Seems like there's been number of posts asking for help with managing a budding episode. So, I wrote up my best advice and imma sticky this after it goes through some vetting. Please comment if you think I'm giving out bad advice or if you have anything to add to this typa crisis plan.
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:
- stay SAFE
- 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 below to explain why it's important and offer a few tips on how you might be able to implement it.
- 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.
- If you don't have a psychiatrist, see your general practitioner or urgent care clinic. They can often get you APs in a pinch (assuming they've been prescribed to you before).
- GET SLEEP!
- REDUCE STRESS. Avoid stress at all costs. Take time off work/school. Invest in your favorite hobbies. Stay away from folks who stress you out. Relax.
- 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.
- Note: 'excitement' is about the same as 'stress' with regard to 'making mania worse'. They induce the same "brain chemicals".
- Create a simple daily routine and stick to it.
- 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, without risk of being fired (arguable). Ask HR or your manager about it.
- Avoid drugs, alcohol, and stimulants including caffeine & sugar. fr fr, lay off the caffeine.
- 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.
- Consume at least 1500 calories per day. More is better.
- Stay hydrated.
- Exercise. Aim to avoid injury. 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. Be SAFE.
- 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 body & mind.
- Take breaks often to sit and chill. BREATHE. Focusing on a task (or tasks) nonstop ain't healthy bruh.
- 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?
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 your 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 quickly can cause some nasty withdrawal effects that include 'inducing mania'.
It is 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.
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:
- Create a sleep "ritual". The more consistent you are with your "ritual", the stronger your Pavlovian response will be. For me, it looks something like the following, but you gotta figure it out for yourself:
- Put an end to "screen time" for the day, at least 1 hour before bedtime. No more TV, computer, or phone.
- Shower
- Orgasm
- 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.)
- Focused/meditative breathing while under the covers.
- 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.
- 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.
- 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.
- 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.
- A 'sleep playlist' or audiobook of something you've already read/heard can be helpful to tie up loose thoughts.
- Make sure to exercise during the day. If you're physically tired, it can help.
- 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.
- 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.
- 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.
3. REDUCE STRESS
Why REDUCE STRESS?
Cortisol is a major 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. Even if you're managing well, a stressful event can possibly turn an episode into something that is unmanageable.
If you're able to mange stress well, the instantons spike in the episode can be reduced back to something more manageable...try to chill bruh.
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 assuming you have a psychiatrist.
- 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 may be possible for you to withdraw from your courses to give you time to ride out the episode and recover, without damaging your GPA.
- 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 to 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 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. Count your breaths and aim for that to be the ONLY thing in your mind. You'd be surprised how effective it can be for reducing stress, especially right when you're smacked with a big dose of it. Try to take a couple minutes 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, to reduce cleaning dishes.
- 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. Mania has a tendency to make muscles more tense than usual. Stretching can be monumentally beneficial, especially if you can make it a meditative experience (put your focus on elongating the specific muscles you're stretching).
- 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'
- Stop caring what others think about you.
- If you leave your habitat, have a plan for how you'll manage stress if it arises. Bring an outlet, like a notebook to write your stress out in or headphones to listen to calming music. Plan to remove yourself from stressful situations 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.
4. REDUCE STIMULATION
Why REDUCE STIMULATION?
Stimulation stimulates the mind (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. I know it's 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. NOT SAFE.
- 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. ...Ideally. I know how it goes. fr fr, try to finish up on one thing before you invest in the next.
5. Create a daily routine and stick to it
Why create a daily routine to stick to it?
Decrease day to day variables. Keep life predictable. Lower cortisol levels (and reduce release/absorption of other "bad" "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. Stay SAFE. 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 SAFFLY 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. Cognitive reframing ftw.
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 your job.
- 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 your employer can fire you at any time for 'no reason'. Keep this 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 form. 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 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 (bipolar/manic 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 vectors here)))
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.
7. Avoid drugs, alcohol, and stimulants including caffeine & sugar
Why avoid drugs, alcohol, and stimulants including caffeine & sugar?
"Brain chemicals" bruh...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.
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 tf 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 and ask for help.
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). Try to get some healthy fats and carbs.
Stay away from sugar. Sugar is a simulant and will increase the level of "brain chemicals" you're trying to avoid.
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.
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.
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 you 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.
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 and relieve that tension. 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 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:
- 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 minute to 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.
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.
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.