Expert: Libby Bonner - 11/15/2008

Question
QUESTION: I have been diagnose bi-polar a few yrs ago and recently lost insurance/meds from losing (another) job. I have been in a relationship for 13 yrs on and off....10 yrs together. I sometimes get these irrational beliefs that he's involved with someone at work, I want to check his phone, emails/dig through computer for anything I can find. This happens every few months---how can I tell when it's just paranoia, it feels real to me at the time and I am driving us both crazy.

ANSWER: So you currently are on meds or not?  If yes, which meds?  [If no, tell me what you have done so far to find less expensive meds.  AND will the boyfriend help you some w/ meds or other expenses?]

Also, re access to meds: are you in a rural area, metro, or something in between?

13 yrs on and off - 10 years together, as in currently together now???

I wouldn't call paranoia that feels real "JUST" paranoia, I'd call it a symptom.  A differenct Q would be How can I tell if it's just insecurity....      When did this start, relative to either moving in or out w/ boyfriend OR losing your [latest] job?  "Happens every few months"....I would note these episodes on a calendar to that you can maybe begin to see if it the correlate w/ anything else going on in youtr life.

Don't know what kinds of providers assist you, other than a psychiatrist, but you might find many kinds of help at a community mental health center.  Go to samhsa.gov to locate the two nearest you.
Would be good if you had a social worker, maybe went to one or more of the center's training classes,...and they might even have supported employment to help you find and keep a job.  They certainly will know what other agencies and resources exist near where you live.

Everyone w/ a mental illness needs meds + as many other sources of help and support as they can find, and they need contact w/ peers.  NAMI has a new program called Connections, where persons w/ mental illnesses can meet in a low-key, undemanding environment.  The NAMI website, nami.org, might list them geographically, or your mental health center might know if one is up and running yet, where you live.

If you still have family contacts, be sure to use them as help and support.

Send me some answers/comments and I will write again.

---------- FOLLOW-UP ----------

QUESTION: We are together now, yes. We first started dating when I was 16. Lived here for 5 years this go round.I have been on several meds such as abilify, zyprexa, depacote. Not currently taking. Without insurance, the one that was actually making me feel better is over $300.00 per month plus visits. It is even high to add me to insurance right now just due to expenses and such. Metro area. The mental health facilities have so many "must do's" to get the meds n such that it's really too much. They seem more interested in marijuana use than anything else. I just seem to get "suspicious, angry and thinking someone or everyone is against me (hates me).

Answer
I stand by most of what I wrote before.

Thanks for adding info, but I am now confused anew.  Do I understand that you could get meds via a MH center but prefer bipolar and the consequences of being biploar?  Or do you mean it overwhelms you to struggle through all the must-do's.  IF the latter, then you really must find a friend, ex-co-worker, or family member to help you get started again w/ a center, esp if that connection will get you less expensive meds.

The centers are always interested in substance use, but perhaps not for the reasons you imagine.  They are interested because other stuff may interfere w/ meds.  They are also interested because number, amount, and frequency of use often indicates how bad the mental illness is making the person feel...their assumption is that much of this use is self-medicating in order to feel less mentally ill.....and usually this is the case, that substance use drops substantially as Rxs kick in and symptoms start to go away.

Wondering what your wonder drug was, and whether it worked because it was added to other meds you were already taking OR whether it alone benefits you, or would benefit you.

And the last sentence?  That's all they are interested in??  OR - you meant something else?  IF paranoia is your most prominent symptom, is there any question about your diagnosis???  Just wondering.

Not sure how many centers you have tried, but if you are in a large area and have transportation, you could try another.  I would want to talk to some other patients, though, and see which centers and which docs they like.

I wonder if you have a Mental Health Assoc where you live [except that I think they have changed their name....but Googling should tell you both the old and new names.]  They do some good work directly w/ clients.  

As to free or low cost meds.  Are there any free clinics where you are?  We have a couple here; they will not prescribe, but can fill Rxs whenever they have the meds on hand.  You might also call the hospitals or the United Way, to see whether there are "indigent care" sources....

Also, you can check the manufactuers of your meds online to see if they have patient assistance programs.  A pharmacy would know mfr.  A psychiatrist's office might have a brochure re all pt assistance programs.  BUT most want your doc to make application for these.

For low-cost meds, try also:  The Medicine Program, 1-573-996-7300, and also try helpingpatients.org to find programs.

One thing I failed to ask was the longest time that you have stayed on a program of Rxs that was helping you.  Wandering on and off meds is not a route to improvement.  I hope you, or you and a helper, will do everything you can to get written prescriptions again, find a way  to obtain them, and then that you will plan to stay on them, being sure to let the doc know that you are or aren't doing well w/ them.  By now, you probably know that bipolar meds and doses often need adjusting from what is first prescribed.

Pls do check nami.org to see if there are affiliates near you, and then contact them to see what activities or programs they have for patients....it could be very helpful for you.

Maybe you will feel you can share some or all of our communications w/ your boyfriend.  I am very concerned that you may not feel well enough to get started on any of these things....and it's important that you do if life is going to get better.

I hope your life does get better.  Get someone to help you get started.  I will be thinking about you.