Depression: It usually always waits until I see my psychiatrist next. I see him, on average, every three weeks. Even if I tell him I'm having a downswing, he usually doesn't do anything with my medications until/unless the downswing worsens and starts to last a long time. Frankly, I haven't had a severe pure depression in ages. The only time he takes more urgent action is when it includes mixed features, though I've been able to manage them quickly using my prn Seroquel and/or Ativan. If not, he makes a medication change. If the mixed episode is severe very quickly, I call him and he either increases my Seroquel XR via phone, or gives me an emergency appointment.

Hypomania/Mania: I can usually calm hypomania once it is realized, usually by my husband and/or pdoc or tdoc. Or, something happens in public (cops or threats of cops, etc.) that turns it into an emergency. Prn Seroquel often does the trick. If the hypomania is just a "blip", sometimes my evening meds, themselves, help. If the hypomania starts to last for days or develops into full blown mania, my Seroquel XR is increased either by phone or emergency appointment. Unlike depression, my manias can occasionally go from mild to full blown very quickly (hours to a couple days). My husband has called my psychiatrist, at times, and taken me to emergency appointments. Even I have called him a couple times, if the episode developed mixed features. I have been psychotic with pure mania, but more often with mania with mixed features.