Fatigued. Lethargic. Drowsy. All words that mean you aren’t feeling 100% awake. Many people with bipolar disorder report this symptom — but is bipolar the cause? Could it be a medication side effect, lifestyle choice, or simply not getting enough sleep? Listen in as we discuss the link between bipolar disorder and feeling tired.

Gabe Howard

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
Dr. Nicole Washington

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.

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 Howard: Hello, 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: Dr. Nicole. I’m tired.

Dr. Nicole Washington: Join the club. But why are you tired?

Gabe Howard: [Laughter]

Dr. Nicole Washington: Why are you tired?

Gabe Howard: We’re all tired. Well, of course I feel like I’m tired because I have bipolar disorder. That’s got to be what it is. You have people who come to your office, sit down, look at you, and you’re like, what are your symptoms? And your symptoms are, I’m tired.

Dr. Nicole Washington: Yeah. Yeah. And a little piece of me kind of shrivels up on the inside and dies because fatigue is such a hard thing to tease out. I know that I’m in for quite a challenge.

Gabe Howard: Now. Why is it I feel like I’m tired is complete, right? And I’m not I. I mean, sincerely, if I walked in to you and I said I’m suicidal, right? You would be like, okay, that’s complete, right? You’d know what to do. You’d have a checklist. You’d start asking me questions. You you’d have ideas of how to help me in your brain. But when I come and say, I’m tired, you’re like, Ah, you’re missing a whole bunch of information. It’s not all there. Apparently, a little piece of you dies.

Dr. Nicole Washington: [Laughter] I don’t say it like that.

Gabe Howard: Did you know that little pieces of our psychiatrist could die?

Dr. Nicole Washington: [Laughter]

Gabe Howard: Look, I feel terrible. I mean, not terrible enough to stop the behavior, but. But. But terrible nonetheless. But. But sincerely, why is that not complete? Why in all? Answer why? Why does a little piece of you. Why is that frustrating? Why is that hard? Why is that difficult? I’m going to save you from yourself.

Dr. Nicole Washington: [Laughter] You don’t need to save me.

Gabe Howard: You’re welcome.

Dr. Nicole Washington: You know, it is it’s hard. I mean, fatigue is one of those things. There’s 50,000 things that could cause a person to feel fatigue. And it’s so subjective. So it’s hard for me to measure. It’s hard for me to know specifically what it means. So I have to get into like, what do you mean, you’re fatigued? What can you not do now that you could do before? Or what do you notice now that you didn’t notice before? What is the problem? I mean, we still have the checklist that we still have the things to go by. But fatigue is so vague and means something so different to so many people. It’s just hard to pin down.

Gabe Howard: I feel like you’re saying that living with bipolar disorder and getting treatment for symptoms of bipolar disorder is difficult. Is that the takeaway? It’s hard to have bipolar because I don’t think that’s a hot take, Dr. Nicole. I don’t think anybody listening is like, that’s amazing.

Dr. Nicole Washington: It.

Gabe Howard: I never thought that having bipolar disorder was a pain in the ass before.

Dr. Nicole Washington: Listen.

Gabe Howard: Oh, this podcast has enlightened me. People are going to write letters. They’re going to be like, Dear Healthline Media.

Dr. Nicole Washington: Listen.

Gabe Howard: I did not know that being bipolar was shitty before.

Dr. Nicole Washington: Gabe.

Gabe Howard: Gabe and Dr. Nicole are true gems in the space.

Dr. Nicole Washington: Gabe. Now I’m tired.

Gabe Howard: [Laughter]

Dr. Nicole Washington: Now I’m tired.

Gabe Howard: Dr. Nicole, you could be tired for many reasons. It could be sleep apnea. It could be anemia. It could be your co-host, Gabe.

Dr. Nicole Washington: It could be.

Gabe Howard: I understand what you’re saying, though, right? People with bipolar disorder, we’re fully formed people.

Dr. Nicole Washington: Yes.

Gabe Howard: Right. It could be because of bipolar disorder. It could be because we don’t get enough sleep. It could be because we’re 50 now. So feeling tired is very vague. We get it, but it is a real symptom and feeling tired is a problem. Nobody wants to feel tired throughout their day and if they’re bringing it to their doctor, it’s obviously bothering them. It’s causing them some sort of disruption. So it’s very worthy of looking into. And there’s just all kinds of things that people do in bed that are not conducive to sleep.

Dr. Nicole Washington: Your band is for two things. Sleep and sex. That’s it.

Gabe Howard: Sleep and sex.

Dr. Nicole Washington: That’s it. You should not be eating, reading, snacking. You should not be doing any of those things. Now, for some people who live like in a studio, right? Like maybe they don’t have anywhere else to sit. So their bed is kind of like sofa and bed. And so I get for some people that can be difficult, but we got to find a way to get you out of the bed. Let’s get a chair, a pretty inexpensive chair. Like let’s find something that we can do to get you out of the bed. You just can’t spend that much time in the bed.

Gabe Howard: Sleep routines are very important for all Americans. But this is a bipolar podcast and we obviously want to tie it back to that. Routines in general are important to managing bipolar disorder

Dr. Nicole Washington: Yes.

Gabe Howard: And going to bed at the same time and getting up at the same time. It’s really important for two reasons. One, it keeps your body on a rhythm, and that’s really valuable.But the second one is if you go to bed at the same time every day and it takes you a half an hour to fall asleep, so you go to bed at ten, you’re asleep by 1030, and that goes on for months. And then one day you go to sleep at ten and you don’t fall asleep till 11. And then that goes on for a few nights. Now you’ve got what Dr. Nicole would refer to as data. I’m tired, and I think it’s because it’s taking me an hour to fall asleep. Where is it used to take me a half an hour.

Dr. Nicole Washington: Right.

Gabe Howard: I now Dr. Nicole has some follow up questions. When that data is all over the place, it’s just, hey, it used to take me a half an hour to fall asleep, and now it takes an hour. What time do you go to bed? I don’t know. Sometime between eight and three. What can you do with that information? I think it’s important to point this out because so often with bipolar disorder, we’re like, well, it’s a symptom of bipolar disorder and we have no control over it. I’m not saying that people with bipolar disorder have control over feeling tired, but you have more control than I think we often think. We sort of feel like, oh, well, I have bipolar disorder. I must have to feel tired. Maybe, but maybe not. And controlling your illness, controlling your symptoms and taking the reins as much as you can, I have always believed is extraordinarily empowering. And I know Dr. Nicole’s going to make a funny face at me, but when Dr. Nicole asks follow-up questions and you can fire off follow-up answers, she’s going to be able to take you a lot more seriously and get you to the Promised Land a lot faster than if you’re just like, I’m tired, fix it.

Dr. Nicole Washington: I take everybody seriously. Gabe, stop it. I take everybody seriously.

Gabe Howard: You said you died on the inside.

Dr. Nicole Washington: [Laughter]

Gabe Howard: I did not make that up.

Dr. Nicole Washington: I said a little piece, just a little piece.

Gabe Howard: Oh, a little piece of you died?

Dr. Nicole Washington: Just a teench, as I would say, a little teench. But you know, another thing. Caffeine. Got to bring it up. Caffeine.

Gabe Howard: Are you? Are you hurting caffeine?

Dr. Nicole Washington: Am I judging you? Do you feel attacked right now?

Gabe Howard: I do feel judged. As somebody who drinks so much caffeine. Are you getting ready to take a drink right now?

Dr. Nicole Washington: Iced coffee, right here.

Gabe Howard: Does it have caffeine in it?

Dr. Nicole Washington: It does. But you know what? It’s morning. It’s before noon. If you have a cup of coffee, if you have an iced coffee, if you like to have your morning Diet Coke or whatever that drink is for you. Gabe sipping on his Diet Coke.

Gabe Howard: They need to be a sponsor. I don’t know why this hasn’t happened yet.

Dr. Nicole Washington: Whatever that is for you, you know, but 8:00 at night, 9:00 at night, you know, how much caffeine are you taking in a day? Caffeine is a huge one because people are chugging back energy drinks and sodas and coffee and those things are going to going to hurt. And especially, you know, if you’re tired. And so you say, oh, my gosh, I’m tired. It’s my bipolar disorder. I don’t have anything I can do about it. I’m just going to chug caffeine, try to keep myself awake. I’m going to eventually become your body’s going to be hooked on it. And then part of your withdrawal is going to be you’re going to feel tired, even more tired than you did before you started pumping back energy drinks and sodas.

Gabe Howard: Caffeine is everywhere in our society. I am surprised that in my lifetime the number of things that used to not have caffeine that now does have caffeine. Root beer, for example. When I was a kid, root beer did not have caffeine. And then somebody came out with it. They called it root beer with a kick, and everybody was amazed. Energy drinks were not a thing. In my formative years, Mountain Dew. Mountain Dew was the scary thing.

Dr. Nicole Washington: Yes. It was the most we had. Yeah.

Gabe Howard: And now Mountain Dew is like light. Like, oh, you only drink Mountain Dew. That’s nothing. Because Red Bull and all of these energy drinks are just the just the thing. So I want to caution everybody that thinks that because they bought them at a gas station, that they’re not impacting you. Look, the gas station is just where you bought it. It is not proof of its safety. It’s not proof that it’s not hurting you. It’s not proof that you can have it just because it’s easy to find. And I think this is something where people with bipolar disorder, they want to be just like everybody else. That was my big thing, Dr. Nicole. All of my friends were doing it and they were having zero adverse effects. I’m like, Well, all my friends do it. And I had many a therapist, many a peer supporter, many a support group member, say, well, do they live with bipolar disorder? I’m like, No. They’re like, then you that’s not a comparable. That. It’s just it’s not. You can’t compare your house to the exact same house in a completely different town or state. Everybody would be like, well, that’s dumb. Why are you doing that? You got to compare like things. And yet for some reason, when we live with bipolar disorder, all of our comparables are people who do not live with bipolar disorder. I understand it. I understand because. Because I want to belong. Right. I don’t want to feel different from my support group. I don’t want to feel different from my friends and family. But I also don’t want to feel tired.

Dr. Nicole Washington: Yeah.

Gabe Howard: Right. And I think that’s the bottom line. If I want to feel the same as my friends and family, they don’t feel tired.

Dr. Nicole Washington: I mean, do you know that? I don’t even know if you know that for sure. Right. I don’t know that people walk around when you say, hey, how are you doing? Most people don’t say, oh, I’m super tired.

Gabe Howard: That’s fair.

Dr. Nicole Washington: Most people just say, Oh, I’m okay. There are people who deal with fatigue and they just don’t walk around with a nametag on that says, Hi, I’m tired, like they just don’t do that.

Gabe Howard: And some people wear it with a badge of honor. Have you noticed that in society? Once again, removing ourselves from bipolar disorder. I’m shocked at the number of people who are so proud of the fact that they only get 4 hours of sleep a night.

Dr. Nicole Washington: Oh, yeah. Let me tell you something.

Gabe Howard: They call it hustling.

Dr. Nicole Washington: Well, I was on call last night. I slept 4 hours last night. Zero out of ten stars. Do not recommend. Get your sleep. Because I am exhausted. And I do not recommend it. Do not.

Gabe Howard: It’s very fascinating to me if you are a new parent. Right, and you get no sleep. Everybody is like, oh, my God, yeah, children keep you up. Right? It’s horrible. I remember the first six months of my child’s life and you need more sleep than that. Yet if you remove the child and you say, I got a new job and I’m working beaucoup overtime and I’m only getting 4 hours of sleep, people are like, Yeah, yeah, you’re awesome, man. That’s the kind of work ethic that we need in this country right now. It’s the same lack of sleep, right? But for some reason, one is, man, you need more sleep. And the other one is, we are so proud of you. And we need to get away from this whether you have bipolar or not.

Dr. Nicole Washington: Yeah.

Gabe Howard: I don’t mean to harp on this, Dr. Nicole, but I really think that many people living with bipolar disorder are having sleep issues not because of the bipolar disorder, but because of poor sleep management. Sleep is very important for people with bipolar disorder. It’s very important to pay attention to it. Lack of sleep can drive you into a depression. It can drive you into a mania. It impacts you. We as humans need sleep. And if you’re managing bipolar disorder, sleep is even more important than it is for people who aren’t.

Sponsor Message: Hey everyone, my name is Rachel Star Withers and I live with schizophrenia. I’m also the host of Inside Schizophrenia, a podcast that dives deep into all things schizophrenia. Featuring personal experiences and experts to help you better understand and navigate schizophrenia, Inside Schizophrenia is a Psych Central and Healthline Media podcast and we are available right now on your favorite podcast player. Check us out!

Dr. Nicole Washington: Wake Up. We’re back talking about fatigue and bipolar disorder.

Gabe Howard: I think we have convinced people that sleep is important. And if we haven’t, we’re probably not going to. But there’s a whole subcategory and I don’t even think subcategories. Right. I’m just making up phrases and words

Dr. Nicole Washington: Okay.

Gabe Howard: Again. But there’s a whole group of people who have fatigue, lethargy, tiredness, and it’s not their fault at all. It’s a side effect of the medication.

Dr. Nicole Washington: It can be.

Gabe Howard: What do you do for those people?

Dr. Nicole Washington: Yeah. That’s when we have to really, really start nit picking your medication regimen. We have to look at side effect profiles. Are you taking something that’s sedating? Can we move some stuff to bedtime from morning? Does that help? It takes a lot of work and it can be frustrating because people start telling me things like, Well, I don’t want to be a guinea pig. You keep making all these changes and moving stuff around. It’s like, I don’t want you to be a guinea pig either. But I tell them that my magic wand and crystal ball are in the shop, so I have no way of knowing specifically, you know, what is going to happen to you specifically when we try. I know what happens to most people, but that is just a part of it. So if you’re experiencing that, then you have to follow up closely and make sure you’re paying attention to your body. Don’t come back and not have any information. If I say, okay, we moved this to bedtime, have you noticed a difference? Oh, I don’t really know. I can’t really remember. Like, I need you to be in it and telling me what’s going on. I need your input and we need to be making those changes.

Gabe Howard: For as frustrating as managing bipolar disorder is, managing bipolar medications are even more frustrating.

Dr. Nicole Washington: And let’s face it, bipolar disorder, medications. If you start going through side effect profiles, it does not sound sexy, right? Like and a lot of them come with, you know, fatigue or weight gain. You mean like weight gain? So, you know, is that your fatigue, right? Like, are you taking something and you’ve gained 20 pounds and now you feel tired because you’re toting around 20 more pounds than you were? Those are all things that we have to try to look at and figure out. It’s just a process.

Gabe Howard: I love how you said that. It’s a process. And in that process is to try to figure out how long it will last. Right. Because I know me personally, I’ve been put on medications and I come back six weeks later and they’re like, Gabe, how is that medication working out? And I’m like, I’m really tired, but I’m not feeling suicidal, depressed. The mania is coming down, but I don’t like how I’m tired. And my doctor will look at me and say, Look, it’s a short time, right? Let’s give it another six weeks, let’s give it the first 90 days and see if your body adjusts to it. And there’s this part of me that’s like, Look, I don’t want to be tired right now,

Dr. Nicole Washington: Yeah.

Gabe Howard: But then there’s this other part of me that’s like, okay, but if I only have to experience this symptom for six, 12, 18 weeks and then suddenly I get perfection, right, my body adjusts to it. These are difficult decisions to make, especially how long can you be tired for? I remember one time I was put on a medication and I said to my doctor, you know, after two weeks, I called on the phone. I said, look, I’m having trouble staying awake. I’m sleeping 12 hours a day and I can’t stay awake. And my doctor said, listen, it’s okay. This, it usually subsides after four, six, eight weeks. And I said, okay, that’s fine. And then a few days later, I fell asleep in a meeting with my boss’s boss’s boss and my boss’s boss and I hit my head on the table. It was almost like an 80’s comedy. Not quite, but it was really embarrassing.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: It was really embarrassing to fall asleep in a meeting.

Dr. Nicole Washington: Yeah.

Gabe Howard: And I can see how this happened. The room was hot. We were all packed in there and it was boring. I mean, it was so boring. And I had this extra thing. I had this medication. There’s a part of me that even to this day is like, Wow, if I would have just stopped taking that medication immediately, I could have saved myself that embarrassment. Now embarrassment you can get over. But let’s say that I would have lost my job because of that. Or listen, I worked in corporate America. Falling asleep in a conference room? Not a big deal. My father, semi-truck driver

Dr. Nicole Washington: Yes. Big deal.

Gabe Howard: Falling asleep while operating a 20-ton 18-wheeler. Huge problem. So the bar is a lot lower for some people than others. And I think we have to figure that out. So, Dr. Nicole, I want to throw it back to you. For Gabe, you might say, look, let’s try it six, eight, 12 weeks. But what would you say to my dad?

Dr. Nicole Washington: We’d have to find something different probably if he just couldn’t tolerate it in the meantime. I mean, it’s frustrating, right? That’s when the guinea pig comes in. It’s like you keep changing stuff every time I come here. And I don’t like to do that. So, you know, the first question I ask is, is it feasible for you to not work right? For some people it is. For some people, it’s not. Like some people are not financially able to do that. So then I have to try to come up with medications that don’t typically cause fatigue and see if that’s what’s going on. We’ll look at your lifestyle like, are you active at all during the day? So we’ll talk about can we try adding a little exercise to your day? Can we get your heart pumping? Can we you know, does that help? What’s your diet like? You know, you consuming tons of carbs, like what can we do there? So I try to figure out what we can do lifestyle wise to in addition to the medication. Now, the other thing that I’m going to say that may upset some people, I don’t know. I guess we’ll find out.

Gabe Howard: I love it when you start off like that.

Dr. Nicole Washington: [Laughter] It may upset people.

Gabe Howard: Like that’s my favorite part.

Dr. Nicole Washington: But it may upset some folks. But one of the things that I do see for my bipolar patients out there who are coming off of mania, everything feels like fatigue because you were just super high. So then they’re like, no, I’m tired. Like, I’m tired, I’m tired, I’m tired. But I am sometimes convinced that for those folks, their definition of fatigue is being compared to their mania or hypomania, which is always going to feel being normal, is going to feel like I don’t have as much energy when you’re comparing yourself to manic you.

Gabe Howard: I completely understand why you think that that will bother people and offend them, because you are probably right. There are people hearing this that will not like that comparison.

Dr. Nicole Washington: Because I’ve said that to people and they’ve said some not so nice things back to me. I know that it upsets people, but I think for some people that is reality.

Gabe Howard: I think there is truth in that. I know that when I was manic, everything moved at the speed of light. I had so much energy. But it wasn’t productive energy. It wasn’t. It wasn’t energy that I could use.

Dr. Nicole Washington: Mania is not your friend.

Gabe Howard: Mania is not your friend.

Dr. Nicole Washington: That is the reality. Mania is not your friend.

Gabe Howard: Doctor Nicole is feeling tired, lethargic, fatigued. It’s bad, right? Nobody wants to feel this way. It is a definite symptom. All joking aside, that you should absolutely, unequivocally report to your psychiatrist.

Dr. Nicole Washington: Absolutely. Because it could be it could be nothing, right? Like we could go through a whole workup and find nothing, which is super frustrating. But just know that a lot of times we don’t really find anything. It’s tough, right? We can check all the vitamin levels and thyroid and blood counts and we can, you know, ask you about sleep apnea questions and see if we think that’s what’s going on. And, you know, there’s all these things that we can do. We may not find anything.

Gabe Howard: And when you say that, you find nothing. The thing that you actually find is that it could be lifestyle choices. Maybe you gained weight, maybe you’re not as active. Maybe you just got older. Right. I know that I do not have as much energy at 45 as I did at 25. Luckily, I don’t really expend a lot of energy because I’m pretty lazy. But if I were somebody that in my twenties played every sport imaginable and was averaging 6 hours of sleep because that’s all my body needed in my twenties, I can see how hitting 45 and needing 8 hours of sleep and having everything hurt after playing a round of golf could be a problem. It’s practically a stereotype of the middle aged man who refuses to acknowledge that they have physical limitations. Now, one of those physical limitations is how much energy you can exert before feeling tired. So it’s certainly possible that some of your patients, there’s nothing wrong with them. They’re just 40 or 50 or 60.

Dr. Nicole Washington: Well, I am definitely not going to tell somebody it’s because you’re old.

Gabe Howard: I mean, you should probably word it better.

Dr. Nicole Washington: It’s because you’re not 20 anymore. Okay, well, how should I word it? Give me advice on how I should tell someone you’re tired because you’re not a spring chicken anymore. I don’t know.

Gabe Howard: I mean, honesty is the best policy. You should be like, look, you’re closer to death than you are to birth. No, I’m just kidding. Don’t say that. But

Dr. Nicole Washington: I would never say that to somebody.

Gabe Howard: You would never say that. But you can’t let somebody like me believe that I can still behave like I’m 25 because it’s dangerous for all involved. It’s not healthy for me. And, you know, that’s an interesting thing. We we’ve talked about this and framed it in the terms of bipolar disorder. But one of the things that keeps coming up is sleep apnea. Sleep apnea is something that happens when you gain weight. It’s something that can happen as you age. It’s something that can just happen over bad luck. And it causes a lot of sleep problems and it has nothing, nothing to do with bipolar disorder. Do you recommend for people when you’re like, look, it doesn’t seem to be related to mental health. Go get a physical right. Go get your physical health checked out.

Dr. Nicole Washington: Regardless, even if we’re in the process of trying to make medication changes, I still have people go see their primary care doctor and get a workup because it doesn’t mean it couldn’t be more than one thing, you know? It doesn’t mean that you won’t go and your thyroid is out of whack or your vitamin D levels are off or you’re, you know, a lady who’s in her childbearing years and your menstrual cycles are heavy. Maybe you’re a name. You know, there’s a lot of things that could happen. And so, you know, especially if we talked about weight gain, right? You gain weight, your neck gets a little thick, you start snoring at night, you’re not sleeping as well. You can have sleep apnea and not realize it. Right. Because, you know, that weight kind of creeps up on you and you don’t really realize it. So I tell people, if they sleep with someone like ask your partner, do you do you snore at night or you’re are you doing the you know, because you’re having these moments of not breathing, like what’s going on there? We just, you know, get the work up.

Gabe Howard: It’s important to remember that if you live with bipolar disorder, not everything that happens to you is related to bipolar disorder. Listen, as a podcaster, I’m like, man, this is this is such a sorry ending. So the ending of your Bipolar and Tiredness podcast is it might not be bipolar and you’re human and Americans don’t pay enough attention to sleep. Gabe, your takeaways don’t have a lot to do with bipolar disorder. Yeah, that’s true. That is true. Not every single thing that happens to somebody living with bipolar disorder is because of bipolar disorder.

Gabe Howard: When I was 25, bipolar disorder was really my biggest concern. In fact, as far as medical concerns were, it was really my only one. And I got really pigeonholed in this thinking mental health, mental illness, bipolar disorder, mental health, mental illness, bipolar disorder, because that was that was all that was going on in my life. And that was beat into my brain for the better part of a decade and a half. And then one day I hit 40, and all of a sudden, they’re starting to talk to me about procedures that I used to make fun of my dad for getting. And I’m like, What do you mean? I got I got to think about my first colonoscopy in ten years. What are you talking about? That’s something that old people get it. It is a shock to the system. But many of us are diagnosed with bipolar disorder in our late teens, early twenties. And maybe when you’re listening to this podcast, you’re 35, you’re 40 or 45, and you’re like, oh, I’m having all these symptoms from bipolar disorder that I never had before. And the reality is, is expand your thinking. You might be having all of these symptoms that you’ve never had before, because I know I know it’s not the word Doctor Nicole likes to use, but it’s because you’re getting old, right? I just I can’t help it. It’s because you’re getting. I had to go through it. I had to go through. I got so much plastic surgery.

Dr. Nicole Washington: Stop it.

Gabe Howard: I got a little bit of plastic surgery. You don’t know. I’m actually 70.

Dr. Nicole Washington: Oh, well, there you go.

Gabe Howard: I can barely smile now. I have people behind me pulling on my skin. That’s why we never did video before, because I couldn’t afford to have the people tugging on my skin behind me.

Dr. Nicole Washington: Yeah. Don’t listen to Gabe.

Gabe Howard: But as the show has gotten more and more popular

Dr. Nicole Washington: Don’t listen to him.

Gabe Howard: [Laughter]

Dr. Nicole Washington: Don’t do it.

Gabe Howard: Dr. Nicole, thank you so much. And thank you to all of our listeners for hanging out with us. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” which of course is available on Amazon because well, everything is. Or you can get a signed copy with free show swag by heading over to gabehoward.com.

Dr. Nicole Washington: And I’m Dr. Nicole Washington. You can follow me on all social media platforms @DrNicolePsych to see what I have my hand in at any given moment.

Gabe Howard: And can you do me a favor? Can you do us a favor? Can you share the show? Tell people about it. Word of mouth. Social media send a text message. Sharing the show is how we grow. And we will see everybody next Monday on Inside Bipolar.

Announcer: You’ve been listening to Inside Bipolar from Healthline Media and psychcentral.com. Have feedback for the show? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/ibp or on your favorite podcast player. Thank you for listening.