, but make sure you stay within your budget. Beware of manic spending.
​
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10. Stay hydrated

Why stay hydrated?
"brain chemicals"...duh. (I feel like a broken record)
Dehydration increases the level of "brain chemicals" that feed the hypo/mania engine.
​
Tips on how to stay hydrated
Get a large water bottle and note how many times you fill it up per day. Aim to drain it at specific times each day. Dr. Google says 15.5 cups (3.7 liters) per day if you're a man or 11.5 cups (2.7 liters) per day if you're a woman...aim to hit those numbers.
Watch your pee. If it's dark, drink more water.
​
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11. Exercise

WARNING
Exercise can stimulate mania if you're not accustomed to it. If that's the case then it's probably best to limit yourself to walking as exercise. Going for peaceful walks in nature can be helpful.

Why exercise?
"Brain chemical" regulation. Exercise is a healthy outlet for stress (read: a healthy way to reduce some of the "brain chemicals" that feed the hypo/mania engine).
Exercise is a great way to burn off the excess energy that maniacs have and will make it easier to do other things that are good for a maniac, like chill out and sleep.
​
Tips on how to exercise
Don't go crazy with it. Exercise is good, but too much exercise can be bad. Keep in mind that mania makes us feel like we can physically exert yourself to an extent that's unhealthy and unsafe...mania can circumvent your brain's pain/strain inhibitors that tell you when your body needs to chill and rest.
Don't go crazy with it, but try to exert yourself to the point of exhaustion as much as you can do safely. Be sure to stretch daily to reduce your physical strain. Give yourself a rest day every few days.
IMO low impact cardio is best. Swimming, elliptical, and HIIT are great ways to exhaust yourself while keeping the strain on your body to a minimum.

PROTIP
Swimming can elicit something called a 'diving response' in your brain, which is great for calming mania down. You can also elicit the 'diving response' by submerging your head in cold water while holding your breath.

Avoid injury like the plague. Injury = stress. Injury = taking time away from exercise, which is a bad thing for a maniac. Stay safe.
IMO, lifting is not a great idea to do while manic. Higher chance of injury with the baseline tension that mania induces and it's very easy to get distracted from the exercise between sets.
​
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12. Stretch

Why stretch?
To relieve muscle tension (tension/strain in muscles = bad brain chems).
You may not notice this, but mania has a tendency to increase your baseline muscle tension. We often walk around with our muscles in a more tense state than normal and that tension can add up to some negative effects on your brain.
Stretching is a great way to chill tf out. After muscles are relaxed from a good stretch, you'll be more comfortable, less on-edge, and find that it's easier to chill tf out.
​
Tips on how to stretch

• When you notice some part of your body is tense, stretch it right away.
• Ideally, you wanna stretch your full body at least once daily and stretch the parts of your body you can feel stress/strain issues in more than once per day.
• If you don't already have a stretching routine, I'd recommend phrakture's 'starting stretching' guide:
  
  • printable image of each stretch: https://imgur.com/surWf
  • written guide on each stretch: https://phrakture.github.io/starting-stretching.html
  • Customize the stretches to fit your abilities and needs. For example: I'm not a fan of the 'reclined hero' position, so I just do a standing quad stretch instead. Also, I like to add in stretches for my glutes and calfs.
• A foam roller can be great for stretching too. Specifically for the IT band, hips, glutes, hamstrings, back, and shoulders.
  
• Rolling a tennis ball against the wall can be great spot treatment for shoulders, back, hips, and glutes.
  

Stretching can (an probably should) be a meditative experience. Take a moment to just relax and commune with your body.

• Focus on each individual muscle...feel yourself release it. Feel how the muscle is is lengthened with your stretch.
• Focus on your breathing.

​
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13. Take breaks often to just sit and chill

Why take breaks?
Your body needs rest. Your mind needs rest. Constantly doing stuff without rest will induce stress & strain that increases the brain chems the hypo/mania engine feeds on.
​
How to take breaks?
Sit and chill. Try not to think about your next moves or whatever, just be in the moment. Focus on your breathing.
Aim for a 10 minute break once every hour or so.
​
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14. Schedule an appointment with your psychiatrist.

WARNING: be aware that if your psychiatrist THINKS you might be a danger to yourself or others, they will put you in the hospital against your will.
If you think you're in danger of being put in the hospital against your will, consider that the hospital might be a good idea. It's generally easier to get released from the hospital if you're the one making the choice to go there.

Why schedule an appointment with your psychiatrist?
If you're in crisis, they should know...so they can be prepared if you need them in an emergency.
They can suggest temporary med increases to try and put an end to the manic episode.
You need them to sign off on FMLA and short term disability.

So I've had anxiety I suppose my whole life. I'm in my 30's now. I even went into residential treatment this year for 33 days and am continuing treatment and thought I was doing better until this week.
I've been waking up about an hour after I fall asleep with this feeling of dread, uncomfortability, not feeling in my own body, and straight up unbearable anxiety. I feel like I'm being tormented.
The feeling is I'm scared/anxious/ cannot bear the concept of time. I have this feeling of dread that is connected to infinity and infinite time and space. The concept of infinity feels like too much to handle. The air feels off, my thoughts don't feel mine, time doesn't seem right. It's such an odd thing to describe but I am doing my best. I used to have this feeling as a child maybe 10 and under and would wake up with this feeling and wake up my parents. But it's been over 20 years since. The hard part about this is, nothing has been helping me to calm myself. I tried to pick up a book and the concept of words and language gave my anxiety and felt just wrong. I tried to exercise but movement felt not real? I ended up going outside and just crying for over an hour and just let the panic take over, hyperventilated until my klonopin kicked it.
Then today I set a work timer for 3 hours and the concept of time and 3 hours really got me feeling dizzy and anxious again. I don't understand. I feel so out of body.
Has anyone had this odd feeling of anxiety? Normally I'm just anxious about my health or dying or if I acted like a dumbass or not in front of people. I'm at the point where I'm afraid to go to sleep. When I talk to my partner about it, he's concerned I may have an un diagnosed personality disorder or got abducted by aliens in the past or something lol
I think I just want to feel less alone on this crazy intense feeling of anxiety that has to be anxiety but feels different than any other anxiety i've felt in the past

So I've had anxiety I suppose my whole life. I'm in my 30's now. I even went into residential treatment this year for 33 days and am continuing treatment and thought I was doing better until this week.
I've been waking up about an hour after I fall asleep with this feeling of dread, uncomfortability, not feeling in my own body, and straight up unbearable anxiety. I feel like I'm being tormented.
The feeling is I'm scared/anxious/ cannot bear the concept of time. I have this feeling of dread that is connected to infinity and infinite time and space. The concept of infinity feels like too much to handle. The air feels off, my thoughts don't feel mine, time doesn't seem right. It's such an odd thing to describe but I am doing my best. I used to have this feeling as a child maybe 10 and under and would wake up with this feeling and wake up my parents. But it's been over 20 years since. The hard part about this is, nothing has been helping me to calm myself. I tried to pick up a book and the concept of words and language gave my anxiety and felt just wrong. I tried to exercise but movement felt not real? I ended up going outside and just crying for over an hour and just let the panic take over, hyperventilated until my klonopin kicked it.
Then today I set a work timer for 3 hours and the concept of time and 3 hours really got me feeling dizzy and anxious again. I don't understand. I feel so out of body.
Has anyone had this odd feeling of anxiety? Normally I'm just anxious about my health or dying or if I acted like a dumbass or not in front of people. I'm at the point where I'm afraid to go to sleep. When I talk to my partner about it, he's concerned I may have an un diagnosed personality disorder or got abducted by aliens in the past or something lol
I think I just want to feel less alone on this crazy intense feeling of anxiety that has to be anxiety but feels different than any other anxiety i've felt in the past.
​

I’ve been on 350 mg Seroquel IR, 2 mg Risperidone, and now 300 mg Seroquel XR over the past months.
I was getting a transitory akathisia throughout these months. (It took me a while to even realize that was what it was and it was a product of the drugs.) I’ve tried Artane, propranolol, and Cogentin but those three don’t seem to work, only the Klonopin gives me relief.
How I would describe it is an artificial state of agitation/restlessness, ie having nothing to do with my personal emotions. It gives me restless legs, compels me to get up and walk around, agitates me when I try to rest in bed, and creates this horrible dysphoria (very nightmarish thoughts, agitation, negativity, and complaining). When you’re in it it feels like it will never go away.
As I said it’s artificial (neurologically caused). So I can’t rest or do breathing exercises to get out of it.
Any hope for me here? I suspect the Risperidone was what really messed me up. If I keep surviving will my brain restore itself? Looking for people with direct experience with akathisia in patients. Thanks.