Bipolar Support Groups.com blog

Taking a Personal Time-Out

It can be very difficult at times to take a little time off from our busy schedules, but let’s face it: we need to. Many of us have a family, full time job, probably going to school or doing other classes, continuing education and the list goes on. It can be hard to find balance in what seems to be a very unbalanced life.

A personal time out means that you can give yourself permission to have some “me-time” if not daily, weekly, monthly. I know that our schedules may not allow us to have a full day or weekend off every week, but can we grant ourselves at least 15 minutes or 1 hour? After all, just like a plane needs to be re-fueled in order to fly the other trip, we too need to re-charge our bodies in order to continue carrying on with our responsibilities. When our energy tank is reading “E” it’s time to pull aside and re-charge!

As the saying goes, a little can go a long way. Taking a personal time out does not have to mean something extreme, it can be something very simple. Remember, in order for this to have the ultimate benefit, it should be something that you enjoy or something you are genuinely interested in. It should not feel like punishment in any way and it should not be something you feel guilt over. This is self care: It is you giving yourself love and attention.

The beauty of taking a personal time-out is that you can plan this around your schedule. Just like you schedule meetings, business trips, seminars and conference calls, you too can schedule your personal time off. For some persons, because of the nature of their job or lifestyle, taking a personal time-out might just very well mean taking time to spend with family and loved ones. Perfect!
These are a few ideas for taking a personal time out either on your own or with family and loved ones:

* schedule a spa day

* take a yoga class

* spend 1 hour without technology: no phone, no internet, no iPad etc.

* visit the beach

* read your favorite book , or a book you have always wanted to read

* cook a new meal, try out a new restaurant or recipe

* take a walk/run/jog on a trail

* go sightseeing/exploring new places

* go on vacation

* meditation

* hot tub

* listening to music

* journal/painting/scrap-booking

* movie night
This list can go on, and on. You can also add your favorite activities to this list.
What are some of the things that you enjoy? What is one thing that you have been longing to do/try/experiment but you can’t find the time for it?

Problems of Mental Health in America

There is more than one problem with the mental health of America. There is more than one problem with the mental health of any country.

But our mental health is uniquely affected by our fascination and worship at the altar of celebrity. It hurts to see so much of human effort that centers around our celebrity-infected culture. Actors, actresses, singers — while I appreciate they entertain us, why are people so fascinated by their insipid lives??

Its this sort of shallow fascination that leads us to value things that don’t matter — celebrity — and de-value things that do — fellow human beings in our own local community.

We pawn off our local problems to “government,” not realizing that government is us. Every time you pass someone on the street that’s homeless — remember, that could be you with a different roll of the dice.
And there’s the rub — a significant portion of the homeless are mentally ill and in need of our compassion and our treatment services in America.

Instead, they get neither. They get jailed. They get no treatment. And worst of all, they get our contempt.
We have a lot of problems with mental health in America. But they can all be traced back to you and I — our individual choices matter. Our individual efforts matter. And our individual focus — whether it be on celebrity or helping those in need in our society — matter.

What are the social determinants of health?

The social determinants of health are the conditions, in which children, youth, and families are born, grow up, live and work, as well as the quality and accessibility to health care (Shern, Steverman, Ahmed, & Shea, 2011). Where you live can be a significant indicator of how well you live as well as how long you live. Such non-medical factors influence health and well-being, including health-related knowledge, attitudes, beliefs, or behaviors.2 Socioeconomic inequalities in health have been widening for decades. In the United States the data consistently show that people living in poverty, and particularly those who are minorities, bear a disproportionate burden of exposure to unhealthy environments and are at greater risk for mental and behavioral health-related conditions.3 In addition to health literacy, gender, education, sexual orientation and geography; culture, acculturation, language, race, ethnicity, socioeconomic status, and social exclusion significantly influence overall health status as well.4 These factors tend to be interrelated and contribute to disparities among, as well as within, groups.

Why address the social determinants of health?

Creating a framework that incorporates the social determinants of health can provide a more complete picture of why people become ill initially, and, moreover, what it will take to restore their health. It recognizes the value of equity and social justice as essential to staying healthy and accessing quality health care. Policy changes to alleviate the social determinants of health, such as poverty, racism, violence and access to resources, can have a far reaching impact on improving the health of a community, state or county. Addressing only the symptoms of illness and ignoring its root cause will not improve population health.

• Approximately 3.5. million individuals are homeless in America.5

• In the U.S., 44 million people are living in poverty and 41.3 million are using food stamps.6

• Children living in poverty are seven times more likely to have poor health than children in higher income households. 7

• With a prison population of 2.3 million, we now have the highest rate of incarceration in the world.8

• Approximately 30 percent of LGBT youth report having been physically abused by family members because of their sexual orientation, gender identity or expression.9

• LGB individuals had a 1.5 times higher risk for depression and anxiety disorders over a period of 12 months or a lifetime than heterosexual individuals.10

• African Americans are 30 percent more likely to report having serious psychological distress than non-Hispanic Whites.11

• In 2007, Hispanics were 3 times more likely to be uninsured than non-Hispanics.12

• American Indians and Alaska Natives have an infant death rate 40 percent higher than the rate for Caucasians.13

• American Indian/Alaska Native adults were 2.3 times as likely as white adults to be diagnosed with diabetes.14

• In 2006, adults with less than a high school degree were 50 percent less likely to have visited a doctor in the past 12 months compared to those with a bachelor’s degree.15

• Only 33 percent of disadvantaged fourth-graders are proficient readers at grade level.16
• Poor Mexican-American children ages 2 to 9 have the highest proportion of untreated decayed teeth (70.5 percent), followed by poor non-Hispanic black children (67.4 percent).17

Key Messages for Everyone

• Social determinants of health are the primary determinants regarding whether individuals stay healthy or become ill

• The larger the gap in health disparities, the more the overall health status of entire populations is reduced

• The larger the difference in health status between the healthiest and least healthy in a community the lower the overall health status of the population.

• Assess the community with the community using a community-based participatory approach (community engagement)

• Significant health inequalities persist among and within minority groups

Tips for Communities

1. Raise awareness of the importance of the social determinants of health and their impact on individuals and communities.

2. Pursue policies to assure that healthful food, safe housing and living wages are available to everyone in the community.

3. Support community activities to build social networks among individuals who represent differing racial or ethnic groups

The world is always ready to tell you who to be. Parents, teachers, friends,

members of the clergy all seem to have their opinion of who you are, what you

should do, how you should act, what should be important to you and who you will

be.

But when someone else is telling you about your life, no matter who they are or

how innocent, loving and caring their intent, they just don’t know.

They don’t what is in your heart. They don’t know your hopes, desires and

dreams. They don’t know your purpose. They don’t know what you can or

cannot accomplish in your life. Only you do.

It’s only you. You are the only one who knows what your life should be. You are

the only one who knows who you will be.

But how often do we look to others for the answers to our own lives? How often

do we look to others for guidance? And while others may give you advice and

they may tell you of their experiences, they are not in your shoes. They are not

part of your creative energy. They are living a different vibration than you are.

You are the only creator of your life experience.

No one else can make the decisions for you that will bring you happiness and

joy. Only you can. Yet, often through fear or apprehension, habits or

socialization we forget that we are the ones who know what is best for ourselves.

The voices of the world, including the people that we love, our friends, family and

even the media, movies, and advertising drown out the voice inside of us that is

giving us our real guidance. Sometimes we even ignore our own intuitions to

follow someone else’s lead.

But if we are to truly find joy and happiness in our lives we need to learn to
follow our own guidance.

“The wisest follow their own direction.”

~Euripedes

There are always clues as to what will bring you joy in life. We all have passions.

We all have things that we would do “no matter what.” We all have things that

make our hearts sing and bring fullness to our lives. There are always the things

that call to us, the things that make us feel passionate and excited, happy and full

of life. They are the things that we enjoy, the things that come easy to us.

And that is your clue.

When you have the good feelings, the feelings of joy, passion and happiness

you are on the right track. It could be no other way if you really think about it.

Human beings will almost always choose what feels best, what feels right and

good if left to their own devices. It is the way we are designed, the way that we

know what is best. It is only when we are following some one else’s guidance or

an arbitrary set of rules that we start believing, thinking, acting and even feeling

as if life should be a struggle.

Life was never meant to be a struggle.

Look at nature. Everything happens in perfect harmony, effortless and easy.

Plants do not struggle to grow. Animals do not fret and worry about the food that

they will eat. They just do, whatever they have

to do, and whatever happens is just part of

life. Life was never meant to be a struggle.

We can see those lessons in nature. The Life

we see in nature never goes against it’s own

instincts. There are no questions. In nature

everything is what it is:

● An elephant never tries to be a Zebra.

● A zebra’s mother never tries to get it to become a monkey.

● A daisy never tries to be a pine tree.

And when we look at nature even in the face of destruction and tragedy, nature

always comes back to what it is, just as beautiful as ever.

I recently saw a beautiful photograph. It was taken in the forest in what looked

like an early spring storm. The clouds in the background were gray and full. The

trees, which were Quaking Aspen, were stark black, white and gray and at the

bottom of the photo was the most brilliant green and pink of new flowering

blooms. It was breathtaking. I was drawn to the beauty of the photograph and as

I got closer I was able to read the caption that had been provided.

The photograph was of the new growth that came after a devastating forest fire.

That was the reason why the aspens were black and gray. That was the reason

why it looked like early spring before the leaves came back on the trees. There

were no leaves but the wild flowers were coming back, the foliage was

reemerging. The natural beauty of the forest was returning.

Even in the face of devastation, nature always comes back. It doesn’t struggle.

It never tries to be something that it is not. It just comes back as beautiful and

strong as ever, just as it is.

Life is not supposed to be a struggle.

When you do what you love to do and when you follow your own guidance, life is

not a struggle. And even though there will be difficult times, like the plants in the

forest you can rejuvenate and renew. Your life can become what you want it

to be. There is always enough time to make a change when you really want to.

So find what you love, do what feels good, follow your own council and decide

your own life. Disregard the opinions of the world and the opinions of other

people. They aren’t living your life. A passionate pastry chef with a law degree

will find more joy, happiness and success than a dispirited and unhappy lawyer.

A passionate writer or an inspired artist who just happens to also have a degree

in medicine will find more joy, happiness and success than an unhappy doctor.

Find your passion…

● Regardless of what has come before.

● Regardless of what the world says you should be.

● Regardless of what happens.

.

Life is not supposed to be a struggle.

When you do what you love to do and when you follow your own guidance, life is

not a struggle. And even though there will be difficult times, like the plants in the

forest you can rejuvenate and renew. Your life can become what you want it

to be. There is always enough time to make a change when you really want to.

So find what you love, do what feels good, follow your own council and decide

your own life. Disregard the opinions of the world and the opinions of other

people. They aren’t living your life. A passionate pastry chef with a law degree

will find more joy, happiness and success than a dispirited and unhappy lawyer.

A passionate writer or an inspired artist who just happens to also have a degree

in medicine will find more joy, happiness and success than an unhappy doctor.

Find your passion…

● Regardless of what has come before.

● Regardless of what the world says you should be.

● Regardless of what happens.

Some people go through life trying to find out what the world holds for them only to find out too late that it’s what they bring to the world that really counts.” – Anne of Green Gables

In today’s fast-paced world, it can be easy to lose sight of what’s important…

No, wait. I take that back. 🙂

It’s not really about our world being fast-paced, is that as we get older, WE become fast-paced.

It seems that as a child we intuitively knew the simple things that made life amazing… and as adults, it sometimes feel like we have so much to do, so much to be, so much to have… so much so that we need reminders of what it is like to live in a more present, aware, conscious, fulfilling way.

We all need reminders to bring us back to our true selves in life.

National Suicide Prevention Lifeline
With Help Comes Hope
1-800-273-TALK (8255)
http://www.suicidepreventionlifeline.org

Paying for Care
Receiving the proper care for your mental health condition is essential to your recovery. The best treatments are the ones prescribed by a doctor or mental health practitioner, and that may include counseling, medication, support, diet and exercise, and alternative therapy among others. Unfortunately, visiting mental health providers and paying for many of these treatments can be expensive. Not all people have access to affordable insurance.
Whether you’re insured or not, and whether that insurance coverage is adequate, there are ways that you can find help paying for your care.
Obtaining Coverage
Shopping for Insurance
Finding Care
Finding Supportive Services
Help Paying for Medication
Paying for Mental Health Care with Insurance

Paying for Care – Without Health Coverage
Much of the health care system in our country depends on health care coverage, which is usually provided by a form of insurance. If you don’t have insurance, it can be difficult to pay for treatment unless you are independently wealthy. Consider the options below to obtain coverage; in the meantime see Finding Care to get immediate help.

Obtaining Coverage
You may be able to obtain insurance if you are not currently insured. Here are some options:
Medicaid
Medicaid is health care coverage offered in combination by the federal government and your state government. It helps low-income individuals in certain groups pay for medical care and prescriptions. Medicaid is not a typical insurance program with monthly payments and deductibles; Medicaid pays providers directly for your care. Low-income beneficiaries aren’t the only group to receive Medicaid, as there are several other qualified groups that are covered (although some of this will change in upcoming healthcare reform).
In addition to covering those who are low income, Medicaid covers:
•Pregnant women
•Women with children under 6
•Children between the ages of 6-19
•Supplemental Security Income recipients
•Young adults up to age 21 living alone
•People over the age of 65
•Those who are blind or deaf
Many states also have a “medically needy” clause, which means you can receive Medicaid without falling under any of those categories if your state determines that you need the medical treatment and you are under the threshold of the Federal Poverty Level.
Many people with mental illness become eligible for Medicaid by qualifying as disabled, either as children or as adults after age 19. Adults determined to be disabled receive Supplemental Security Income (SSI) from the Social Security Administration. SSI provides a small amount of monthly income To find out if you qualify for SSI, visit http://connections.govbenefits.gov/ssa_en.portal.
Many children can receive Medicaid even if they are not otherwise eligible through their State’s Children’s Health Insurance Program (SCHIP). SCHIP requirements tend to be broader.
If you believe that you meet the income and eligibility requirements, you can apply for Medicaid. For specific questions about eligibility for Medicaid in your state, you should call your state office. For more information on Medicaid, click here – https://www.cms.gov/MedicaidEligibility/downloads/ListStateMedicaidWebsites.pdf
Medicare
Medicare, like Medicaid, is a health coverage plan run by the federal government. Medicare operates more like traditionally funded health insurance than Medicaid. Unlike Medicaid, Medicare is a federal program (without state differences) and is geared toward people based on age or disability status and not income. To enroll for Medicare, you must have received social security disability benefits (SSDI) for at least two years. [Add link on qualifying for SSDI]
Medicare mimics a private insurance plan and has deductibles and co-pays. Medicare is structured into four parts, and you may be eligible for one or more of the parts.
•Part A – Medicare Part A deals with hospitalization and inpatient services.
•Part B – Medicare Part B deals with outpatient services and routine medical care.
•Part C – Medicare Part C or Medicare Advantage is a way to extend benefits of A,B, and D
•Part D – Medicare Part D deals with drugs. People with very low income get extra help paying for the prescription costs and deductibles in Part D.
Coverage under Family Insurance
You may be eligible for coverage under your parents’ insurance plan if you are under the age of 26 due to new changes in the healthcare reform law. If you had previously been removed from coverage upon reaching age 22, you can re-enter the plan until you reach 26.
Employer Coverage
If you are employed, your company may offer health insurance as a benefit package. Employers may pay some or all of the monthly payments or premiums for your package. Employer plans tend to be more expensive and comprehensive than those on the individual market and frequently do not discriminate on the basis of pre-existing conditions. Often, employers who do not pay any part of your health insurance may still have a company plan that you can opt to enroll in.
COBRA
If you have recently lost your job, you may be eligible to keep your health insurance at a cost to you through the Consolidated Omnibus Business Reconciliation Act (COBRA). COBRA allows you to keep your health insurance for a specified period of time as long as you continue to pay the premiums.
School
If you are attending a state university as an undergraduate student, your state may offer a healthcare plan for you. Large schools and universities may have their own clinics or teaching hospitals. Some schools may offer programs for graduate students.
Private Insurance
If you are not able to obtain insurance coverage through family, work or school and you are not eligible for government insurance, you can consider buying insurance on the private market. Private insurance can be expensive, and you will need to evaluate your plan very closely.

Shopping for Insurance
There are several terms you will need to know before shopping for insurance:
Primary Care Physician – In many managed care plans or health maintenance organizations, you will have to choose a primary care physician, also sometimes called a general practitioner. Primary care physicians typically specialize in Internal Medicine or Pediatrics. Your primary care physician is the main doctor you will see for most of your ailments that don’t require urgent care. If you want to see a specialist, you may need a referral from a primary care physician.
Specialist – A specialist is a doctor such as an allergist, a gynecologist, or a podiatrist who specializes in treating one or more similar conditions or specializes in a specific age or gender group. Specialists may be able to run more tests and diagnose more problems than a primary care physician.
Referral – A referral is an authorization from your primary care physician to see a specialist or another doctor. It does not mean your insurance company will cover the cost.
Pre-approval – A pre-approval is when your insurance company “OKs” paying for a treatment before you take it.
Network – Insurance companies will typically list doctors or facilities as “in network” or “out of network.” Anyone who is “in network” has a pre-existing arrangement with your insurance company for how much can be billed and paid by the company. Out-of-network practitioners do not have a relationship with your insurance company; they may cost you more.
You will have to pick what kind of plan you want when you are shopping for insurance. There are several different structures of plans:
•A managed care plan, though often the most affordable, is the strictest when it comes to choosing your doctors. In a managed care plan, you may receive all of your services from pre-determined doctors or facilities. You might always have to go to Facility A to see your primary care physician and receive a referral before you can see a specialist chosen by your plan who also works in Facility A, and you may have to get all of your prescriptions at the same facility.
•A health maintenance organization is similar to a managed care plan, but instead of your doctors being chosen for you, you will have a choice as long as you remain “in network.”
•A point of service plan is similar to a health maintenance organization, but you may not need to visit a primary care physician for referrals to specialists as long as you stay within the network.
•A preferred provider organization (PPO) plan is the broadest type of plan, where you never need to see a specialist. You can go both in and out of network, but in-network care is cheapest.
There are several kinds of expenses involved when you are shopping for insurance.
•A premium is a monthly payment that you make to buy into the insurance,.
•A co-pay is any payment you make out of pocket when you visit a doctor or buy medication. For example, you may have to pay $20 when you visit your primary care physician and $40 when you visit a specialist.
•A deductible is the total amount you will have to pay out of pocket before your insurance coverage activates (although routine visits for general health may be excluded from this deductible). For example, you may have a deductible of $5,000. So if you are hospitalized and it costs $10,000, you will have to pay $5,000 before your insurance company will make payments on your behalf.
•A cap is the final amount that an insurance company will pay on your behalf either per year or over your lifetime, although this is going away. For example, you might have an annual cap of $100,000 and a lifetime cap of $1,000,000.
Generally, the higher the premiums are, the lower the deductible. Private insurance may also be more discriminatory than employer plans based on pre-existing conditions (although this is going away) and other statuses that affect your health (such as smoking or age). You may be able to find cheaper private insurance if you look for incentive-based plans that charge lower premiums for people who actively work to eliminate health risks such as smoking and obesity.
There are also some other things to watch out for: A pre-existing condition is a health condition you have before you applied for insurance, such as major depression. Before the passage of the health care reform law, insurance companies could deny you based on a pre-existing condition, give you a very high premium and/or deductible because of your condition, or agree to cover any illnesses except those related to your pre-existing condition. This will change as health care reform goes into effect.
Your insurance will have a list of covered conditions and procedures. You should always read this to make sure your plan is comprehensive. Insurance companies can refuse to cover certain diagnoses and treatments not on the list.

Finding Care
If you are applying for insurance or you can’t find affordable health coverage, there are a number of ways that you can still get care. You should never be turned away from a hospital if you are having a medical emergency, regardless of your ability to pay.
Free Clinics are non-profit organizations that perform medical safety net services for free or at a highly reduced cost. You can find free clinics in your area by visiting http://www.freeclinics.us/.
Free Clinics provide safety net services, which are intended to help people who are ineligible for Medicaid and Medicare but can’t find affordable health insurance. They are often found in hospitals or as stand-alone facilities in densely populated areas of poverty. Some, but not all, free clinics provide mental health services in addition to preventative general health and maintenance.
Generally, free clinics will perform services for free, charge a nominal fee ($15/visit, for example), or initiate a sliding scale fee based on your income. , When visiting a free clinic, you may need to take your identification, as well as proof of income, such as a prior year’s W2 form. Some clinics may take walk-in clients on a daily basis; others are more like doctor’s offices that you will have to join.
Community Mental Health Centers offer low-cost or free care on a sliding scale to the public. Typical services include emergency services, therapy and psychiatric care for adults and for children. You can expect to go through an intake interview that determines the kind of care you will receive. Mental health centers also may offer a variety of services on a long-term basis for clients with persistent mental health conditions. Find your local mental health center by contacting your local government.

Local Nonprofits that aren’t specifically designated as health clinics may still have therapists, psychologists, or psychiatrists who donate their time and agree to see patients for free or at a reduced cost. Many groups will organize professionals who will donate some time each week or month to see patients. These professionals will often meet at drop-in centers or other clinics.
Even if community mental health centers or local nonprofits don’t have a pro bono program, they may know of other resources available to you in your community.
Medical Schools may provide another way of finding help. Students and interns may meet with clients at a highly reduced rate, if you are comfortable seeing them. These students will be under the supervision of a licensed professional.

Finding Supportive Services
If you are interested in finding supportive services in addition to professional counseling look for these options in your community:
Hotlines and Warmlines provide immediate support by telephone for people in emotional crisis and people with mental health conditions. Where hotlines provide emergency support and crisis intervention, warmlines provide assistance, comfort and referral services. Hotlines and warmlines can be lifesaving, they provide referral to help and care, and they are comforting because they are anonymous and easily accessible by telephone.
Drop-in Centers are organizations that are generally run by people with mental health conditions for their peers. A safe, accepting place to go for company and support. Drop-in centers may organize activities such as support groups or trainings, but they may also be more informal gathering sites.
Support Groups may meet at various places in your community such as churches, schools or government buildings. You can find information about support groups on the Internet, on bulletin boards at local mental health centers and restaurants, or by asking other people with similar conditions. Some support groups also meet anonymously on the Internet, posting on forums or using e-mail to stay in touch. Support groups should either be free or should have a very low cost to cover food or activities ($5 a meeting).
You can find more information about support groups by visiting http://www.mentalhealthamerica.net/go/find_support_group.
The American Self-Help Clearinghouse (http://www.mentalhelp.net/selfhelp/) and the National Mental Health Consumers’ Self-Help Clearinghouse (http://www.mhselfhelp.org/) maintain listings of support groups on a broad range of mental health topics. The National Mental Health Consumers’ Self-Help Group Clearinghouse also maintains a Directory of Consumer-Driven Services (http://www.cdsdirectory.org/) that includes peer-run organizations throughout the United States that offer a variety of supportive services and activities.

Help Paying for Medication
The ongoing cost of prescription medications can be a challenge, especially if you are taking more than one prescribed medication.
Some pharmaceutical companies offer prescription assistance programs to individuals and families with financial needs. These programs typically require a doctor’s consent and proof of your financial status. They may also require that you have either no health insurance or no prescription drug benefit through your health insurance.
In addition, there are county, state, and national prescription programs for which you may qualify and special drug discount cards offered by some pharmaceutical companies.
The Partnership for Prescription Assistance can help qualifying patients without prescription drug coverage get the medicines they need through the program that is right for them. Many will get their medications free or nearly free. For more information, visit http://www.pparx.org/ or call 1-888-477-2669.
Cutting Costs
Discuss with your doctor if switching to generic drugs or less expensive brand-name prescription drugs is a safe option for you. It is important to let your doctor know if you cannot afford your prescriptions. He or she may be able to give you free samples of your medications.
Compare the prices of your prescription drugs at different retail pharmacies. Many retail pharmacies list their prices for commonly prescribed drugs online, or you can call local pharmacies to request prices for your medications.
Want to try out a comparison tool? Check out Destination Rx at http://www.destinationrx.com/ to compare pricing of your prescription medications.
Medicare Part D
Medicare prescription drug coverage, also referred to as Part D, is a program that helps individuals who receive Medicare benefits pay for prescription drugs. This program covers both brand name and generic prescription drugs at participating pharmacies in your area. Everyone on Medicare is eligible, regardless of income, health status, or current prescription expenses.
There are two types of insurance plans that vary in cost and drugs covered:
1.Medicare Prescription Drug Plans, sometimes called “PDPs” only offer the Medicare drug benefit.
2.Medicare Advantage Plans, sometimes called “MA-PDs,” are managed care plans (like HMOs and PPOs) that offer more comprehensive health care coverage, to which the drug benefit will be added.
Extra Help is a program that helps eligible people with Medicare pay for some or most of their prescription drug costs. To learn more about Extra Help, visit http://www.mentalhealthpartd.org/consumers/04_Extra_Help.php.
For more information on Medicare Part D visit http://www.mentalhealthpartd.org/, and click on “Consumers and their Families.”
Want to find and compare Medicare drug plans or enroll? Visit http://www.medicare.gov/Default.aspx.

Paying for Mental Health Care – With Health Coverage
Dealing with insurance plans can be challenging, especially when you are already stressed and worried about mental health issues you or a loved one are experiencing. For this reason, it is best to understand your benefits before you need to use them, if at all possible. The following are steps you can take to make sure you understand your benefits so that you can do whatever is within your control to have your treatment covered.

Reviewing Your Insurance Policy
The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. You should have received a copy of your insurance policy when you enrolled in the program, whether at work or independently. If you did not receive a copy of the policy or have lost yours, you can call your insurance company and ask for another one to be sent to you.
Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. This way you can identify any possible points of confusion before you receive a bill. You should have a number on your card or on the website that will tell you whom to contact.
The following are some questions you will want to ask your insurance company, if possible, before starting treatment:
1) Do I need a referral from my primary care physician to a mental health professional?
Many insurance companies, especially Health Maintenance Organizations (HMOs) require referrals from a primary care physician to visit any specialist, including mental health professionals. If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance.
2) Do I need any pre-approval from the insurance company before I see a mental health professional?
A referral is an authorization from a doctor saying that the treatment is medically necessary; pre-approval or pre-authorization­ requires that your insurance company agrees to make the payment. You should call your insurance company to see if you need pre-approval, but you should also keep other questions in mind-how many visits are you approved for? Do you need a new approval for each visit? If you are going to be hospitalized or in inpatient care, how many days are you allowed to stay?
3) Do I need to see a mental health professional who is on a list provided by my insurance company (in a “network”) or am I free to choose any qualified professional?
If you need an “in network” provider, you can usually find a directory online or ask your primary care physician to help pick someone out.
4) Does the amount paid by my insurance company depend on whether I see a professional who is “in their network or preferred provider list” or “outside the network”? If so, what is the difference in the amount paid or percent reimbursement for “in network” vs. “out of network” providers?
“In network” providers are almost always cheaper than “out of network” providers, although whether you want to save money or visit a doctor you prefer is a choice you will have to make. Bear in mind that your insurance company may not always have a flat difference. For some companies, seeing an “in network” provider may cost you a $20 co-pay, and an “out of network” provider will cost you $30; in others, “in network” may cost you $20 and an “out of network” may cost you 20% – which could be significantly higher than $30.
5) Are there dollar limits, visit limits or other coverage limits for my mental health benefits? Is there a difference in what is paid for outpatient vs. inpatient treatment? If so, what are my benefits for each of these?
It is not uncommon, based on your state and your plan, to have limits on psychiatric visits or medication management visits. Your plan may limit you to something like 25 sessions with a psychiatrist each year, up to 7 days of inpatient treatment a year, and 12 medication management visits a year. If you exceed these services, you will have to pay out of pocket.
6) Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?
Insurance companies often have the option to not include certain diagnoses in all policies. If you applied with your condition as a pre-existing condition, they may not cover anything related to that. Your insurance company will provide you with a list of covered and uncovered diagnoses.
7) What prescription benefit does my policy offer? What are the co-pays for medications? Are there different levels of prescription coverage depending on the specific medication? Do co-payments vary depending on whether the medication is generic or name brand?
Not all health insurance plans offer a prescription benefit plan in addition to a treatment plan. Even if you have a prescription plan, not all medications are covered. Many prescription plans have “formularies” that determine how much you pay for different classes or brands of drugs. Covered medications fall into three categories:
•Generic: These drugs are copies of brand-name drugs that have been on the market for a number of years and are often offered at very cheap prices.
•Preferred: These drugs are name brand but are available to you at a price below the retail price.
•Non-Preferred: These drugs are name brand but are not offered at a very large discount.
Insurance companies regularly update their formularies to classify drugs under certain payment categories. It’s best to ask your doctor to help you find out what payment category your drug is in before you go to the pharmacy to avoid an unpleasant surprise when the bill arrives.
However, many prescription medications for mental health conditions are very expensive and even with health insurance, you can find yourself paying a lot for a prescription.
Mail Order Pharmacy – Some insurance plans will allow you to order a three- month supply of maintenance drugs through the mail for a reduced, standard price.
Seek Outside Assistance – Go here to find out other ways to help pay for your prescription medication.

Seeking Help in Understanding Your Policy
If you have trouble understanding the policy, see if someone from your doctor’s office, your employer, or a trusted friend, can help explain the information.
If you receive health insurance through your employer, you may be able to go to your Human Resources department. If your company is large, you may have a dedicated Benefits Specialist who will be able to help you navigate health care. If you work for a smaller business, you will want to talk to the person who arranged the health care. They may not be able to help and their knowledge may be administrative, but they may help put you in touch with an advocate who can put you on the right track. You may be hesitant to admit to your employer that you need help with a mental health condition, but it is not legal for your employer to fire you over a disability.
If you have private insurance, you can contact your state Insurance Department (http://www.naic.org/state_web_map.htm) or state Insurance Commissioner’s office (http://www.naic.org/documents/consumer_hipaareps.pdf (their consumer hotline may be the most helpful) for help in understanding your insurance policy. They can also help you find out whether your company benefits follow the state mental health parity laws (laws that guarantee equal coverage for mental health conditions as for other health conditions), and can assist you in dealing with your insurance company if you are having a problem.

National Suicide Prevention Lifeline
With Help Comes Hope
1-800-273-TALK (8255)
http://www.suicidepreventionlifeline.org

“Have Faith ”
“Give More”
Expect Less”
Be true 2 You”

Meaningful Work and Recovery
Although you will encounter roadblocks and setbacks on the road to recovery, working at something that is meaningful to you can bring you a sense of purpose that will anchor you. Meaningful activity expands your sense of self-worth by adding to your skills and helping you accomplish your personal goals and feel good about yourself. Meaningful activity, which includes school, volunteer work, part-time work and full-time employment, also enables you to meet new people and make friends.
We all need some form of meaningful activity in our lives and a means of supporting ourselves, but having a mental health condition can be an obstacle. Mental health conditions impact different people in various ways. Some people with mental health conditions may never stop working; others find that their condition interrupts their career, and still others may be able to do only limited work. As people recover from a mental health condition, they also face varied challenges in relation to work. Some people with mental health conditions find that they are able, with minor accommodations, to work in the same way they did before. Others may have to re-enter work gradually. And people on disability benefits will need to observe back-to-work rules when employed.
No matter your situation and no matter the hurdles you face, hold on to your goals for yourself and keep striving to incorporate meaningful activity into your life. In the past, people with mental illness were often discouraged from working, but today we understand that work is not only a possibility, but it can also play a vital role in recovery.
It’s true, however, that having a mental health condition can pose some practical barriers to working, such as having breaks in your career, feeling unsure of yourself, or needing to ask for an accommodation such as time for doctors’ appointments. You can figure out strategies to work around these barriers, often with the help of friends, mentors or an employment specialist. Don’t give up!
Supported Employment
Your Work Choices
Work-Related Issues

Supported Employment
Supported employment services assist you in preparing to work, finding and keeping a job and thriving in a work environment. Depending on where you live, you might be offered supported employment help through the local office of your state’s vocational rehabilitation service, through the mental health agency where you get mental health services, or through a nonprofit disability employment agency. Because of local differences, be sure to check with all of these sources. Your state’s Office of Vocational Rehabilitation should be able to help you find supported employment services.
In supported employment, a vocational counselor will help you assess your career interests, job skills, and work challenges. The counselor may suggest job categories that fit your interests, help you write a resume, coach you for interviews, and prepare you for what to expect if you haven’t worked recently. While you will get a lot of help, you will also be expected to work hard on solving problems, planning your career, and looking for jobs. Don’t expect to be handed a job or simply placed in work. The main responsibility will be yours.
The prospect of job hunting can seem daunting, and looking for work is like a job in itself. You need to put in regular hours and keep at it. Perhaps the biggest challenge is getting discouraged. In the competitive marketplace for work, expect to be turned down by many prospective employers before landing a job.
An important source of help that many job hunters in your community use is the local public employment office. These days, such offices are typically called “career one-stop centers”. They offer a wealth of self-help resources on preparing for and finding jobs, computers you can use, and trained staff. Many have a staff person trained as a disability navigator who will understand the challenges you face and guide you to sources of help. Find your state’s network of employment centers here.
Once you find a job, your next challenge is to keep it. Work is rewarding, but it also can be tiring, so be sure to get enough rest and care for yourself. Give yourself time to get used to the demands of working. Above all, it’s critical to use your support system – friends and family, your therapist or case manager and peer support group – so you can talk over your experiences at work and get help if your mental health condition is affected. Be sure to let your doctor know that you are going to work and get help in making any needed adjustments to medications as your situation changes.

Your Work Choices
What comes to mind when you think of a job? Is it working full-time, five days a week? If that prospect feels daunting to you, remember that there are other work choices to choose from. One of them might be more suited to your current abilities and stamina, and might be easier to find than full-time work.

Volunteer Work
While many people want to have a paying job, volunteer work is another form of meaningful activity for many people with mental health conditions. Some people use volunteer work as a stepping stone to paid employment; volunteering can help them re-learn skills and grow comfortable working with other people. Others decide to volunteer instead of work. Volunteering not only gives you a sense of pride, but it can make you feel good about yourself to help out in the community.
If you have a cause that you feel passionately about, you may already know where you want to volunteer. Most organizations that have a lot of volunteers will have a coordinator who can help bring you on board. To find volunteer opportunities, you can contact your city or county information line for the contact information for a coordinator. You can also look for “Volunteer Clearinghouse” or “Volunteer Center” in a phone book. The Internet can be a great tool to search for volunteer opportunities; try visiting http://www.volunteermatch.org/ or http://www.1-800-volunteer.org/.
Remember that just because you don’t receive a wage as a volunteer doesn’t mean you aren’t entitled to fair treatment and respect. You should feel safe and comfortable in your work environment, and people should treat you like a human being.

Internships
When most people think of internships, they think of college students working for free for credit. Internships aren’t actually student specific; they are a blend of education and work. An internship usually involves a close relationship with other staff at a business working on specific projects and tasks. Where a volunteer might answer phones or bring food to homeless people, an intern might help a program staff member develop strategies to bring the food to the homeless. Sometimes the line between intern and volunteer can be blurred. Some internships will offer an hourly wage or a paid stipend, although such internships can be highly competitive. If you are a full-time college student, ask your career office whether they participate in the U.S. Department of Labor’s Workforce Recruitment Program. Recruiters interview college students with disabilities early in the year for summer intern positions.
If you are interested in an internship, make sure you ask your employer at the interview about the specific tasks and projects you will work on. You should expect to spend some of your time doing administrative work like filing, but you should also get a sense of a real opportunity to learn on the job.

Temporary Employment
Temporary employment can be a good bridge to permanent work. You register with a temp agency that can then place you in short-term assignments in companies that need extra help. These assignments could last from a few days to several months and can sometimes lead to an offer of permanent work. By temping, you establish a current resume, sharpen your skills and test your own ability to return to work.

Part-Time Employment
Some people use part-time employment (working less than 35-40 hours a week) to transition to full-time employment; other people find that they prefer working part-time to working full-time permanently. Part-time employment can give you more free time to take care of yourself and your responsibilities. It may be more accommodating if you find that you need more time away from the office to handle your mental health condition. However, part-time employment usually pays less than full-time employment, and part-time work often comes without benefits.

Full-time Employment
Many people with mental health conditions are able to work full-time. Full-time employment usually includes sick leave and may include health insurance, making it easier to handle health problems. Company retirement plans for full-time employees enable you to grow your savings. You may want to look for government work, as local, state and federal employers have a good record of hiring diversity and respecting disability regulations.
Finding employment, whether full-time or part-time, usually involves preparing your own resume and job-hunting in your local employment market. Job hunting can be discouraging for anyone, especially if job openings are scarce and there is a lot of competition. If you are having a hard time finding a job, you can look for help from an employment agency, supported employment services or close family members or friends. It is important to have support while job hunting; seek it from friends, from a job-hunting club, a support group, or a peer-run drop-in center.

Self-Employment
Some people are not interested in traditional employment-working for someone else-but are able to work for themselves. You might want to start and grow your own business. Do you have a product or service that you can sell? Do you have a hobby or skill like jewelry making, baking, or playing and instrument? Can you provide a service such as lawn mowing, pet-sitting, or writing and editing?
Working for yourself enables you to set your own schedule, and avoids the problem of disclosing your condition that sometimes arises in the workplace. On the other hand, it demands self-discipline and for tax purposes, you need to track your expenses and income.
To prepare yourself, develop a simple business plan that outlines what you plan to sell, your customers, your competition, and your expenses. You can get help with starting your own business from local offices of the Small Business Administration, your county or state economic development office or craft guilds and associations. Also, be sure to contact your state’s vocational rehabilitation office for help with self-employment.
The Abilities Fund (http://www.abilitiesfund.org/index.php) is an organization that provides assistance to people with disabilities interested in self-employment and entrepreneurship.

Common Work-Related Issues

How will working affect my government benefits?
If you have a mental health condition, you may receive Social Security or other government-funded disability benefits, or private disability benefits from a previous employer. While disability benefits typically pay below a wage you would expect to get while working, they provide regular income. Additionally, if you are on disability and/or below the poverty line, you may receive health care through Medicaid or Medicare. Remember, too, that eligibility for housing programs and the rent you pay may be affected by your income.
Having a paying job or earning other types of income can affect your status in Medicaid or Medicare. This does not mean you should be afraid to work, it means it is important to understand the rules before you work. While the interaction between Medicaid and Medicare can be complicated, under either program, you can earn a certain amount of money without losing your benefits.
Because everyone’s situation is different, you should always talk to a trusted and knowledgeable person who can help you understand your work options and how your choices will affect your benefits. A good starting place is reading about Social Security Administration work incentives and reading the SSA manual called the Red Book. Contact your Social Security office, local Center for Independent Living or Office of Vocational Rehabilitation to find people with special training to help you understand how the rules apply to you. Case managers at your mental health center also may be able to help.
The Social Security Administration sponsors a program called Ticket to Work. Ticket to Work is a voluntary and free program where people with disabilities receiving social security are helped to go back to work by a local employment network. For information call 1-866-968-7842.

What are some things to watch out for?
If you haven’t worked in a while, here are some things you need to pay attention to:
Look out for advertisements that promise large sums of money for small amounts of work, such as making $2,000 a week while learning to buy and re-sell houses or making $3,000 a week sitting at home using your computer. Very few, if any, people make money doing these activities, and it may end up being harmful.
•The possibility of working from home may be very appealing to you. Be sure to look into such opportunities very carefully to be sure they are legitimate.
•When you work, your employer must withhold payroll taxes and Social Security tax. Beware of people who don’t ask you to fill out any tax forms or take taxes out of your paycheck. You can get in legal trouble if you don’t pay required taxes, and it might keep you from receiving government benefits.
•If you receive Social Security disability benefits, you must report your income regularly. Keep original pay stubs as proof of your earnings in case questions arise.

What are some other things I might need while looking for a job?
Documents – When you apply for a job, you will need certain documents to verify your identity and your right to work in the United States. A U.S. passport usually satisfies all requirements, but if you don’t have a passport, you will need other forms of ID, including a state-issued picture ID, a social security card or a birth certificate. If you don’t have a driver’s license, your state’s Department of Motor Vehicles (DMV) office can still issue you a walker’s ID.
E-mail, phone and permanent address – If you’re moving around frequently or staying with friends, you will still want an e-mail address, phone number and a permanent address that you can check regularly for your work. A cell-phone enables employers to contact you quickly. If you visit family and friends and trust them, ask if you can use their address temporarily. Otherwise, you might want to consider getting a P.O. Box from a local post office. You can get a free e-mail address from Yahoo, Google g-mail, MSN and other sources.
Transportation – You might also encounter a problem with transportation. If you do not have a car, you should always ask the places you’re interested in working for if they are accessible by public transportation.

How do I explain the gaps in my employment history?
If you have been out of work or changed jobs frequently because of your mental health condition, your resume may reflect that.
Highlight your skills first. Most people are used to a chronological resume, which shows the jobs you worked with your most recent job first. A functional resume displays your list of skills and qualifications before it shows a chronological breakdown of where and when you worked. Stress your skills, abilities and expertise first.
Be honest. One of the worst things you can do is lie in an interview or on a resume. If your employer finds out that you lied in the hiring process, he or she can usually fire you and leave you with no unemployment benefits.
Be prepared. Know what you’re going to say if or when your employer asks you why there is a gap in your employment. You do not have to disclose information about your condition during job interviews or when you are first employed.

How will my mental health condition affect my job?
If you’re already working when you are diagnosed with a mental health condition, you may be worried about the effect it will have on your employment. You may wonder how it will be possible to manage your condition and balance your work, or you may worry if you can even keep your job. Many people with mental health conditions lead very fulfilling lives, and work can be a big part of that life.
If your mental health condition affects your ability to work, you may need to ask for a reasonable accommodation under the Americans with Disabilities Act of 1990 (ADA). The Act requires that many employers make reasonable accommodations for employees with disabilities. A disability is legally defined as a physical or mental impairment that substantially limits one or more of the major life activities of a person, or a history or appearance of such impairment. You may have a disability as a result of your mental health condition.
It is illegal to discriminate against an employee in the workplace based on a disability if a reasonable accommodation can be made. However, an employer doesn’t have to make an accommodation if it would cause an undue burden-financial, administrative or otherwise-to the company. Asking your employer if you can take two small breaks instead of one large lunch break might be considered reasonable if it doesn’t interfere with your ability to help customers. Asking an employer to build you a soundproof quiet space if you work at a train station might not be considered reasonable. Some small organizations may also be exempt from ADA requirements based on their size.
Plan ahead before you bring up the subject of disability and reasonable accommodations. Make sure that you know what elements of your disability are interfering with what parts of your job and what specific steps you can take to address those concerns. Don’t assume that because the ADA is the law that your employer will be familiar with its requirements or receptive. Put your request in terms of help you need to keep doing a job for the employer, rather than a demand for an accommodation. It can be helpful to talk about your request with people who support you to get feedback and make you feel more comfortable. For free support, contact the Job Accommodation Network at 1-800-526-7234 or visit http://www.jan.wvu.edu/.

What if I’m uncomfortable in the workplace?
Despite efforts to educate the public about mental health and mental health conditions, you may still encounter prejudice from people who don’t know or understand what you are going through. If you think that your employer has illegally discriminated against you or violated your privacy rights because of your mental health condition, you should ask for help.
However, you might feel uncomfortable in your workplace even if your employer hasn’t done anything illegal. Maybe your co-workers are judgmental; maybe your work doesn’t offer enough benefits for someone with your condition. Or maybe, you are feeling self-conscious or awkward in a new situation.
Give yourself time to get accustomed to work and the people you work with. Be friendly, but use discretion in how much personal information, such as information about your condition, you share with others. Remember that the primary relationship at work is with your supervisor; listen carefully to what your boss asks of you, and ask for guidance when you need help or are unsure. Get feedback on the things disturbing you at work by talking with trusted friends or a support group outside of work.
You can suggest that your employer take steps to make your workplace more mental health friendly. Send your suggestions to your human resources department or your management team; many offices will have an anonymous suggestion box. Others might have a reward system in place for offering good suggestions.

What are the qualities of a mental health friendly employer?
A mental health friendly employer might have some or all of the qualities below:
•A Good Track Record – Employers who treat their employees with dignity and respect earn a good reputation. Ask people you know about any positive experiences they may have had with particular businesses that were especially accommodating. Ask your treatment team if they can recommend any local employers that stand out.
•Flexible Time and Scheduling – Businesses that allow employees to work outside of the typical hours of 9-5 have shown that they can balance worker and workplace needs to make employees more comfortable.
•Telecommuting and Part-Time – Employers who allow employees to telecommute and work from home on some or all days or allow people to work part time may be more accommodating.
•Time-off Benefits – You may want to consider an employer who offers a lot of sick and/or vacation leave or the ability to take “leave without pay.”
•Employee Assistance Program – An Employee Assistance Program (EAP) is a benefit that an employer provides where anyone who needs help can talk about his or her problems, confidentially by phone or in person. Some visits may be limited.
•Mental Health Benefits in a Health Plan – You can ask to see what kind of benefits an employer’s health plan includes. There may be different payment structures for mental or general health, depending on your employer’s size. You also might want to make sure that your mental health condition is covered and understand the process for mental health visits (if the plan restricts medication management or therapy).
•Short-Term and Long-Term Disability Plans – Short-term and Long-term disability can provide you 60% of your salary (including short-term disability) if a doctor decides you are too disabled to work. Some disability plans may also cover mental health conditions.

National Suicide Prevention Lifeline
With Help Comes Hope
1-800-273-TALK (8255)
http://www.suicidepreventionlifeline.org

Have Faith
Give More
Expect Less
Be True To You

Signs of bipolar depression
Signs of bipolar depression are more varied than you may expect.
Actually one of the critical ways bipolar depression can be distinguished from unipolar depression is this variability in the symptoms of depression – bipolar depression symptoms are varied, whereas unipolar depression is more predictable.
A summary of the existing research indicates you could be looking at bipolar depression if there is:
1. Substance abuse also present.
2. Abnormally irritable or hostile (or both).
3. Psychosis of any kind.
4. More changes in mood so that the person appears more emotionally unstable.
5. Symptoms are different from episode to episode for any one particular individual, and symptoms are more varied on the whole.
On the other hand, you are more likely dealing with unipolar (“Ordinary” or “Classic”) depression if there are:
1. Physical symptoms such as unexplained pains or heightened sensitivity to pain.
2. Anorexia and/or appetite loss and/or weight loss.
3. Anxiety and agitation.
4. Insomnia.
5. Less variability in symptoms. Tends more towards the stereotypical cliche of a depressed person.
Also, there are COGNITIVE symptoms of bipolar depression that many people (including clinicians) are NOT well informed about.
By “cognitive symptoms” I mean those things that show some problems with what we usually consider normal day to day thought processes. Examples would be functions such as:
1. Concentration
2. Judgment
3. Memory
4. Comprehension, and
5. Capacity for abstract thinking.
Cognitive difficulties are increasingly recognized and researched as bipolar depression symptoms.
If the topic of cognitive problems in bipolar depression interests you, see our page on “Bipolar Memory Loss”.

Learn more about bipolar depression.

Bipolar 2 depression
Is there a difference between Bipolar 2 depression versus “classic” Bipolar 1 depression?
Traditionally we distinguish Bipolar Type 1 from Bipolar Type 2 according to the presence or absence of mania OR the intensity of any manic episodes.

Learn more about Bipolar Type 2
However, all this focus on mania may not give us the full picture of bipolar symptoms.
It seems there are differences in how depression is experienced in Bipolar Type I versus Bipolar Type II.

Bipolar depression symptoms can lead to suicide attempts.

In Bipolar Type II:
1. Sufferers are more likely to be women.
2. Episodes of depression are less severe but are more frequent and last longer.
3. In Bipolar Type II depression, the accompanying conditions are more likely to be substance abuse and/or anxiety, but Bipolar Type I is more likely to be co-morbid with psychosis and hospitalizations.
NO NOT MAKE THE MISTAKE OF THINKING THAT DEPRESSION IN BIPOLAR TYPE II IS LESS IMPORTANT OR DANGEROUS. RESEARCH SHOWS MORE SUICIDE ATTEMPTS AMONGST THOSE WITH BIPOLAR TYPE II DEPRESSION.
In summary, specific bipolar depression treatments are needed in order to successfully overcome bipolar depression symptoms. Bipolar depression differs from other causes of depression such as postnatal depression or “regular”, “unipolar”, or “classic” depression. In particular bipolar depression does not exist in isolation from other bipolar symptoms such as switches into bipolar mania.
(Anyone who wants to learn more about bipolar depression symptoms should read Manic-Depressive Illness: Bipolar Disorder and Recurrent Depression, 2nd edition, by Goodwin and Jamison – the most authoritative text book on bipolar and depression and the main source of the information reported here.)

So is it depression or bipolar?
The wrong diagnosis may lead to disaster. Is it depression or bipolar?
The short answer is that the difference between the two lies in the presence or absence of mania.
For the person who is suffering, their subjective experience will feel a lot the same. And it will suck!
A “regular” depression and a bipolar depression may feel the same on the inside:

It is dangerous to confuse bipolar depression symtoms with

1. Feelings of hopelessness or worthlessness
2. Lethargy or outright exhaustion
3. No interest in the people, activities and things that once mattered most
4. Changes in appetite, sleep and concentration
5. Zero interest in sex and/or no confidence in one’s own sexual appeal
6. Social withdrawal
7. Sometimes feeling weepy or outright crying jags
8. Sometimes decline in personal grooming or hygiene
9. In extreme cases, an inability to keep getting up and going to work or school, or even get out of bed.
Is mania present or not? With mania = bipolar! Without mania = depression!
Bipolar disorder is characterized by the presence of major depression, AS WELL AS episodes of mania that last for at least one week.
So what is mania anyway? The tricky part is that mania can take different forms.
Sometimes it can be feeling euphoric or expansive. A manic episode may lead a person to feel highly energized, on top of the world, or like they can do anything (feelings of grandiosity).
A manic person may:
1. Need little or no sleep
2. Become very talkative
3. Become very uninhibited
4. Have racing thoughts
5. Engage in reckless or impulsive behavior like excessive spending where they waste cash or run up credit cards, or be very sexually active (in contrast with usual attitudes and behaviors about sex).
To satisfy the clinical criteria, the manic episode must negatively effect the person’s life.
However, some manic episodes go undiagnosed because the signs overlap with certain symptoms of depression or other conditions, and do not fit into the old time stereotype of the manic-depressive.
For example, instead of seeming euphoric or energized, the manic person may be extremely irritable, disorganized or anxious.

Bipolar or depressed? Discover commonly overlooked clues.
Differentiating depression from bipolar depression symptoms matters a lot because of the difference in treatment options.
You can check for unipolar depression using a reputable online depression test. For example, the Beck Depression Inventory Test.

Some of the most effective treatments for depression are medications such as SSRIs like Lexapro, Prozac and Zoloft.
The issues are complex and still being debated, but it seems that at least sometimes, these medications can trigger mania in a person with bipolar depression symptoms and make their condition much worse.
The most effective treatments for bipolar are different to the more commonly prescribed SSRIs and include mood stabilizers such as lithium

BIPOLAR SERENITY PRAYER”
God- Life is about more than me. There is a meaning and design to the world independent of what I think or feel. The first (and maybe biggest) trap of bipolar is to convince you that “it” is all about you and the measure of how things are is how you feel. “Life is not about what I can or cannot control, thank goodness, because so much of this is beyond my control.” There is a “higher power.” There is someone to turn to when I feel all alone and powerless and all feels loss. grant me the serenity-“Grant”- that means it is a gift.

It is not something I earn or create. Serenity is not something that I accomplish. It is something I accept. And again it means giving up my need to control. “If everytime I say control I could change it to manage or influence my life would be so much better.” Serenity is a focus on here and now. It is not being angry or sad about things gone wrong, or anxious about things yet to go wrong. Serenity is about taking things as they come. To accept the things I cannot change-acceptance is such a major part of dealing with this. So much time is needlessly worrying about “what I got”, and not enough about “what I do with it.” Control is a focus on what I got. Management is a focus on what I do with it. A first rule of walls- “No matter how much you bang your head on them it doesn’t create a door to walk through.” the courage to change the things I can..

To live with bipolar means to be scared. There is a good reason some people call it a “terminal disease.” Positive steps are sometimes so small that they don’t always even seem a step. There are enough wounds and scars that you can’t help but worry sometimes about what is next. “And sometimes it so hard and so tiring and seems so impossible you just don’t want to try. Giving up seems to make such good sense.”

And the wisdom to know the difference-The beginning of all is to know. “Knowledge is necessity.” A big part of knowing what to do is knowing what you got. Another major part of wisdom is staying focused. Looking. Not assuming that because something feels so it doesn’t make it so. Wisdom also means realizing when you are not being so smart. The smartest thing is to be able to see our foolishness quick enough not to wreck. It is important to realize that these things don’t just happen sequentially. It isn’t just do this first and this second and so on. Each one feeds into the other and the other feeds into it. Serenity helps give you courage, but courage increases your serenity. Wisdom helps to develop both, but each of them also increases wisdom. It is a net in effect. The serenity prayer in a real way is a safety net to keep you from drowning in the high waters of bipolar.
God grant me the serenity to accept the things I cannot change the courage to change the things I can and the wisdom to know the difference.
Amen

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