in the twenty years you have not been medicated, drugs have changed a lot. there are many effective drugs for treating bipolar that do not turn you into a zombie. you just have to be persistent in finding the right mix. it took me nearly three years to find the right meds for me that totally stabilized me without side effects. anything I didn't like, I insisted my drs change it. they did not like changing my meds so often and wanted me to stay on meds longer to see what happened but I refused. my persistence paid off. you are being a bit catastrophic and using the worst case scenario in your thinking. I think starting with outpatient will be sufficient unless you feel you are a danger to yourself and others then you need to go inpatient until you are stabilized.