Inside Bipolar Podcast: Answering the Overlooked: Brain Changes, Vertigo, TMS, and More (From Listener Questions)

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Hey everybody, and welcome to the podcast. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: And we get your emails. Believe me, we get your emails, your DMs, we get your social media posts. We hear from you and we love it. One absolutely. Keep it up. Two if you have a question, email us at show@psychcentral.com and let us know what it is because it absolutely informs the show. And we now have a stack of questions that we can answer relatively quickly, but we have enough of them that it will fill a show. So this topic is your random questions about bipolar disorder that are important, but too short to fill an entire podcast topic all by themselves.

Dr. Nicole: I feel like we’re going to have to figure out how to shorten that. Maybe. Maybe post-production?

Gabe: You don’t, you don’t think that title is SEO based.

Dr. Nicole: I don’t. I don’t think that’s gonna wok. I don’t think so.

Gabe: We’ll workshop it. We’ll workshop it. But, Dr. Nicole, are you ready to jump in with the first question?

Dr. Nicole: Let’s go for it.

Gabe: And I want to say before we get started that these are in no particular order. It’s all just random. One question is not more important or more serious than the other. This is just the order in which they came. All right, here we go. Is dizziness or vertigo a side effect of my medication and how can I deal with it? Is it caused by bipolar disorder itself? Could it be caused by anxiety? Could it be physical in nature? Could it be a medication symptom? If I live with bipolar disorder, what is causing dizziness or vertigo?

Dr. Nicole: That was like six questions. That was that was like six questions.

Gabe: But it’s all surrounding dizziness and vertigo. This is apparently an issue.

Dr. Nicole: You cheated. You cheated. That was not one question. That was like six questions.

Gabe: I didn’t cheat, the listeners cheated. We’ve gotta give the people what they want, Dr. Nicole.

Dr. Nicole: [Laughter] Okay, well, apparently the people want to talk about vertigo. So dizziness can be a side effect of some of the medications that we use to treat bipolar disorder. It can be I definitely think it’s one of those that you should mention when you go to your next appointment. I do believe there are symptoms that you all have, side effects you’ll experience, and when you go see your Dr. Nicole you don’t bring them up ever. Somebody will sit in front of me and after six months, nine months, a year, they’ll say, well, I just, you know, I just don’t want to keep taking that because it’s making me dizzy. And I’ll say, well, well, how long has it been making you dizzy? And they’ll tell me since I started it. And my mind is blown. Because I do always ask. Taking your meds? Yes. Are you tolerating your meds? And I usually get yes. I don’t specifically say. Are you having dizziness? Are you having weight gain? Are you having sexual side effects? Are you having like I don’t specifically tease out every potential side effect. I just ask a generic and I just usually get a yeah, it’s fine or yeah, I’m tolerating it. So make sure you’re telling the person prescribing your medicine. If you’re having dizziness, that’s important. How can I deal with it. You know that’s always a what do I do? I’m dizzy.

Dr. Nicole: Well ideally you would be on a medication that wouldn’t cause you to be dizzy. So that’s why you need to let them know so that you can have some discussions about. Do I need to be on something different? If in the off chance you’re on the one drug that’s ever been great for you and you’re more stable than you’ve ever been, but now you have this dizziness, you all need to have a conversation about that and how you think you might want to approach that. And then could it be anxiety that that was a great question. With panic attacks, people do sometimes experience lightheadedness. So yeah, I mean, I guess if you were having a panic attack or you were having a rush of anxiety, a wave of anxiety, you could experience something that feels like dizziness that could be associated with that anxiety or with that panic attack. But let’s just talk about dizziness in general. Half of y’all are walking around dehydrated and not drinking water. I mean, Gabe is out here living on Diet Coke. I don’t know what’s happening. He’s out here living, living on Diet Coke.

Gabe: [Laughter] It’s true. It’s true.

Dr. Nicole: It is true.

Gabe: They should sponsor us. I keep saying it.

Dr. Nicole: [Laughter] Diet Coke should sponsor us. Ah, ugh, are we? Anyway But what else could it be? You know, sometimes I think it’s easy to try to blame your medication for things that happen in your body. So people will say, oh, I got I was dizzy today. It’s the medicine. It has to be the bipolar medication. Is it the medicine? How do we know it’s the medicine? Is it consistent? Is it just certain times? Will you go months and not feel dizzy? And then all of a sudden you do feel dizzy? How do we know it’s the medicine? So yes, if it’s if it’s something that started with the medicine and has been consistent, I’ll give you that. But sometimes we do have the tendency to blame the medication for things when a feeling of dizziness or vertigo could be sinus stuff, fluid in your ears, dehydration there’s all kinds of things that could cause you to feel that way. So I wouldn’t just assume it’s the medicine if you’re not 100% sure. And that may be a good reason for you to have a primary care doctor so that you can have these conversations to determine, is this something more than just, oh, my medicine’s causing this thing because I do. I do see people blame their medicine for things that when you start whittling away at the problem, it becomes less and less likely that it is the medicine.

Gabe: That is a very thorough answer and I love it. But I couldn’t help but notice that the answer comes down to maybe. And in a way, I think it’s important that people recognize that it could absolutely be the medication,

Dr. Nicole: Mm-hmm.

Gabe: It could be a lifestyle choice, it could be physical, and you need to see where it works in. But I really I hate to cosign things that you say, Dr. Nicole, but I want to say to all of my, my bipolar peeps, she’s right. We do have a tendency to want to blame things on the medication because we hate the medication the most, and it may not have anything to do with it. Or it may. This is where self-advocacy becomes really important. But you’ve got to self-advocate with an open mind. You just can’t say it’s definitely the medicine. But I’m really glad that you let us know, Dr. Nicole that it could be the medication, because I got to tell you, I really think one of the reasons for this question is because a lot of times people with bipolar disorder go to their Dr. Nicole and say, I’m experiencing this physical symptom, and they throw up their hands and tell them to go see their general practitioner. Then they go to their general practitioner and they say, hey, I’m experiencing this symptom. The general practitioner throws up their hand and says, oh, it’s because of your medication. And as we’ve talked

Dr. Nicole: Yes.

Gabe: About before, these two sides don’t talk. So

Dr. Nicole: [Sigh]

Gabe: I so I’m really glad that you let people know that it could be the medication because they are getting pushback from both sides. Don’t just come in and say, oh, I’m dizzy or I’ve been dizzy. How often is it every day? Well, not every day. Okay. Well, when, when and when have you noticed it’s happening? Start logging those symptoms come up with with a good timeline of how often it’s happening. Is it happening every day? Is it happening on certain days only? And then if it’s only happening on certain days, maybe you have the ability to go back and look at, okay, what did I do those days? What made those days different that might help both your primary care doctor and your psychiatrist figure out, is this medication related, or is this something else?

Gabe: Alright. And moving on to the next question, Dr. Nicole, what do you think about TMS as a treatment for bipolar disorder? I don’t even know what TMS is.

Dr. Nicole: Well, that’s a good place to start. Probably. TMS is a procedure called Transcranial Magnetic Stimulation. And what it does is it uses magnetic fields to stimulate nerve cells. And we’ve seen.

Gabe: Does it work?

Dr. Nicole: [Laughter] Well it depends on who you

Gabe: I mean, it sounds like science fiction. I’ll be the first to admit it. It sounds like sci fi.

Dr. Nicole: I mean, I think most procedures for mental health sound that way. I mean, think about even ECT for an example. Or electroconvulsive therapy. It all sounds kind of like you’re gonna do what? That doesn’t sound right. You’re gonna give me a seizure, you’re gonna put magnets on my brain Like, what? What the heck? But there is some good data out there to support it being an effective treatment for depression, especially, there is some use and some utility in using this. For bipolar depression, we don’t really have any data to support using it during a manic episode or, or during something more severe, like a catatonia or anything like that. We just don’t have that data, but that is where maybe an ECT would come in. So if we’re going to talk about TMS, we got to talk about ECT. Electroconvulsive therapy, you know, you go into a very controlled environment. I like to tell people all the time, this is not your grandma’s ECT. This is not One Flew Over the Cuckoo’s Nest’s ECT This is very controlled. It’s usually in a hospital and a post-anesthesia care unit or in the, in the operating area where you’ll have an anesthesiologist there because they, they do they do sedate you. You will be given paralytics. So it’s not like you’re going to be breaking bones and muscles clenching and all that. That used to happen back in the day. And you have a very controlled seizure. It’s very controlled. I have seen ECT. Let me tell y’all something. It is not exciting.

Dr. Nicole: It is not exciting at all. So people think like you watch people get shocked and they have a seizure and they’re flopping all over the tape. No, no, the very first time I saw it, I remember thinking, did they have a seizure? Because I missed it. So they’re they’re monitoring the brain activity. So the brain is having the seizure. But the body never I never saw it. I never saw it in the body. And it was so boring. And I was like, oh, this is it. Like, this is what this is it, this is it. This is not, I repeat, not your One Flew Over the Cuckoo’s Nest, ECT. So but ECT is a little bit more invasive, a little bit more intense. So you’re talking the multiple sessions. You have to have someone drive you. You have to go three days a week for however many weeks you’re given anesthesia, so, you know, you can’t drive home. You have all these things that go with it. TMS is done in an office setting. You’re not, you’re not being sedated. Nobody’s putting you, putting you under. You don’t have to go to the hospital. It is a little bit easier to maneuver logistically and can be done in outpatient offices. And there are people in your community that I’m sure are offering TMS. If you just Google TMS in whatever your wonderful city is you probably can find someone who’s doing it if you have some depression that you’d like to address with TMS.

Gabe: My non-medical opinion is the best treatment for bipolar disorder is the one that works. And I mean legitimately works.

Dr. Nicole: Mm-hmm.

Gabe: Not that you’ve decided that works, but all of your friends and family are telling you isn’t working. So TMS does have research behind it. And as Dr. Nicole, just illustrated, TMS and ECT are important offerings for people living with bipolar disorder. But of course your mileage may vary. Now I want to address just a slight little bit of controversy with TMS. And that’s the word magnets, right? There’s magnets in there. And then some people believe in these, these kits that they can buy online, or they can put magnets on their brain at home, and they can purchase these things that cost hundreds of dollars and do TMS at home and save money. That is a complete and utter scam. It does not work it hard. Stop scam BS. If you’re not getting TMS from an authorized medical professional, you are being ripped off. I feel the need to throw that out there.

Dr. Nicole: Yes, do not buy the DIY home TMS kit to try to address your depression.

Gabe: It does not work and it’s dangerous. I mean, in the best-case scenario is that it does nothing, but

Dr. Nicole: Yeah.

Gabe: The worst-case scenario is that you hurt yourself in some way. You’re also not being medically monitored if you do it at home, there’s really no gain in it. The best-case scenario is that it does absolutely nothing and you’ve just wasted your money. The worst-case scenario is that it hurts you, harms you, or makes it worse in some way.

Dr. Nicole: I’ve never even heard of these home do it yourself kits. I don’t know what’s in them. I don’t know how dangerous they can be, but yeah. Be careful. I mean, that’s wow.

Gabe: All right. And moving on to the next question. Can my bipolar medication affect my skin? I had clear skin and after being medicated, I do not.

Dr. Nicole: Well, isn’t that always great? [Laughter] I mean, not great, but we hate these kind of side effects. We hate side effects that affect us cosmetically. Of course we would. We don’t want the weight gain. We don’t want the acne. Who wants that? But I have to tell you, it is a possibility. And specifically, lithium is the biggest culprit usually when it comes to causing acne. And that can be so frustrating. For anybody who’s ever been a teenager who had acne it was not a pleasant time of life. And to make it through puberty, to get to adulthood, to start your bipolar treatment. So all of a sudden, then start developing acne again on top of the fact that you probably aren’t feeling that great about yourself in general, because here you are. I have bipolar disorder, and now I’m taking this medicine, and now my skin is breaking out like I’m a pre-teen. It is not. It is not good. I completely would understand why it would be frustrating, but it could absolutely be. Especially if you’re taking lithium. I think the question then becomes, well, what in the heck do I do? Do I just say, well, I can’t take lithium because it caused me to have acne? Yeah. You know, that’s a very personal decision that very, very. That’s a very.

Gabe: Can’t we all just go out and get some Clearasil gel and just Noxzema?

Dr. Nicole: Yeah.

Gabe: Clean this right up?

Dr. Nicole: I mean, for some people it’s not that severe. I mean, severity is really going to be what makes you decide to do one thing over another. Can you see your primary care doctor? Can you see a dermatologist and come up with something? I have had people do that.

Gabe: Side effects suck as you say all the time. Dr. Nicole. The side effects of these drugs are not sexy. They don’t have sexy profiles. But I got to tell you, your mileage may vary as well. And, you know, lithium is a standard treatment for bipolar disorder. So I imagine a lot of our listeners have either been on it or could be put on it in the future. It’s pretty it’s a pretty common drug. We usually don’t discuss specific medication treatments, but lithium is so connected to bipolar disorder that it’s unavoidable.

Dr. Nicole: Mm-hmm.

Gabe: And with that, we’ll go ahead and move on to the next question. Dr. Nicole, I honestly do not know the answer to this at all. And I, I tried to use my non-medical degree to come up with some stuff, but but sincerely, I have an opinion on it though. Is there such a thing as medication resistant bipolar disorder?

Dr. Nicole: Okay, well, now I’m curious about your? I want to hear your opinion on it. Before I give my answer. I want to know. I want to know what you think about it.

Gabe: So my opinion is that by and large, no, by and large, what people think of as medication resistant bipolar disorder is just difficult to treat bipolar disorder or had to try many different medications, many different combinations, etc.. What I saw out there when I was trying to do research on it, remember, I’m I only have access to layman’s tools. What I found was a lot of people saying, I went to my doctor and they gave me medication and it didn’t work. I have treatment resistant bipolar disorder or people saying, I’ve tried for the last year to get stable with bipolar disorder, and I’m still not stable. I have medication resistant bipolar disorder. And what immediately popped into my brain is there are a couple of hundred drugs that that, that that are able to treat bipolar disorder, and many of us are on multiples. So you start doing some quick math and you get into trillions of combinations before you can truly say there’s no medications that will treat bipolar disorder. I’m not sure if treatment resistant bipolar disorder is a thing or not, but I am almost positive that many people who say that they haven’t just made that up in their head because they’re having trouble with the treatment process that is actually, unfortunately, very normal for people with bipolar disorder.

Dr. Nicole: Okay, I’m following you. I’m picking up what you’re putting down. Okay. So treatment resistant. Whatever. You know, treatment resistant depression treatment resistant bipolar disorder I mean, basically that’s what we’re saying is that you haven’t responded like we’ve given you adequate courses and adequate is the word. We’ve given you appropriate treatments. You’ve taken it for enough time at a high enough dose. You’ve done all those things, and we just aren’t seeing improvement within a time frame that we would expect to see improvement. So I treatment refractory is sometimes another term that’s used instead of treatment resistant. But basically we’ve given you the medicine. We’ve done what what evidence tells us to do. And we’re just not able to see to see the benefit. So we then have to get creative in some instances. So yeah, I could see based on that definition that yes, a person could have a treatment refractory bipolar illness. We’ve given you the meds, we’ve done the mood stabilizers, we’ve done all the things, and you’re just not able to maintain a level of stability that makes any of us feel comfortable. We aren’t able to get you into a remission of your mood episodes.

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Gabe: And we’re back discussing listener questions about bipolar disorder.

Dr. Nicole: So yeah, a person can have a treatment refractory bipolar illness. The person can have a treatment refractory schizophrenia, a treatment refractory depression like those things can happen. Now I will say the first thing that I typically do when that is the case is I start to question my diagnosis, I really do. I then have to start thinking, okay, am I even treating the right thing? So the first step in that case for me is to look back at the diagnostic criteria and see if I’ve missed something along the way. Is this not bipolar disorder at all? And I missed it. Like, is this something else? Does this person have a significant trauma history in the shifts that they’re experiencing? Are more in line with a more complex PTSD? Do they have a personality disorder? Does this person have borderline personality disorder? We’ve done an episode before talking about how these two disorders get confused all the time. I have to go back and ask myself, was I even correct? And so we start, I start over, I start over from the beginning. And then if we still think, no, we still think we’re on the right track, but for whatever reason, we aren’t able to gain control.

Dr. Nicole: Then we may have to look at some maybe off label treatments. And those are things that we do in psychiatry, that medications that may be FDA approved for one reason, but we may use it for a different reason. So your doctor may give you some things that are quote unquote off label, and they may have that conversation with you about. That isn’t what this method is designed for, but it’s very common for us in psychiatry to use it for this other purpose. So that may be on the table maybe some off the beaten path things we might look at. This might be a time to consider looking into an ECT, for example, electroconvulsive therapy or to look into transcranial magnetic stimulation or TMS, it might be time to start considering some of those things if we’re not able to get you there. But yeah, I mean, it’s a thing I think you could argue, you know, should we call it that? Is that an adequate term for it? But yeah, it’s it’s a thing.

Gabe: All right. No shock there, doctor. Nicole, I was wrong. It’s a real thing, but, but but thank you for acknowledging that. I do think some people don’t understand the process, and they’re quick to label themselves with something because they’ve heard it out in the real world. So I, I do want to say to all of my bipolar peeps, unless you have been told that you have medication resistant bipolar disorder by a licensed professional, don’t just assume it, but it is a good question to ask if

Dr. Nicole: Mm-hmm.

Gabe: You feel that that this is taking longer than it should, or that you may be a more difficult case, say to your Dr. Nicole hey, is it possible that I have medication resistant bipolar disorder? What are your thoughts on that? And then truly listen to what they have to say?

Dr. Nicole: And maybe it is that your expectations are off because people will say to me, oh, I’ve tried five different mood stabilizers and none of them work. And when we dig into, well, how much did you take? How long did you take it for? A lot of times, it really isn’t uncommon for me to discover that they didn’t take a high enough dose, or they didn’t take it for long enough to see, you know, long term benefit. So then the person is saying, well, I just I guess I just have a treatment resistant bipolar disorder or medication resistant bipolar disorder, when in actuality they never really had an adequate trial of the medication to start with. So yes, expectations need to be it needs to be evaluated.

Gabe: And with that, we’re going to go ahead and move on to the next question. What should I do if I have a side effect from my medication? For example, if I think that it’s something serious, should I just go straight to the emergency room? And if I go to the emergency room, are they likely to commit me because of a psychiatric condition?

Dr. Nicole: Again, it’s like four questions for four. That’s four questions. And one that’s like four. Okay. Okay. So what should I do if I have a side effect from my medication. Write it down. Keep a running list. Take it with you to appointments. If it is something that feels a little more urgent or is so uncomfortable that you don’t think you can wait till your next visit. Then call your Dr. Nicole’s office, talk to their nurse, talk to their front desk staff. Say, hey, I’m experiencing this. Can you get a message to the doctor for me? If it is something severe, should you go to the emergency room? Absolutely. If you are experiencing something that is severe, what? What could be a serious thing that you would go to the emergency room for?

Gabe: Let me help you out here, Dr. Nicole. So, for example, if you have vertigo so bad that when you stand up, you immediately fall over. If you’re unable to eat or drink because your medication is making you nauseous, are

Gabe: These things that maybe you should go to the ER for? Or should you start with that call to your doctor? Nicole unless of course, your life is in immediate danger.

Dr. Nicole: If you’re experiencing something serious and you’re questioning if you should go to the emergency room, the answer is probably yes, because we want to get those things evaluated. What is serious chest pain is serious, right? Feeling like you’re on the verge of passing out? That is serious. Being so nauseous and vomiting to the point that you aren’t eating or drinking and you’re dehydrated, those are very serious things that you may want to go to the emergency room. But listen to this. I want you to go in those instances, whether you think it’s from the medicine or not, because you don’t know 100%. I don’t think you can tell 100% that it’s the medicine.

Gabe: Dr. Nicole. There’s always these moments where I think that that patients and doctors see things slightly differently. And what was interesting to me when I read the question, the first thing I thought is, oh, they don’t want to know whether or not they have permission to go to the emergency room. They want to know if they walk in and say, hi, my name is Gabe Howard. I live with bipolar disorder. I’m having a side effect of my medication. If they’re immediately going to be committed to a psychiatric hospital before they even look into the side effect. I think there’s a real fear there that

Gabe: If they openly admit that they’re having a side effect of a psychiatric medication, that

Gabe: That means commitment protocol. What are your thoughts on that?

Dr. Nicole: You know I wish I could say that that was something that you did not have to be concerned about. But I couldn’t tell you that. I will say that there are definitely biases that people hold, and medical staff are no different. And I have had patients show up to the ER, and once they found out that they were a quote unquote psych patient the treatment that they received was not adequate, in my opinion. I do hope that with training, we are getting through some of that and we’re moving beyond some of that. But I could not tell you that somebody wouldn’t say, oh, I don’t have to take this very seriously. Like, it’s probably this person’s a psych patient and it’s probably their psych meds, and maybe you don’t get a lot of effort. I still say if it’s something serious and something that’s causing you extreme discomfort, there’s nothing wrong with you being evaluated. Now, the whole question about will they commit me? Happens a lot. And I would venture to say it is probably very rare that a person would be committed to an inpatient facility or held involuntarily just for going in and saying that they’re having this physical symptom or having this thing. I would say that would be extremely rare. But we just recently in the news saw this story about this individual who was an entertainer who went into the emergency department with chest pain. And when he mentioned about him being an entertainer and a celebrity, they did think he was delusional. And they did put him on a brief hold not letting him leave the emergency department until he could be evaluated. Because they just assumed that it was his illness talking. And he is actually suing the hospital? Because he says that medical treatment was withheld because they were so focused on his mental health issues. So I can’t tell you it doesn’t happen.

Gabe: Of which he had none.

Dr. Nicole: Of which he had none.

Gabe: His mental health issues, of which he had none. Because he was actually a famous entertainer.

Dr. Nicole: Yes. Of which he had none. And so I think you see situations like that and you’re like, see if they’ll do it to him. They sure as heck will do it to me. And I think those instances are very rare, but then I can’t sit here and say, oh, but that never that’ll never happen because it we don’t know the world. The world is full of surprises and we none of us were there. We don’t really know both sides of this or how it’s going to shake out. But never say never, right? I never say never. But I will say it’s probably very rare that you will go in with chest pain and they try to commit you. That rare, but I can’t tell you it wouldn’t happen. I would say if you’re going to go to the emergency department, if you have someone to take with you, take them with you so that you have someone that can advocate for you if it gets serious and you can’t advocate for yourself.

Gabe: Unfortunately for people with bipolar disorder, this is a reality. Thank you for talking about it. Honestly, Dr. Nicole and not just waving that off like, unfortunately so many people do.

Dr. Nicole: Well, it’s definitely no point in me lying about it and pretending like the system is perfect. It is absolutely not perfect. But we do the best we can with what we have to work with for sure.

Gabe: And with that we will go ahead and move on to the next question. This is one that I don’t know the answer to. The, the and it’s kind of macabre, I gotta be honest, is the brain of someone with bipolar disorder physically different? For example, at autopsy, could you look at my brain and tell that I have bipolar disorder?

Dr. Nicole: Well, you probably aren’t going to be very surprised that I’m going to give you a very vague answer for this. I know you’re wanting me to say yes or absolutely not. I’m going to be very vague for a second. So with illnesses like bipolar disorder, schizophrenia, we’re still doing the research, still trying to figure out all the things that are going on in the brain. There are certain changes that we see in people who have bipolar disorder more than people who don’t. However, there’s still lots of people that have those changes that don’t go on to develop bipolar disorder. So we can’t say with 100% certainty, oh, if you have this kind of brain shape or this kind of brain change, that you absolutely have bipolar disorder, we just aren’t there yet. And I don’t I don’t know if we’ll get there, I think I don’t know I don’t know if we’ll get there. I get very pessimistic and I just don’t have a lot of I think the brain is so fascinating and so intricate and so complex, and I just feel like there’s certain things we’re always going to be left going what is this thing? It’s the brain. It’s so it’s so interesting, but it’s why I do psychiatry in the first place. It’s what led me here. It’s it’s different. There’s always questions. I don’t think we’ll ever crack the code. But for now, I mean, there are things that we know we can see, but nothing’s definitive yet. We just are here making a lot of assumptions and hoping that with further research and people donating their bodies to science for research, you know, after their death, that maybe we’ll figure these things out.

Gabe: This is always fascinating for me because I know people want that definitive test, and I think that’s where this question comes from. They’re like, look, if I can’t prove for an absolute certainty that I have bipolar disorder while I’m alive,

Dr. Nicole: Yeah.

Gabe: Can I at least recommend that somebody autopsy my brain and say to all the doubters out there, I

Dr. Nicole: Right.

Gabe: Wasn’t faking, why did you do this to me? And it it sounds like we’re not there yet. Alright. And with that, we’re going to go ahead and move on to the next question. Dr. Nicole was lithium really first used in guinea pigs, and how did they go from guinea pigs to humans? This almost sounds made up.

Dr. Nicole: Y’all have a lot of time on your on your hands, y’all. Y’all y’all. Y’all have a lot of time on your hands to research how lithium was first used for bipolar disorder. I will say I am not an expert on the history of lithium and the guinea pig saga, but I do, I do recall lithium being initially researched in the treatment of gout and that there were guinea pigs involved, actual guinea pigs. And the researcher noticed that when the guinea pigs were injected, they were more calm, they were more relaxed, they were more chill. And so they thought I wonder if we could use this for bipolar disorder. And there you are. But isn’t that how a lot of things happen? I mean, isn’t that how a lot of research, a lot of the things that we know about medications? Isn’t that how it happened? Like we were researching it, for one thing, and then all of a sudden we’re like, oh, but I noticed in addition to that one thing being helped, this other thing is also exponentially better. I think that’s how research goes and how medication research has gone. And medication development has gone for decades, especially early on. They didn’t have fancy machines and things. They were, you know, poor little guinea pigs. But I imagine lots of drugs in the early days were tested on animals first. And I’m, I’m certain guinea pigs were fair game.

Gabe: I think they’re still probably testing on animals.

Dr. Nicole: Yes, absolutely. There are still animal trials. Yes, this still happens.

Gabe: I love this question. This might be my most favorite question because on one hand it sounds completely ridiculous, but on the other hand, yeah, this is how it works. I think that sometimes our listeners don’t realize that a lot of the advancements in medicine were serendipitous. They came from researching other things. For example, Viagra. Viagra came because Pfizer was looking for a high blood pressure medication to alleviate chest pain. Right. And then suddenly they realized during the clinical trials that men were getting erections. And the men were pointing out that, hey, we haven’t been able to get erections for a while, and now we’re. And they’re like, wait a minute. And the next thing you know, we have erectile dysfunction drugs and it’s a multi-billion-dollar industry. And it all came about accidentally. Nobody was researching this. They stumbled upon it. Now I want to move over to mental health there. There are no gigantic research studies right now looking for the cure for bipolar disorder or schizophrenia that I am aware of. It’s

Dr. Nicole: Mm-hmm.

Gabe: Always serendipitous. They discover these things accidentally. And again, this happens with other illnesses as well. This is what a research study is. But I just want to say to my listeners, if you honestly believe that they’re out there looking for the cure for schizophrenia or bipolar disorder, they’re not. They’re just not there. They’re doing frontline research on cancer. They’re doing frontline research on heart disease. But frontline research on schizophrenia and bipolar disorder. No, no, they’re stumbling upon things. And if they notice it, they’re smart enough to then investigate it. But it’s second tier. It’s serendipitous. It’s accidental. So, so I just, I love this question because on at first blush it’s like, well that’s ridiculous. They were they were testing gout on guinea pigs and they came up with a treatment for bipolar disorder. Yes, that’s pretty much exactly what happened. But two, if you really stop and think about it, why is that so hard to believe?

Dr. Nicole: Yeah.

Gabe: But I have to admit, upon first reading the question, I just thought, well, that’s ridiculous. It’s a favorite question of mine. It just is.

Dr. Nicole: It’s your favorite question. You’re just envisioning all of these little manic guinea pigs running around, and then they gave them lithium, and all of a sudden they were just, you know, chill, leisurely walking around the pen is the. [Laughter]

Gabe: Yeah, yeah. They were just like, ‘sup? I want to chill with you. Before, they were climbing all over each other and climbing up the walls. And I mean, some of

Dr. Nicole: [Laughter]

Gabe: Them were depressed. I mean, some of the guinea pigs weren’t climbing up. They were just, like, laying there, like, I don’t want any, like. Yeah, it was just it was just a bipolar mixture of guinea pigs. Cute, furry, cuddly little guinea

Dr. Nicole: Oh, my gosh.

Gabe: Pigs. I just the question is also extra funny, of course, because they’re guinea pigs. And you know how they always

Dr. Nicole: Yes.

Gabe: Say, well, I’m just a guinea pig for medication. I’m just

Dr. Nicole: Yeah.

Gabe: A guinea pig for bipolar treatment. I feel like a guinea pig when I go to Dr. Nicole.

Dr. Nicole: Which I’m pretty sure is where that came from, right?

Gabe: Hey, look at that.

Dr. Nicole: Like they were researching on guinea pigs. Yeah. Like that’s probably where that, where that came from.

Gabe: Look at that, Dr. Nicole. I always learn new things with you every time we hang out.

Dr. Nicole: Haha. Glad to be of service. Glad to be of service.

Gabe: And with that, that is the end of our reader questions. I have no idea how this episode is going to go. Dr. Nicole and I would be curious if the listeners would email us at this point, because you’re still listening at the end of the show.

Dr. Nicole: And if you like it, send us some more questions. Send us some of your questions. The questions that you have been wanting to ask your Dr. Nicole, but have been too afraid to bring them up. Just send them in. We’ll we’ll tackle them here.

Gabe: You should get the message that we’ll do anything for our listeners, but we would like you to do some things for us. First. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. Next, recommend the show to people. Bring it up in a support group. Share it on a forum. Share your favorite episodes on social media. Send people an email or a text message. Sharing the show with the people you know is how we’re going to grow. My name is Gabe Howard, and I’m an award-winning public speaker who could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can get a signed copy with some free swag, or you can learn more about me just by hitting up my website, gabehoward.com. You can also follow me on Instagram and TikTok @AskABipolar.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or on my website, DrNicolePsych.com.

Gabe: And we will see everybody next time on Inside Bipolar.

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