Inside Bipolar Podcast: Essential Questions to Ask About Your Bipolar Diagnosis and Treatment

Inside Bipolar Podcast Episode Transcript:

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 everyone, thanks for listening 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 Dr. Nicole and I love to get your questions, your feedback, your emails. You can hit us up at show@psychcentral.com. You can also follow us on TikTok and Instagram. Dr. Nicole is @DrNicolePsych and I’m @AskABipolar. We are great followers and you can even watch clips of the show over there. Now today we’re going to discuss the five main questions that you should ask your provider when you’re diagnosed with bipolar disorder. But I am curious, Dr. Nicole, what is the number one question that you ask your patients after you diagnose them with bipolar disorder?

Dr. Nicole: Well, Gabe, I’m glad you asked. I usually ask them if they have any questions about anything. So this is this is fitting. It fits right in.

Gabe: So you make space in the diagnosis process to answer those questions? You just you just create that time right there?

Dr. Nicole: It’s easier in the outpatient setting. So if I am seeing somebody in an outpatient setting and we aren’t really sure, and we’re going back and forth about is this bipolar disorder, is this depression and something else? If we’re uncertain, I usually will send people to go do some research. And we spend some visits really trying to nail down a diagnosis. I don’t feel the pressure to immediately say, oh, you absolutely have bipolar disorder or you don’t. And so we take some time. If we have the luxury of time in those situations, it’s a whole lot easier to say, okay, do you have any questions in the hospital? All bets are off.

Gabe: My knee jerk reaction is to say, hey, just ask the next psychiatrist. Ask whomever you’re seeing right now if you’ve never gotten these questions answered. But some of these questions are specific to the person who diagnosed you. Like for example, let’s list. Let’s just rip the Band-Aid off and start with the first one. What led you to diagnose me with bipolar disorder versus any other disorder? Help me understand the diagnosis process. Now you can ask your, the non person who diagnosed you to help understand the diagnosis process. And I think that’s very valuable. But the first part of the question, what led you to diagnose me with bipolar disorder versus any other illness or disorder, can only ask the person who diagnosed you that so or am I wrong?

Dr. Nicole: I don’t think you.

Gabe: You gave me a look

Dr. Nicole: [Laughter]

Gabe: Dr. Nicole gave me a look.

Dr. Nicole: I don’t think you can only ask the person who

Gabe: Okay.

Dr. Nicole: Initially diagnosed you. Because in theory, when you see someone for the first time in the outpatient setting, they should be going back over your criteria. So they should be going back over. Okay, so I see you were diagnosed with bipolar disorder. Tell me what was going on that led to that diagnosis. Because y’all know I’m not I’m not very trusting. So I side I everyone, including my colleagues. I will have to admit. So just because a person comes to me with a bipolar diagnosis, it doesn’t mean that I am 100% bound to keeping that as their diagnosis. If I genuinely don’t believe that’s the case, or let’s say if the patient did not give the previous person the full story or they’re giving me more information, or now they have a family member in the room who’s able to give me more information than what was received in the hospital. Sometimes it changes, but the person who is seeing you in the outpatient setting should absolutely be going back over that criteria and or at least reviewing with you the records from the hospital to say, oh, I see this is what was going on, or I see that is what was going on. So they should be able to help give you some guidance as to how come you were diagnosed with bipolar disorder versus something else.

Gabe: So, for example, you could change up the question ever so slightly to why do you agree with the bipolar diagnosis?

Dr. Nicole: Yeah, that that would be

Gabe: Yeah.

Dr. Nicole: A reasonable way to approach that. Yes.

Gabe: Now, obviously Dr. Nicole can’t answer all of these questions. For example, what led you to diagnose me with bipolar disorder versus any other illness is not in Dr. Nicole’s wheelhouse. Because she and I are colleagues. She’s not my well, she’s not my Dr. Nicole. She’s my doctor. Nicole. Right. But you can answer the second question. Can you help people understand the diagnostic process for bipolar disorder?

Dr. Nicole: I know it feels like we just talked to you one time, and all of a sudden people say, oh, you have bipolar disorder. That is something I hear a lot. I think it’s important to remember that there are very specific criteria for mania, hypomania, very specific criteria for major depressive episodes. And oftentimes, as you are talking to us, I am in my head making this checklist in my brain of okay, they check that they’re describing that that’s what’s going on. So sometimes we can sometimes the person comes in and they can give you the best history, even if they don’t know the criteria. As they’re telling me what they were like during these episodes, I can check off the criteria in my head and go, yep, that checks that box. That checks that box. This sounds very consistent with what we know to be hypomania and mania, and sometimes it’s a slam dunk. Sometimes it’s not. Sometimes it is not quite clear because we’ve talked about how when a person has mania or hypomania, sometimes they aren’t the best at remembering their symptoms. So maybe they under-report because they really can’t remember what they were like when they were manic. And if I don’t have a lot of great information coming from outside sources, sometimes it’s hard to be able to know, like, are you describing mania? Hypomania? Like, what is that? Were you just having a bad couple of days? Was that anger? We also will do a full evaluation. So even if you come in and you say, oh, I have a history of bipolar disorder, I’m still going to ask you about other things.

Dr. Nicole: I’m going to ask you about your depressions and what are they like. I’m going to ask you about trauma history, because people who have extensive trauma histories or who also have a diagnosis of PTSD, can sometimes get misdiagnosed as bipolar disorder because they have these emotional swings and these outbursts and. Sometimes those emotional shifts can be misinterpreted as mania or hypomania. So I will ask you all those things and you think, well, why is she asking me all that? Why is she all in my business? Because I need to be able to figure out. I need to know about your substance history. I need to know if you have a history of using especially stimulant drugs like cocaine or methamphetamines, or abusing prescription stimulants or things like that. I need to know that. Because if that is what you were doing around the time of life when you were diagnosed with your bipolar disorder, I need to be able to help distinguish between is this substance induced bipolar disorder or is this you have a primary bipolar illness, and maybe you were just using to compensate for some of the symptoms that you had. That takes some time. So I should be asking you all those questions. So a full evaluation should absolutely happen as well. And that’s how we that’s how we figure it all out. We, we ask you a ton of questions. And it may seem like we’re just being intrusive and just all in your business, but we’re asking all these questions because the way you answer, the way symptoms overlap or not overlap, might give us a lot of insight into what exactly it is that you have.

Gabe: It’s a long explanation because it’s a long process.

Dr. Nicole: Yeah.

Gabe: There’s a there’s a lot to turn over. I, I suppose if somebody wanted to they could go get the DSM five, the Diagnostic and Statistical Manual. It’s how you diagnose. Well, I think all mental illnesses, but specifically it’s how you diagnose bipolar. Now in that section for bipolar disorder, how many little check marks do you need before you get bipolar I or II?

Dr. Nicole: Well, we’re going to look at the symptoms, how intense they are. How long do they last. There is a certain number of days for hypomania versus mania. There’s also an intensity of symptoms. So if a person is hospitalized during an up mood we’re going to call that mania. If they experience psychosis we’re going to call that mania. If they’re having hallucinations or delusional thoughts, we’re going to call that mania because they may get to the point where their symptoms are so severe, they don’t make it to the full week because they end up in the hospital before that week gets there. And we’re looking at what else is going on in your life. What was your functioning like? We’re looking at were substances involved, because the DSM has those little things that say if it’s substance induced, it doesn’t count here. If this is what’s going on, you can’t call that here. And so we are looking at all of those things. But yes, the DSM is the book that we use. I don’t recommend you go out and get one and read it in your leisure time, but that is what we use. That is where the criteria lives.

Gabe: That is where the criteria lives. It sounds like a troll, right? Like the criteria lives under the bridge for bipolar disorder. It sounds scary, but yes, I, I don’t necessarily recommend reading the DSM-5 either. It’s kind of a boring read. However, that is the manual that that doctors use to diagnose.

Dr. Nicole: It may also be equally as important for you to ask them why bipolar disorder and not this other thing? Because a lot of times people will say, well, I think that I had this or I was told before I had this because diagnoses change. So it may be just as valuable for you to ask and why not that why? Why bipolar disorder and not borderline personality disorder? Why bipolar disorder and not depression and complex PTSD? Why bipolar disorder and not schizoaffective disorder? It may be equally as valuable for you to kind of explore that stuff to.

Gabe: I really like that you pointed that out, because we should also point out that it might be why bipolar disorder and not my previous diagnosis of depression, or borderline or anxiety or whatever it was because we did an episode on Diagnosis Flip Flop where you can be diagnosed with one thing, and then another doctor takes a look at it, or you establish more symptoms. So then the diagnosis changes. I think that’s a really important question to ask if your diagnosis changed. So we’ll call that like A1B to go with the one A. Now our next question which is number two what treatments are available for bipolar. And what do you recommend for me now obviously Dr. Nicole can’t answer the second one on this podcast, but you should still ask your Dr. Nicole. But Dr. Nicole can answer the first one on this podcast to give you a little bit of a leg up to make excellent use of that managed care time that we all get with our Dr. Nicole’s, which is, you know, ranging around 12 minutes these

Dr. Nicole: Ugh.

Gabe: Days. But what treatment options are available for bipolar disorder? And I know you can’t create an exhaustive list, but

Dr. Nicole: Yes.

Gabe: What are the what are the primary ones?

Dr. Nicole: Yeah. We can talk about general categories.

Gabe: Yeah.

Dr. Nicole: There are traditional mood stabilizing drugs. A lot of these medications also fall under the anticonvulsant category of medications. So you should know that there are several seizure medicines that are also FDA approved and indicated and studied for bipolar disorder. So you may be prescribed something that or recommended to take something that you recognize like, oh, I know somebody who has seizures and they take that thing. So that is very common. I think when you’re new to this, it can be a little overwhelming and it can feel very scary when people are just throwing things out at you. So that is a general category. Lithium is a unique little beast. It’s its unique little bugger. It is for bipolar disorder, but it kind of fits in its own category. It is a mood stabilizer, but it’s very unique in what it does. And it is in its own little category. And it also can sound scary. I will not lie to you. I get it, I get it, I get it. We also have the category of medications that we use that are categorically described as antipsychotics, but several of them are also FDA approved and studied and have indications for bipolar disorder. So you may also have those recommended to you as part of this process.

Dr. Nicole: I do want to add in, though a lot of times people will say, well, but you know, I’m depressed, so can you just give me an antidepressant? But can you just give me like, give me an SSRI? Most of the time we try to avoid antidepressants, traditional antidepressants, your SSRIs, your SNRIs, your nontraditional antidepressants. Most of the time, we try to avoid those in people with bipolar illness, because we do know that there can be a risk of switching or inducing a manic episode or creating more instability where there’s already instability. So a lot of times we avoid those, and that is a source of contention sometimes with folks who are like, But I’m depressed, why are you not giving me an antidepressant? So there is a reason why your doctor is resistant or hesitant to give you something like that. I’m not saying it never happens. If you’ve been seeing someone for a long time and they have your regiment all worked out and you two come to the agreement that that is the best thing to do. It may happen, but it is not a very common thing that happens. And so sometimes they can be a source of stress between patients and their doctors.

Gabe: I can certainly see where somebody’s feeling the full effects of depression would want an antidepressant. It’s very aptly named. Just out of curiosity, why isn’t there an anti-bipolar medication? I’m kidding a little bit. But at the same time I’m not. I mean, depression is its own illness. Major depressive disorder is a thing.

Dr. Nicole: Mm-hmm.

Gabe: And they’ve got something that’s called anti that thing. But bipolar disorder really huge. And it’s like no no no. What we’re going to do is we’re going to give you all of these medications, each attacking a different symptom. You’re going to just take a handful of pills in the morning, a handful of pills at night. It’s going to be fine. Why does nobody invent anti bipolar meds?

Dr. Nicole: If I could, maybe I’d be a wealthy woman, I don’t know, I mean, if I, if I could come up with a pill that just took you to center immediately and it was the anti-bipolar pill, I would probably not be sitting here with you right now, Gabe. I would be on an

Gabe: Well.

Dr. Nicole: Island. I’d be on my personal island that was named after me, and I would not be with you right now. I wouldn’t be here.

Gabe: Even if I were a multi-millionaire, I would still be doing this show with you.

Dr. Nicole: Okay,

Gabe: I’d be doing it from a much nicer house.

Dr. Nicole: Well, you can come to the island. And I will do the show on the island, but I would not be in my house. [Laughter]

Gabe: Okay. Will you pay for me to come to the island? You have dump trucks of money. At this point, you can

Dr. Nicole: Yeah.

Gabe: Give me a plane ticket.

Dr. Nicole: That’s true. That’s. That is very true. But we don’t have that. We just don’t have that. But Mood Stabilizer is aptly named. Like, it’s a mood stabilizer. We are stabilizing your mood. We are trying to not have you go too high. We are trying to not have you go too low. I want you in the middle, mood stabilizing. And we do use the anti-psychotics as mood stabilizers. In some instances. So yes, we don’t have an anti-bipolar. But. I think, to answer your specific question, yes, people want antidepressants because it is so named. But really you have to decide do you trust the person that is taking care of you? Do you trust the person who’s prescribing you medication? Because you have to know that we’re not out here just trying to withhold things from you because we don’t want you to be better. It is. It is definitely not. We’re keeping it from you. It’s not that we don’t want you. Well, it’s not that we don’t want you better. We are. We are trying to not harm you. And we know that that has the potential to harm you.

Gabe: Dr. Nicole I’m just curious. Another question that comes up, another, 2B, for lack of a better word, is why do you recommend this treatment for me? And I know that you can’t answer the why because you don’t

Dr. Nicole: Mm-hmm.

Gabe: Know what the treatment is. But. But I’m asking you as a patient to a psychiatrist, does that question bother you when patients question your why?

Dr. Nicole: I don’t ever have a problem with people questioning my why in general, like just in life in general. I don’t have an issue with people being genuinely curious. Especially when it comes to medication that is going to go into their bodies. I’m perfectly fine with the ask. I will say the tone makes all the difference in the world with the ask.

Gabe: Fair. Very fair.

Dr. Nicole: If you’re angry, like, why are you giving me this and not blankety blank? My neighbor takes this and he’s doing great. Why won’t you give me that? Like, the tone will totally change the color of the situation. But if you just are curious about, like, hey, I saw a commercial for this drug, or oh, hey, I have a neighbor who is taking this, and they said it worked really well for them. How come you didn’t recommend that one? Or one of my favorite questions is when people say, well, I took such and such and it did great. And how come you aren’t giving me that? And then my question is always, well, if it did so great, why? Why are we here? Why are you not still on it? Why did you go off of it? What was the deal? What happened? And sometimes that opens up conversation to where I find out they did really well on something. And maybe they stopped taking it because they couldn’t afford it, or they just forgot, or they got sick and quit taking it. And the person who saw them just didn’t put them back on it. But if they genuinely can paint a picture for me of no, I did really well on that medicine.

Dr. Nicole: And then I wasn’t taking it anymore. And everybody wanted to give me new stuff, and I just felt really good on that. We can revisit that for sure. So there are factors that go into the why. What have you taken before? What did you do well on before? What side effect profiles are deal breakers for you? We have talked time and time again about how some people don’t care if they gain a few pounds, some people, if they gain a half a pound, they’re ready to quit all their meds. Some people don’t care about prolonged orgasm or not having as high of a sex drive. Some people absolutely care. So I figure out what are your deal breaker side effects that may go into our profile. I may find out if sleep is a problem for you. If you’re somebody who really struggles with getting to sleep, maybe we talk about something a little bit more sedating something at bedtime. We try to figure out specifically for you why a particular medication makes sense. And that is not a conversation that I think is rude to have. I just think sometimes the tone that comes with it is not always the best.

Gabe: Now, Dr. Nicole, when it comes to treatment, you’ve only mentioned medications. Are there other treatments available for bipolar disorder?

Dr. Nicole: Absolutely. I think diet and exercise are important physical activity. I will say in the beginning, I don’t talk about these things when I have someone who’s fresh out of the hospital or coming off a manic episode, or in the middle of an episode that we’re trying to get under control. I am definitely not saying. So tell me, can you keep a food log? Are you eating salads? What kind of vegetables? You’re not eating enough veggies. So I’m not gonna lie to you. When somebody is in the middle of an episode or just coming off a manic episode or just getting out of the hospital, I am probably not talking to them about diet and exercise. I am not badgering them about healthy living and how many servings of vegetables and fruits they’re getting a day. I’m probably not doing those things in the beginning, but yes, we absolutely no diet, exercise, those kinds of lifestyle things can be very, very helpful in helping someone maintain stability once they get it. For sure. Therapy is a very valuable tool for someone who has bipolar disorder, and a lot of times my bipolar patients think, well, what do I need therapy for? Therapy ain’t gonna stop me from getting mania. It’s not going to stop me from getting depressed. But. Therapy can go a long way with helping you with the acceptance of your illness, with the putting tools and putting routines and structures in place to help you manage your illness. To help you maintain stability, to help you set boundaries with yourself and with your family and your loved one. It can help you with so many things to help you manage your illness. So while yeah, therapy isn’t going to prevent a manic episode or a depressive episode, it can definitely help you maintain and can help you keep healthier lifestyle strategies in place to hopefully prevent some of those things from happening in the first place.

Dr. Nicole: It maybe it could help prevent if you have the right plan in place. So I think therapy is fantastic. And then the last thing I think is that you need support. You need your people. You need people who get it. And I don’t care what you do in life, you need people that you all share something in common with. And if you have bipolar disorder, you need people who have been where you are in your corner. That’s why peer support systems and support groups are so important, because you need people who get it. Sometimes it is maddening to try to talk to your loved ones about your bipolar disorder, because inherently we’re going to say the wrong thing. We’re going to say something that sounds dumb to you because we’ve never been there, and we’re going to say something stupid, and you just want to talk to somebody who gets it. You want to be able to say something about your illness that if you said it to your mom, she’d clutch her pearls and go, oh, Gabe, I can’t believe you said that. Like, I can’t believe you said that. You need a space. You you don’t need people being just completely taken aback by the things you say. You need to be able to say. All those hateful, ugly things that you want to say that are related to your illness. You need all of those things. So that’s also a very important part of treating your bipolar disorder and your recovery is finding community.

Gabe: Thank you so much for that, Dr. Nicole. It leads us to question number three. And it’s once medications have been decided, the very important question that you should ask is what are the side effects of those

Gabe: Medications? What can I expect when taking these drugs? Now obviously you can’t answer specifically,

Dr. Nicole: Yes.

Gabe: But you have a famous saying that I love.

Dr. Nicole: I do. These side effect profiles are not sexy, y’all. They are not. They are so not sexy.

Sponsor Break

Gabe: And we’re back discussing five questions you should ask after being diagnosed with bipolar disorder.

Dr. Nicole: When you hear those commercials on TV and everybody always jokes about at the end how, you know, they’re like, your left toe might go numb, you might, you know.

Gabe: Yeah, yeah. Anal leakage always comes up.

Dr. Nicole: Yes.

Gabe: That’s my favorite part.

Dr. Nicole: Yes.

Gabe: Yeah, I’m like, wow.

Dr. Nicole: Yes, you know, they, they, they give you those kind of there at the end, they want to make sure they’re giving you the big ones. And I think it is important to know the big ones. So you have to think of side effects going into two categories. There are the common things and then there are the these are not common, but they’re bad juju things. And I think you need to know about both. So you need to know about the little things like sedation and weight gain, the things that happen more commonly. You also need to know about the big things that don’t happen quite as often, but are big. You need to know about the bad rashes, and you need to know about the liver damage and the kidney failure and the thyroid dysfunction. And you need to know about all of those things because you need to be able to make an informed decision. But I think it’s important for you to take that information and figure out where to put it. So this is a common side effect. This is a severe, rare side effect. And you also need to think about what can I tolerate. Like what what am I willing to put up with. And we talk about deal breaker side effects. And what’s more important to you may not be what’s more important to another person. So I think it’s important to take a deep breath to come into these conversations with an open mind, because I am going to make it sound like, why in the heck would anybody ever take medication? When I start going over side effect profiles with you, you’re going to think, I.

Dr. Nicole: I don’t want either of those things like that. That’s horrible. Why would I take that? Because the reason you would take it is that everything in life that we do is a risk benefit conversation. Every decision you make in life is a risk benefit conversation. Like, it all is. You’re thinking about, if I don’t, what’s the worse that’s going to happen? If I do, what’s the worst that’s going to happen? And which of those two things to me is worse than the other? Every decision we make. Do I eat the cookie? Do I not do? Do I call in to work today, do I go? All of these things are risk benefit conversations. Your medication? Absolutely risk benefit. What kind of benefits have you gotten? No. Treatment is not good either. No treatment. Having your brain be exposed to multiple mood episodes, having your life disrupted, and your quality of life be crap to avoid the potential for those medication side effects. That doesn’t sound like a good move either, so I think it’s important to be able to step back a little bit and think about what the questions are you need to ask about the side effect profiles.

Gabe: I think being able to understand what the side effect profiles may be allows you to get ahead of them. For example, me personally, I didn’t really understand that these medications had side effects. I just understood all the good things because I was really sick. I was diagnosed after being committed to a psychiatric hospital and they told me, hey, this is the solution to never having to be admitted to a psychiatric hospital again. So I just had rose colored glasses on, and then all of a sudden things started happening, right? I was sleeping all day. I felt like a zombie. I had sexual side effects, and I was like, what the hell is going on here? And that made me want to stop the whole thing. It

Dr. Nicole: Yeah.

Gabe: Made me want to just throw my hands up and say, hey, nobody warned me about this because nobody warned me about this. So I completely agree that the side effect panel is not sexy. But I also agree with the there’s risk versus reward, and

Dr. Nicole: Mm-hmm.

Gabe: Understanding what those side effects might be allows you to understand when they’re happening. Understand that it’s just a side effect, and be able to report back to your Dr. Nicole immediately. Hey, you know that side effect we were worried about? It’s absolutely happening. I’m ready to move on to plan B, which ideally has already been discussed. It’s already out in the open, so you can have a comfort level that you’re going to be taken seriously. In the case of, of a of a bad outcome.

Dr. Nicole: And it sounds like what you’re saying because this is what we’re talking about before, I think it’s that, that hospital, it’s that, it’s that person who was diagnosed in the hospital. And then that isn’t the time to talk about side effect profiles. You’re manic, you’re running around, you’re not stable. You’re largely unstable. Mood is either super low, super high. We’re trying to get you stable. We’re trying to stop you from killing yourself. We’re trying to stop you from doing things that are dangerous, to get yourself into legal trouble or to hurt yourself. So we are not having those conversations then. But then you get into the outpatient setting and who’s having those, who’s having those conversations? We need a book that says, you’re bipolar. What’s next? You’re now you have bipolar disorder. What’s next? Because it sounds like that is a place where we’re missing a lot of the education pieces that should come, because there is a lot of education about the medicine, about the illness. What does treatment look like? What’s the natural course, what can you expect? You know, but those conversations never happened. And that’s what leads to frustration on your part, because then you feel like we were hoodwinking you, or just didn’t care enough to tell you what the side effects were.

Gabe: Well. And that leads us to number four. What are the major lifestyle considerations that somebody newly diagnosed should be aware of? And I want to rip the band aid off of one real quick. Alcohol and medication don’t mix. It’s the number one thing that gets me hate mail when I’m on a stage and people are like, what do you recommend? I’m like, I recommend you don’t drink. How dare you tell me I can’t drink? I’m a grown ass person and I’ll drink if I want.

Dr. Nicole: Right. Right.

Gabe: I fully understand you’re going to drink if I want to, but an important lifestyle change that you should make is to be really, really careful. Mixing alcohol and psychiatric medications. That’s. I just want to get that one out of the way. And I decided that I would take the hit so that I would get all the hate mail.

Dr. Nicole: Well,

Gabe: You’re welcome, Dr. Nicole.

Dr. Nicole: So I fully believe language matters. Words matter. I probably well, no, I can say I rarely tell somebody what they can’t do, because I fully know that you are an adult and you can do whatever it is you want to do. But my job is to tell you what are the risks involved with you doing the things you want to do, and then you making the decision to either pay attention to what I’m saying or disregard it and let the chips fall where they may. So alcohol is 100% one of those things. It’s not that we don’t want you to have fun. It’s not that we think like, oh, we just. We just want to be a killjoy. We just don’t want Gabe to ever have a good time. So we’re going to tell you, you can never drink. There can be interaction with medication. So many of the medications that we prescribe can be sedating. If you drink alcohol, which can also be sedating, and you are taking a medication that can be sedating, you can get an extra sedation factor in there that we weren’t accounting for. That can be dangerous. That’s the that’s the bottom line that that is what we’re concerned about. Of course, we’re also concerned about routine. Alcohol. Drinking alcohol affects your sleep cycle. I am all over your sleep cycle when you have bipolar disorder. Alcohol is a depressant. So you drinking regularly can affect your mood control and stability. Alcohol is disinhibiting. So the things that your normal filter says, oh, I’m not gonna say that. I’m not going to behave in this way. We know that once you have a drink for some people, that disinhibition can get them into a lot of trouble. So there’s lots of reasons why we recommend you consider the potential negative effects that alcohol can have. Ultimately, you will decide to do what you want to do. But these are

Gabe: Yes.

Dr. Nicole: The things that we are concerned about. When we tell you that, we think you should consider cutting back or stopping your alcohol altogether.

Gabe: What are some other major lifestyle changes that you think people should make? I know you’ve mentioned diet and exercise before. We obviously talked about alcohol, but are there any other ones?

Dr. Nicole: You know how I feel about sleep. I just say I’m all over your sleep cycle. When someone has bipolar disorder, that’s probably the one thing I’m sure patients are rolling their eyes about when I am constantly like, so how’s your sleep? So finals is coming up. Are you sleeping during finals? It’s your birthday. You’re going out of town. That Vegas trip sounds amazing, but what about your sleep? I am, I am the ultimate in in buzzkill when it comes to sleep. That may be a big one for you. If you are the kind of person who enjoys being a night owl and staying up late and burning the candle at both ends, and you have gotten used to functioning with very little sleep at night, that that may be something that might have to change for you. You may find that once you are diagnosed with bipolar disorder, you may find that you’re more sensitive to lack of sleep. You may find that you’re having more mood episodes when your sleep is not stable. So for you. That inability to stay up all night, or that inability to party late into the night with friends, that that might be something that you have to change and that can be very difficult.

Dr. Nicole: I can think of a person who really enjoyed those times, and that was something that they found was disruptive to their mood. So they ended up having to be a stickler about getting a full night of sleep. And the way they ended up having to frame that was to be able to recognize that I may have to go to bed early at night, but I’m able to be more present for a longer period of time and to enjoy the whole process or the totality of this situation or this trip. Whereas if they stayed up the first couple of nights kicking it too hard, then they would be worthless for the whole rest of the trip. They wouldn’t have a good time, they’d be in bed. They’d they just would not be getting along with people. Well, just the whole trip was ruined. So it’s a again, it’s a risk benefit decision. But I definitely recommend that you pay attention to your sleep and how it can affect your mood. Episodes.

Gabe: One of the things that I really, really, really advise people who are newly diagnosed with bipolar disorder to manage it well is to be a slave to your routine. Routine is so important and sleep hygiene is in there, going to bed at the same time, getting up at the same time, but also how you structure the rest of the day when you eat your meals, when you take your medications. All of these things play a big role. And one of the reasons that I bring this up, and this is a little bit of a, of a of a pro tip, not everybody thinks this way, but I’m able to design my day. So I think about when in the day am I at my best, you know, are you a morning person? Are you an afternoon person or you’re an evening person. And I put my most important assignments in there. For example, I like to record these podcasts during the day. I don’t like to record after 6:00 because I know that I tend to be lower energy in the evening. My mind kind of slows down. I’m sort of getting into that, you know, eat dinner, rest, go to bed. So trying to have all of this, you know, intellectual conversation with a doctor would be too much for me. And I want the podcast to be good. So if you’re able to design your life and design routines around your bipolar disorder moods or just around your moods, I just say bipolar disorder moods because it’s a bipolar podcast. I think this really gives us a leg up. And here’s where I want to point out that I think everybody’s this way. My wife has zero mental illnesses whatsoever. She’s a super morning person, so she’s on a flex schedule at her job. She shows up at her job at 6:30 a.m.. I don’t understand that to save my life, but she knows that she is super productive in the morning. Number one and

Dr. Nicole: Mm-hmm.

Gabe: Two. She knows that most people don’t get it until eight, so

Dr. Nicole: Mm-hmm.

Gabe: She has silence and quiet that she can get all of this work done before the rush of the day starts. I think that routine is very important for everybody, but I think it’s super important for people managing bipolar disorder.

Dr. Nicole: I think that was a really good one, because whether you have bipolar disorder or not, most people don’t have great routines in life. And so this can feel like a pretty major shift in how you live your life. And it can also not feel good. Some people really hate the idea of having to do routines, and they think of it as well. You just want me to do that because now I have bipolar disorder, and I just hope that everybody out there listening realizes this is a recommendation that I make to people, whether they have bipolar disorder or not, because it can be so valuable in helping you get through a rough patch and helping you to achieve a level of stability.

Gabe: Truer words. Never spoken. Dr. Nicole I had zero routine before I was forced to have a routine, but it has paid off very, very well. So we’re nearing the end of the show. And this is the fifth question that I absolutely think that everybody should ask their Dr. Nicole no matter what age they are, how is it best to manage my physical health? With my mental health? We need to treat our mental health and our physical health together. And oftentimes we are met with this, this barrier that says that physical health goes over here and that mental health goes over here. It is imperative, I believe, that you ask your doctor, Nicole, how am I going to treat all of my health conditions together? This is especially true if you are taking medications or under treatment for another health condition, because obviously you can’t have Dr. Nicole prescribing you medications that could interact with other medications that you

Dr. Nicole: Mm-hmm.

Gabe: Are on. This is a huge question, and I imagine that this is a challenge for you, Dr. Nicole, because you don’t always have access to our physical health records and our physical health doctors don’t always have access to our mental health records, and there’s really not a good mechanism of communication between the two.

Dr. Nicole: There is you. You are the mechanism. You are the.

Gabe: You. You. It’s you. It’s on us.

Dr. Nicole: It’s not. It’s not us. It’s you.

Gabe: It’s all. It’s on us. Everybody. You heard her. The

Dr. Nicole: It is.

Gabe: Sick person with bipolar disorder has to wrangle the doctors. That’s all I’m hearing.

Dr. Nicole: It is. It’s on you. It’s not on us.

Gabe: I agree. I agree.

Dr. Nicole: I can’t see those things. They can’t see my things. So it is important that you are sharing the first thing somebody will tell me. Because my patients all are conditioned to tell me these things. They’ll say, oh since I saw you last, my primary care doctor started me on such and such a medicine. Or. Oh, since you saw me last, my primary care doctor increased this or decreased that, or we’re trying new medicine for this or that. And that is super important because there are interactions. There are things that we need to know about. And you may not think that they’re relevant. But that’s for us to decide. You tell us and we’ll decide if it’s relevant or not. But you are it. You tag. You’re it, you’re it, it’s you. It’s all it’s all you. Because unfortunately, we still are not at a place where our medical records are communicating to the point that I can just get that information. So it’s important that you not only share that with me, but that you also are sharing with them. When changes are made, when additions happen, they need to know that stuff.

Gabe: You heard her. It’s all on us. But obviously, if you are in a situation where you can sign for a release of information, if you can sign it and let each side see it, you should absolutely do it for continuity of care. If you’re in the position where you’re the hold up, don’t be the hold up. But also remember report every single thing that you do to both doctors. Is it a pain? Absolutely. But you know what else is a pain? Having a medication side effect because you didn’t communicate accurately with your doctor. So is it a burden on us? Absolutely. But listen, bipolar disorder is a burden on us. So don’t let bipolar disorder win because we’re being stubborn. And also this is my little advocacy moment. Keep advocating to bring mental health and physical health into the realm just called health.

Dr. Nicole: That would be great. But, I do think it’s important for everyone to have a primary care doctor.

Gabe: Of course.

Dr. Nicole: I always say stay ready so you don’t have to get ready. And we know that health is something that can change at the drop of a hat. It is something that you may find, like, I never needed a primary care doctor until I needed a primary care doctor. So it’s nice to have someone that you just go see annually, that you have those routine labs checked, that you’re looking at your cholesterol and you’re looking at your glucose and things like that. Some of the medications that we talked about, they may not lead to you seeing a difference weight wise, but we can see metabolic changes. So we can see your cholesterol increase, your lipids increase. We can see your glucose control get out of control without you having the tip off of oh, I’ve put on weight. So it’s important to have someone to monitor those things for you on an ongoing basis. Because when you need them, you want to have somebody that you’re already established with. And we just never know when that’s going to happen.

Gabe: And like it or not, we all get older. I am no longer a 26-year-old battling bipolar disorder.

Dr. Nicole: You are absolutely not.

Gabe: Age comes for us all.

Dr. Nicole: You are absolutely not.

Gabe: Is that another you’re old joke, Dr. Nicole?

Dr. Nicole: Older than me.

Gabe: You know, we’re very close to the same age.

Dr. Nicole: Older than me. that’s all I got.

Gabe: Very close to the same age.

Dr. Nicole: But you’ll always be older. [Laughter]

Gabe: [Laughter] I will always be older. All right, everybody, with that, those are the five questions that we recommend that you ask your Dr. Nicole when you’re diagnosed with bipolar disorder. And I hope that you got something out of it. And, Dr. Nicole, as always, I appreciate your candor. I appreciate your honesty, and I appreciate you answering as many of these questions as you could, because it will, in fact, free up time availability and the baseline knowledge for the people asking the question. So you’ve done a great service today.

Dr. Nicole: Oh, well, I mean, I guess I needed that today. Thank you, thank thank

Gabe: You’re very, very welcome.

Dr. Nicole: Thank you, thank you.

Gabe: You’re very welcome. All right. We need some favors from you all as well. Wherever you downloaded this podcast, please follow or subscribe to the show. It is absolutely free, and it’s the best way to ensure that you don’t miss a thing. And also do us a favor. Recommend the show to everybody you know. Bring it up in a support group, share your favorite episodes on social media, host discussion groups. Send people emails, text messages. Sharing the show with the people you know is how we grow. My name is Gabe Howard and I am an award-winning public speaker and I 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. But if you want a signed copy with some free swag or you want to learn more about me, just head over to our website gabehoward.com. If you want to follow me on Instagram or TikTok, hit me up @AskABipolar.

Dr. Nicole: And I’m Dr. Nicole. 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: All right, everyone, we’ll see you next time on Inside Bipolar.

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