You can do everything “right” and still find yourself in a depressive episode. This is largely because bipolar disorder is a cyclical illness. But what are some things you can do to minimize your chances or to break free? Join us as Gabe and Dr. Nicole give us some tips for recognizing, heading off, and even pulling out of a depressive episode.
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.
He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.
Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.
Find out more at DrNicolePsych.com.
Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Gabe Howard: Hey, everyone. My name is Gabe Howard and I live with bipolar disorder.
Dr. Nicole Washington: And I’m Dr. Nicole Washington, a board-certified psychiatrist.
Gabe Howard: Today we’re going to be talking about pulling yourself out of a depressive episode. And I, I tend to hate these topics, Dr. Nicole, because on one hand, as a mental health advocate, I really work very, very hard to teach people that depression is really serious. I see all of these memes all over Facebook like depressed nature, bathe, depressed, do yoga, depressed by a gym membership. And I’m like, no, depression is really, really serious. And then, on the other hand, I have a podcast. It’s like, Hey, are you depressed? Five Simple Tips to pull yourself out of that episode. And everybody’s like, Wait a minute, I thought you said it was serious. So it does hit a certain way. Whenever I do, here are some things that you can do to ward off a depressive episode when I’ve also banged the drum that this is really, really serious and probably needs medical intervention.
Dr. Nicole Washington: Yeah, we do oversimplify it. We absolutely oversimplify the whole pulling yourself out of an episode. But you can, you can figure out what your subtle cues are that you’re going into an episode and maybe stop it from being quite as severe as it could be if you ignore it.
Gabe Howard: The example that I like to use is lifeguards at a public pool. If you are not a strong swimmer, I do not recommend going to a pool that doesn’t have lifeguards. However, just because lifeguards are important and they can and absolutely do save lives, it doesn’t mean that if you find yourself in in a drowning situation, that there are not things that you can do. And we teach these in safety classes all over the country, all over the world to give people better odds of one, preventing them from being in a situation where they could drown in a first place. And two, if they do find them themselves in a situation where they are drowning. Here are maybe some steps that you can take to save yourself. It doesn’t diminish the seriousness or the efficacy of the lifeguards. It just shows what you can do to help yourself. And that’s what I want people to be thinking of as we go through these tips. Nobody is saying that if the lifeguard shows up, you’re supposed to swat them away and say no. I listen to a podcast and I’m going to swim to shore. No, do it, the lifeguard says. But if you find yourself in the middle of the pool all alone and you think you’re in harm’s way. Here are some things that you can do to potentially improve your situation. And some of the tips I think are actually really good to work with your lifeguard. Right. And Dr. Nicole, in case you didn’t pick up on this, in this analogy,
Dr. Nicole Washington: I’m the lifeguard
Gabe Howard: You’re the lifeguard.
Dr. Nicole Washington: I am. I like that. I like that. I like that a lot. I think most people have these kind of subtle things that they notice when they are about to drown, Right? Like when they when they are about to get to that that darkness pace. And a lot of times maybe they don’t, maybe they don’t know that they’re getting there. And so a lot of times it’s the people around them who say, Oh, yeah, I knew you were getting depressed because on Saturdays you’re normally the first one up and you’re bathed and you’re ready to go and shower and putting clothes on. But not, not lately. Lately you’ve been sleeping in. You may stay in your pajamas all day like people around you notice. And then my question is always, well, why the heck didn’t you say anything? Like, why didn’t you just why did you just watch your loved one drown? Right? Why did you just let them sink into this really dark place? So I think there’s a lot of discussion that we can have with loved ones and our mental health team to kind of prevent that from happening.
Gabe Howard: And the answer to that is really twofold, right? I, I to wonder, it’s like, didn’t anybody tell you that you were acting weird? Didn’t anybody tell you not to swim in shark infested waters? Did you really just stand up? I’m going to get every drop out of this swimming lifeguard analogy that I can. But seriously, most people don’t dive into the deep end off the high dive without somebody seeing them climb up and say, Whoa, whoa, you’re not a diver. Don’t you dive in there. That’s 15 feet. That’s for the professional divers. And we, of course, keep climbing. So hint number one. Do listen to the people around you. If somebody is pointing out that you are acting different. I know, I know. Living with bipolar disorder, so many people are questioning your every move. I get it and it’s awful and we want to ignore them all. And as somebody who lives with bipolar disorder, I understand it. I’m speaking directly to you. I get it. But you got to find some people. You got to find some people who you trust. Everybody. Everybody, period, needs somebody in their lives. It’s like, dude, you’re off. You’re you were mean to your your spouse, your children, your mom. You you’re not you’re not at 100%. Maybe you need to take a break. You’ve been really snippy lately. And with bipolar disorder, we need somebody that we trust to say to us, you’ve been off lately and it could be a symptom of bipolar disorder. It doesn’t mean that you have to deputize everybody to do that,
Dr. Nicole Washington: Right.
Gabe Howard: But find a couple of people. Find a couple of people that you trust. That’s like that’s like depression, warding off depression, tip number one.
Dr. Nicole Washington: Yeah. Like people you trust, though, right? Like, not. Not the person who every time you, you know, get mad because somebody cuts you off in traffic, they say, have you taken your meds?
Gabe Howard: Yeah. God, I hate those people.
Dr. Nicole Washington: You’re irritable today. You’re angry. It’s like, I can be. I’m alive. I’m human. This person did something crappy. I’m angry. Not that person. Right. Like, not that super sensitive person. But if there’s someone who you really, really trust that has your best interest at heart, that’s a person I would go to after an episode and just ask them, Hey, do you do I do anything that kind of tips you off that I’m heading to a place? And if you’re a loved one listening and you have someone in your life that you can usually tell before the mania or before the depression, because they have a certain tail, they do this kind of the same thing every time. Once they’re stable, key words, once they are stable, have a conversation with them and just say, hey, listen, I noticed that before depressions, you tend to do this. And it seems like every time that’s what happens. I didn’t want to say anything because I was you know, I didn’t want to upset you. I didn’t know if I was just imagining things. But do you mind if next time I say something to you, because maybe we can get you in with your doctor and see if we can prevent it from going to that severe place? I think those are very reasonable things to do.
Gabe Howard: I’m a really big fan of the post mortem where you look at everything that happened when you’re stable, when things are going well, and you can do this right now. If you are stable right now and you’re just listening to this as a you know, to get ahead of the next episode, think about your episode a year ago, two years ago, whatever. Think about who’s around who you can trust and sit down with them and say, Hey, mom, dad, brother, sister, spouse, bestie. Remember a year and a half ago when I flipped out at the local supermarket or remember a year and a half ago when I quit my job because I couldn’t get out of bed for a week and a half, whatever it is, just whatever it is, and bring them to that place and say, hey, look, I’m well, there’s nothing to worry about. I want to talk about some things, like, here’s what I remember. What did you see and be? This is important. Be open minded. Even if they say something that’s hurtful, it’s like, Oh yeah, you were a complete asshole that week. Don’t. Don’t know I wasn’t. And that’s remember, we’re just. We’re just gathering information. I, I don’t like it when my friends say that I was a complete asshole that week either, but they are describing what they saw and that is data I can use. Now. I do have a conversation with them like, Hey, maybe when we do this you can just say that I was irritable. Like maybe you can say that I was I was difficult. Like, that would be nice.
Dr. Nicole Washington: Yeah, well, ask him to expound.
Gabe Howard: Don’t fall down the rabbit hole on semantics on conversation one.
Dr. Nicole Washington: Ask them to go deeper. Right. Ask them to go deeper. Don’t just leave it at, Oh, you’re a butthole. Well. Well, thank you. But what does that mean to you? What was I doing? Like, give me examples. I love this idea. In medicine, we do what’s called M&M, morbidity and mortality. Right. If a doctor has a patient who has a really bad outcome, they’ll gather with some other doctors in the department. Usually happens in academic settings. Hospitals do it and you’ll gather and you’ll present the case and you’ll kind of give like, This is what the person came in, this is what was going on. This is what happened. This is what I did. This is, you know, you go through the whole thing and basically you get a bunch of, you know, was it Monday or Monday morning quarterbacks? You get you get a bunch of people to say, oh, well, this was the problem. Like this is what was going on. And so it is helpful to do that after the fact, to just kind of go backwards, like start at the end and then go backwards and figure out what could we check, what could we have changed? You know, hindsight’s always 20, 20, what could we have done differently? And they could really save you from future severe episodes.
Gabe Howard: I love that you brought up Monday morning quarterbacking because so many people hear that looking back at an episode or looking back on their depression and getting advice from the people around them, is Monday morning quarterback. Well, you don’t know. I wasn’t there. I get it. Like there’s this part. It was like I made the best decision that I could at the time. Why are you judging me? I understand that. But let’s put that aside. Here’s the thing about Monday morning quarterbacking that nobody wants to admit. On all of the sports talk radio, the teams are doing it. That’s what game tape is. That’s what video footage is. That is what’s practicing the OK, Let’s throw the ball in the rain 1000 times, because in the big game, if you would have caught that ball, we’d have won. And everybody in there, brother is Monday morning quarterbacking that if you would have just wrapped your hands, your fingers a little tighter, pulled it to your chest, you’d be Super Bowl champions. People are so quick to dismiss Monday morning quarterbacking. But everybody does it. We just call it something different.
Dr. Nicole Washington: Yeah.
Gabe Howard: Call it whatever you want, but get that information and use that information again. Remember, I said, I’m going to I’m going to use the lifeguard analogy. I am a decent swimmer. Dr. Nicole, I’m a 45-year-old man away, 250 pounds, and I’m a decent swimmer. If anybody sees me climbing up on a 30-foot-high diving board, Olympic diving board to jump into the 40-foot pool, I don’t I don’t even know where this exists in central Ohio. But if anybody sees me climbing a 30-foot diving board, they should stop me. They should do whatever it takes to stop me. So I want to figure out in my depressive episodes, where is the Gabe’s walking over to the diving board moment. Where is the Gabe starts to climb the diving board moment? Where is the halfway up? Where is the Gabe’s on the platform Because before I jump off, I’ve got I’ve got control, right. I can climb all the way to the top of that platform, walk off to the edge. And if I can stop myself right there and think this is not a good idea, I am not an Olympic diver. I am not Greg Louganis. I don’t know what I was thinking, turn around and climb back down. I can prevent, I can prevent potential death. I can prevent a lot of heartache. I can prevent the Dr. Nicole’s from having to get their swimsuits wet and save me. So I feel that there is an element of control up until the point where I dive off the diving board and I want to figure out where those moments are.
Dr. Nicole Washington: Yeah. And not just the death, but more likely the disability, right? Like the death. I mean, definitely. We know that death literally can be a consequence of a severe depressive episode. But more often than not, it’s the disability. It’s the have to miss work. It’s I’m not performing up to my to my standard. It’s the you know, I’m not being present for my family and my my wife, my husband and my kids the way I want to be. Like, there’s a lot of disability that comes for a lot of people that’s just disruptive to living. I mean, if, you know, most of us we work because we need to pay for stuff, right? Like we need things.
Gabe Howard: We need health insurance to pay our lifeguards.
Dr. Nicole Washington: Exactly. We can’t get to the pool if we don’t have money to afford to get to the pool. So, you know, I mean, we want to be able to keep those things going and keep our livelihoods going. So, yeah, I mean, that’s huge.
Gabe Howard: I’m so glad that you touched on disability, because so often when we talk about depression, we only want to prevent suicide and we don’t think about any of the other ramifications the losing the job, the losing the marriage, the losing, the relationship, the just. There are so many I could do an entire podcast just naming bad outcomes from depression and never get to suicidality, suicide attempt or death. And in many ways I think those things are much more prominent. I have known by far more people that have lost a significant relationship or a job than have who attempted suicide. And and I think that is something that we want to consider when we’re looking at this, because while everybody has their eye on the worst-case scenario, all of these other scenarios are just running around unchecked. So the thing that I think about in my analogy of climbing up the ladder is was I aware that I was climbing up a 30 foot ladder? Maybe I was completely unaware. Maybe I just thought, hey, I just thought this was a good way to get into a swimming pool.
Gabe Howard: Depression alters your brain. In my mind, I’m just getting in the pool. I don’t know anything about this. This Olympic diving board or any sort of danger. I just. I’m just. I’m just doing the thing that is maybe alleviating some stress in the moment. I’m just trying to get into the water. I haven’t thought about any of these ramifications. And now we need that intervention and intervention. We need to understand what that looks like not only for ourselves, but we need to educate our loved ones around us.
Dr. Nicole Washington: And I like that because. So let’s say you have the awareness. Let’s say that you have spoken to your people and they’ve told you, hey, we notice that you tend not to cook and you eat out more fast food or we notice that you, you know, tend to not hang out with us on the weekends or you sleep in. So when you catch yourself like, oh, this is the third drive through I’ve gone to this week, like, what’s going on with me? So when you notice that, then the choice is yours. Like, what do you do with that information? Do you just say, Hey, maybe it’s just a few days now. Have anything to worry about? Maybe, maybe, maybe. I just didn’t feel like cooking because I’ve been real busy at work because we make a lot of excuses for why those things are happening, right? Which is. Which is how the episode gets out of control. But what if you contacted your doctor and said, Hey, listen, every time I get depressed, my diet changes. Every severe depression I’ve had, I tend to be a little less focused on what I’m eating.
Dr. Nicole Washington: I don’t eat as healthy. I eat a lot of junk, I sleep in. I’m starting to get there, you know, can we talk about what we can do? Absolutely. You can do that. But you know what you should not do? Maybe you shouldn’t go to the bar, right? Maybe if you enjoy going to happy hour with friends, maybe that’s the time to not go. Or if you go, maybe that’s the time for you to get a Sprite with a splash of grenadine and pretend like you’re drinking. So nobody asks you, why aren’t you drinking? Maybe that’s the time for you to just be honest with your happy hour crew and say, Hey, I’m feeling a little down and alcohol’s a depressant and I’m just thinking I probably shouldn’t drink tonight until I can figure out if I’m going to pull out of this thing or what’s going on. And let me tell you something. If they love you and they care about you, they are going to go, Oh, absolutely. Let me get you a 7 Up. Let me get you a ginger ale. Like that will be fine.
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Gabe Howard: And we’re back discussing pulling yourself out of a depressive episode. So often when we’re judging success in managing depression and bipolar disorder, we try to judge it against what we’ve lost. So, for example, using your happy hour analogy, if we go to happy hour every Thursday and then we don’t get to go on one Thursday, we’re like, Oh, I lost happy hour. And that’s a way that you can think about things if you want. I cannot stop you, but I’m a big reframe here. I choose to reframe that to I made the decision not to go to Happy Hour because it wasn’t in the best interest of my mental health and I needed to sit that one out so that next Thursday I could be in full control, full capacity, and not have a depressive episode that lasted five days, ten days, 20 days, 30 days, six months. By taking control of my bipolar disorder, by taking control of depression and missing one event, one thing, and then communicating with everybody, hey, I won’t be here this Thursday. I look at what I’ve gained and what I’ve gained is an incredible amount of insight and control over a debilitating illness. I put those in the win column every single time. Now, it’s it did not come easy. I don’t want everybody to think that Gabe got diagnosed with bipolar disorder on Monday.
Gabe Howard: And on Wednesday he had this this great. No, no, I was I was down. It’s not fair. I missed this. Why can’t I do this? I can’t go here. It’s not everything in my life was tabled in the this is what bipolar disorder took for me. And it was empty and it was awful. And here’s the kicker. It was depressing because, of course, I was focusing on what I lost rather than what I gained. And what I have gained is a lot of really great coping skills surrounding depression and bipolar disorder. And I want to talk about a couple of specifics, and I want to use myself as an example. Not showering is a big one for me. I have learned this over the years and I know it’s like clockwork, right? If Gabe does not take a shower in a day, there is a problem. So a whole day will go by, no shower. And I notice this. I’m like, I did not take a shower today. Here is what I do. Immediately I take a shower and you’re thinking, Wow, wow. That was that was really simple. You notice that you didn’t take a shower, so you take one or two.
Gabe Howard: But see that if it was that simple, then it would just be, Oh, I forgot to take a shower. I’m going to take one now. And it wouldn’t even wouldn’t need to be brought up in this show. What happens is, is I’m like, I didn’t take a shower today. Okay, I’ll take one tomorrow. Then tomorrow comes. I’m like, I’m going to, I’m going to. And C then it starts to snowball, right? Not only did I not take a shower, but I didn’t get dressed. I didn’t leave the house. I didn’t start doing stuff on my chore list. I didn’t I didn’t call my mom back. I whatever it is, stuff starts getting missed. And oh, by the way, I didn’t take a shower. So now we’re on day three. Here it is. Three to remember I shower like two or three times a day, but I definitely shower one time a day. I’m just I’m very, very fussy about. So. So now we’re on day three and it’s like, okay, well now what do you do? And I take a shower. Okay. Gabe, How? This is how I take a shower. Dr. Nicole, are you ready?
Dr. Nicole Washington: I’m ready.
Gabe Howard: So first I turn on the water. No, I’m just kidding. Here. Here is what I learned a long, long time ago. We tend to say things in completion. Like. Like you probably say I went to medical school, right? You don’t say I went to medical school for three years. You don’t say earn 180 credit hours. You don’t say I passed the following three boards. You just say I went to medical school. Or you probably just say I’m a doctor. Or you say I’m a board certified doctor. And that encompasses this large list of accomplishments. You list it. I’m a board certified psychiatrist. That sounds like it’s one accomplishment, but it’s not. It’s hundreds of accomplishments. I believe that showering is the same thing. We always say I took a shower or I got ready to go, as if it’s one accomplishment.
Dr. Nicole Washington: Right.
Gabe Howard: And for the most part, when we’re mentally healthy and well, it is one accomplishment.
Dr. Nicole Washington: Yeah.
Gabe Howard: But what I’m really, really sick. I need to look at it as multiple accomplishments.
Dr. Nicole Washington: And celebrating every victory, Right. Like it took motivation, it took energy, it took the planning, it took action like I’m huge on celebrating small things like that. And you should, too, if you’re depressed.
Gabe Howard: I completely agree. And here is a little hint. So I took a dry erase marker. You can get it anywhere and buy them ahead of time. Just go buy a pack of them. They’re like ten bucks at Walmart. You can throw them in your drawer. I buy the black ones, and and I take them and I keep them in my bathroom because I have a mirror in my bathroom. And dry erase markers on most mirrors. Use a little place in the corner and make sure, especially if you’re in a renter, they’ll just wipe right off with your finger. And this is how my, my, my, you know, $12 mirror that I hung up in my bathroom works. But I take that marker and I write. Make list to take shower. That’s number one. You know why it’s number one? Because as soon as I’m done with the list, I can cross it off immediately. And that just feels good. Step two is get undressed. Step three, turn on shower. Step four, Get in. Shower. Step five, Soap up. Step six, Wash your hair. Step. You can just go as. As wild as you want. There are no rules. This is your shower list. You want to brush your teeth in the shower, shave in the shower, whatever you want to do. Stand in the shower for one minute and do mindfulness. Put it on the list. It is whatever you want. Just just break it down into as many steps as humanly possible. You can even go as far. You know, I wrote Get undressed. You can be like, take off shirt, take off socks, take off underwear, take off pants. What? I mean, probably take off your pants for your underwear, but you can put it as much as you want and as you complete each thing, cross it off, and that builds momentum. The next thing that people always like. Well, now wait a minute. Doesn’t it take you like 2 hours then to take this shower? So you know how long it took me not to take the shower?
Dr. Nicole Washington: Yeah.
Gabe Howard: We were on three days, I believe, at the beginning of this story.
Dr. Nicole Washington: Yes. Yes.
Gabe Howard: So I’ve now reduced three days of not showering to 2 hours. That’s a huge improvement.
Dr. Nicole Washington: Yeah, that absolutely is a huge improvement and depression. I mean, you all know where it takes you. You know, it has taken you to places where you just don’t even recognize yourself. So, I mean, I think these are great tips. You know, the other thing I think that we should always remember is that people do these kinds of things for more than just bipolar illness. Right? Like, again, we always go back to sometimes people with bipolar disorder think, oh, this bipolar disorder is taking all this away from me. It’s my bipolar disorder. People have to miss stuff, p eople have to take small steps. Thinking about somebody who’s trying to lose weight, if they’re really in a crunch of I need to lose weight because I need to be healthier because I’m going to be diabetic or my doctor said my sugars are up or whatever. You know, they probably aren’t going to the buffet with their friends, you know, or maybe they have to sit that buffet out and they think, But we love brunch and we love you do love brunch, but you love the idea of not being diabetic five years from now, more so with your depression. You like the idea of being stable and not missing work and not having to be in a financial hole. You love that more than you love hanging out for happy hours. So thinking about the big picture, I think you’re you are a spot on.
Gabe Howard: Here’s the great thing. Once you master it for one symptom, you can apply it to many symptoms, whether it’s mania, anxiety, grandiosity, whatever flavor of bipolar disorder you have, whichever symptoms you need to manage. Learning these skills and figuring it out before it gets too bad when you recognize that you’re getting bad. Right? Because a stitch in time saves nine. If you can solve this problem on day one versus day 40, you are going to be in a better position learning coping skills and practicing those coping skills. And it takes time. I learned the writing the list on a mere trick a year before it ever worked for me. The first couple of times I did it, I wrote half a list. I didn’t really do it. I couldn’t find a marker. I was way too depressed and and I was like, Man, maybe I should have tried that list four days ago. Yeah, you kind of missed your window, right? But I kept at it, and I kept it in my brain, and it works. And. And people do tease me, and I’ve reached the point where, yeah, it is kind of funny. And now I kind of make fun of myself and people make fun of me. I get it. I, I can look at the humorous side. It is, it is sort of funny that a 45 year old married man with a career and a job that people put me in charge of children, for Pete’s sake. But I have like a 20 step shower list. Sometimes I can appreciate and see the humor in that, but I can also appreciate that it works. And that is a coping skill that I have developed and I have developed, practiced it, committed it to memory, and it works every single time now. And I learned that through just being open and honest with myself, it’s hard to have those conversations.
Dr. Nicole Washington: Yeah, it is. But first of all, I want to say I do not see the humor in, like, kind of ragging somebody for having a toe stuff shower playing when they’re depressed. Like, to me, there is nothing funny about that. And actually it should be a sign to me if I love somebody or if I’m close to somebody who has depression and all of a sudden somebody who showers 1 to 3 times a day needs a list, to me, that should be a sign of me checking in a little bit more and saying, Hey, are you okay? Not making fun of them for not showering for days and having to come up with a list. So if you are listening as a loved one and you want to try to make light of something, this as I say often not on this show. This ain’t it. This is. This is not it.
Gabe Howard: Your friends are very different from mine.
Dr. Nicole Washington: This isn’t. This is not it. But this is why people don’t talk to their loved ones about their illness. And this is why we have stigma. Right. And this is why. So, no, I don’t see the humor in making fun of somebody. And if you love somebody who has bipolar disorder, pull it together. And let’s reframe your thinking on this matter, because that’s not supportive and that’s not helpful. But yes, you are right. People come to me and, even beforehand, Right. So they come to me and they say, hey, I feel like maybe I’m starting to get a little low. Like, I can’t tell. Like, I don’t know. We have a conversation, we talk about it, right? But the reality is sometimes you can’t get in quickly. Sometimes it takes you, you call and you’re like, Oh, I need to see you, Dr. Nicole, I need to see you. I need to see her. And what if I’m booked out two or three weeks? What if you can’t get to me? Right? So then the frustration starts to set in and depression will make you give up. So you’ll just say, Well, we’ll forget about it. I’m just not going to worry about it. I try it and you just don’t try anymore. So I would say then the next step is for you to advocate with the nurse or whoever staff and you say, Hey, listen, I know she can’t see me. I feel like I’m dipping into a depression and I’m really just trying to not dip quickly. And I’d like to see if there’s something we can do. Can she call me? Can you tell her what’s going on and see what she says?
Dr. Nicole Washington: I know you all are busy. I’m just trying to kind of have this off. I think that’s a reasonable thing to do. Now, once you get in front of me and you start saying, Oh my God, I’m depressed again, like, what in the world? Like, what do I do wrong? I did everything right. I’m taking my meds every day. You told me to, you know, stop drinking. I don’t drink. I don’t do drugs. You know, I’m doing everything right. And yet I have this thing. Well, the uncomfortable reality of bipolar disorder is it’s a cyclical illness. It happens whether you do everything right or not, there is the chance that you’re going to randomly have an episode because it is a cyclical illness. So just by nature of having that disorder, this is this is a risk that you run, right? Like we know this. This is part of it. So we just jump on it early and we do what we need to do. But, you know, I definitely don’t let people sit in front of me and blame themselves because lots of things can trigger an episode, good stresses, bad stresses. You’re building a house and you’re that stress. I had a patient once who came into a large sum of money and an inheritance and had an episode. That was a very good stress, but it was a stress, right? We just have to remind ourselves that the illness itself, it’s just part of it.
Gabe Howard: Sometimes, despite our best efforts, the quote-unquote bad thing just happens. That is what bipolar disorder is. And it’s it’s really important to understand that just because the bad thing happened doesn’t mean that you did anything wrong, number one. And number two, just because the bad thing happened doesn’t mean that there’s nothing to learn. Let’s look at a football analogy. Every single football team wants to convert every first down, right? They don’t want to use their second, third or fourth down. They don’t ever want to have to punt. But could you imagine if they didn’t convert the first down and they’re just like, what? We suck. We suck as a football team. We’re never going to win. We can’t do anything. We had our shot. No, they understand that the game is long and they understand that the error here, the incomplete pass here, even the interception, even the other team’s scored, is all part of the overall game. And managing the overall game well gives them the best chance, doesn’t guarantee it, gives them the best chance to victory. And they also know, really good teams know, winning teams know that dwelling on all the mistakes, it beats down their players, it beats down their fans, it beats down their momentum, and it means that they’re not concentrating on the things that they need to do to win. It means they’re ultra-focused on the mistakes of the past, and that’s not going to get anybody anywhere.
Dr. Nicole Washington: No.
Gabe Howard: We need that balance.
Dr. Nicole Washington: Yeah, we do.
Gabe Howard: We need to learn, need to learn from our mistakes and we need to press forward at all costs.
Dr. Nicole Washington: And, you know, do you know a quarterback who’s never had an interception? I mean, maybe if they only played one game. But do you know anybody who’s been in in the game long enough, who has none. Right. Probably not. Do you, as a person with bipolar illness, know anyone who has bipolar disorder, who’s never had an episode after they started medication? Probably not. I mean, this is part of it. You know, sometimes we do like to think ourselves a little bit special, and it’s not going to happen to us because we’re going to do all the right things. But the reality is, none of us are special. Not one. Not one of us is special in a lot of ways. You’re not any different than the people that you’re in support groups with who say, Oh, I took my meds and then I had an episode or, Oh, I did this and I had an episode. You’re no different.
Gabe Howard: And I feel that that’s very comforting because I always do feel different whenever I have that depressive episode. The first thing that I do is get on the Internet and I look for all of the social media posts, all of the blogs, all of the podcasts, all of the writing where somebody is like, I learn the following three skills and now I am depression free and they always table it that way. So sorry. Inside bipolar podcast listeners. We’re not tabling that way.
Dr. Nicole Washington: No.
Gabe Howard: Here are some hints and tips. Here are some ideas, here is some encouragement, and here are some things that you can do to put yourself in the best position to move forward. But if you were hoping that this was going to end with do X, get Y, do X, be depression-free, you need to go find the YouTube channel on the flat Earther station because unfortunately, that is just not the reality. But if you do the right things, if you practice your coping skills, you can minimize this
Dr. Nicole Washington: Yeah.
Gabe Howard: A lot. And that’s the message that we want you to carry through. And if it happens, that’s okay.
Dr. Nicole Washington: You know, I think we always go back to having your people having those conversations when you’re stable so that once you do start to enter an episode, regardless of what it is that you are able to recognize those things early and try to try to get in too. We talked about contacting your mental health team, right? Do you need to see your therapist a little more often? Maybe because you were so stable you’ve only been doing every two weeks or maybe you’ve only been doing once a month, or maybe you’ve kind of graduated from therapy and your therapist said, Hey, just call me if you need me because you’re doing so well. That might be the time that you contact that therapist and say, Oh, can I get back on your schedule? Like I need to talk. I feel like I’m thinking I’m dipping and I don’t like where I’m heading. That may be calling your psychiatrist’s office. And we talked about how we are super busy, so you may have to advocate for yourself a little bit with staff.
Dr. Nicole Washington: Celebrating small victories. Right? When you are depressed, be kind to yourself. Something as simple as taking a shower can feel like the biggest thing in the world. Because when you’re depressed, small things feel very big. They feel very overwhelming and that’s okay. So if you have to break them into smaller bites to be able to accomplish them, that’s what you do. And that’s still much better than you going three, four or five days without bathing, without getting out of bed. All of those things. And the last thing you know, we talked about was just not beating yourself up like it’s a cyclical illness. This is just how it is. And just being patient with yourself and just realizing that success may look differently at this phase. So success may not be that I never have an episode, but success. Maybe if I catch myself going into an episode that I catch it before it becomes as severe as my previous episodes. So sometimes improvement is the success. Not that it never happens, but that you make it through the situation a little bit smoother, a little bit easier with a little less disability than you have before.
Gabe Howard: And with that, we want to thank all of our listeners. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who travels nationally. You can get my book on Amazon because, well, everything is on Amazon. Or if you go to my website, I’ll sign the book and I’ll give you free swag. Just head over to gabehoward.com.
Dr. Nicole Washington: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.
Gabe Howard: And we need a favor. It turns out we cannot afford Super Bowl ads. I had no idea they were so expensive. But what we can afford is to ask you to spread the word. Tell a friend, a support group, a colleague, put it in social media, send an email, a text message. Sharing the show is how we grow. We will see everybody next time on Inside Bipolar.
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