Did you know that age changes not only potential symptoms of bipolar disorder, but also what care is available, how doctors see the illness, and even our own perspective? It’s even possible for bipolar disorder to show up for the first time in your 50s, 60s, or even later. Listen in as Gabe Howard and Dr. Nicole Washington discuss bipolar and aging — from myths about diagnosis, to whether the symptoms of bipolar disorder subside with age.

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.

Dr. Nicole Washington: I am Dr. Nicole Washington, a board certified psychiatrist.

Gabe Howard: And I’m Gabe Howard, and I live with bipolar disorder.

Dr. Nicole Washington: All right, so, Gabe, you’re old, right? Like you’re old.

Gabe Howard: I prefer middle aged or at least like 25 with 20 years’ experience.

Dr. Nicole Washington: Okay.

Gabe Howard: But. But old is not the term I would use.

Dr. Nicole Washington: No? Can we say seasoned, mature? Like I can pull out my thesaurus and come out with all kind of words if you need me to.

Gabe Howard: All of those are better than old.

Dr. Nicole Washington: Okay.

Gabe Howard: I have a cousin who calls me the elder cousin

Dr. Nicole Washington: Oh.

Gabe Howard: Because she’s 16 years younger than me.

Dr. Nicole Washington: Elder stings.

Gabe Howard: I call her lives in my house for free.

Dr. Nicole Washington: Well, elder stings. But you’re getting older. We can agree on that, right?

Gabe Howard: That is true. I am no longer what society considers young, although that does raise an interesting question. We are talking about aging and bipolar disorder, which means there’s probably a medical definition of what is considered young, young adult, middle aged.

Dr. Nicole Washington: You know, we don’t have I mean, we think of adults as 18, right? Like you’re 18, you’re an adult. But there’s lots of definitions that, you know, are very loose and not well accepted, you know, across the board. So let’s use what we want to use 50, 60 for our purposes today.

Gabe Howard: I think between 50 and 60 is probably a good age, although at 45 years old it does make me sad that 50 is considered old.

Dr. Nicole Washington: Yeah. Yeah.

Gabe Howard: But I sort of understand it.

Dr. Nicole Washington: Yeah, yeah, yeah.

Gabe Howard: Because our bodies change,

Dr. Nicole Washington: Yeah,

Gabe Howard: Right?

Dr. Nicole Washington: Yeah.

Gabe Howard: So the first thing is you’re only as old as you feel and you can do whatever you want and there’s no limits anymore. Nobody should listen to this podcast and hear Gabe and Dr. Nicole saying that because you’re old, you can’t go to a concert

Dr. Nicole Washington: No.

Gabe Howard: And stand on a chair. You do whatever you want.

Dr. Nicole Washington: Wear your short skirts and do it all.

Gabe Howard: Yeah. Wear your shorts.

Dr. Nicole Washington: Do it all.

Gabe Howard: You just party like a rock star.

Dr. Nicole Washington: Do it all.

Gabe Howard: But from a managing bipolar perspective and a data collection perspective, we’ve got to have some hard numbers. So for the majority of this conversation, we’re going to consider 50, 60 to be old,

Dr. Nicole Washington: Right?

Gabe Howard: Mature, seasoned.

Dr. Nicole Washington: Yeah, I mean, if you do if you do your own research after this and you start going down the black hole of what kind of research is out there, you’ll see 50 thrown around. You’ll see 60 thrown around as a kind of point that we start thinking about. This is an older age, bipolar disorder. So let’s somewhere between 50 and 60 is what we’ll use today.

Gabe Howard: Now, as you’ve established, I am not old, right? I want to make sure that we stick with that. Gabe is not old, but I am middle aged.

Dr. Nicole Washington: Gabe is not old.

Gabe Howard: Thank you.

Dr. Nicole Washington: Gabe is not old.

Gabe Howard: Thank you.

Dr. Nicole Washington: Gabe is not old, but

Gabe Howard: But I am middle aged.

Dr. Nicole Washington: And you are older.

Gabe Howard: I am older.

Dr. Nicole Washington: Than you were when you were diagnosed.

Gabe Howard: And this is why this matters. First off, whether you have bipolar disorder or not. Everybody ages and with aging comes challenges, new experiences and joints that used to be silent, suddenly creak. And that is just part of life. But from managing bipolar disorder, I personally, Dr. Nicole was diagnosed with bipolar disorder at 26 years old

Dr. Nicole Washington: Okay.

Gabe Howard: And I was put on all these medications. And obviously it took four years to find the right medications. And we finally found all the right medications and I reached recovery and yay, I am happy and I am pleased and I’m on many of those same medications still to this day.

Dr. Nicole Washington: Mm hmm.

Gabe Howard: But what happened from, you know, let’s go with 30, right? 30 is when I was perfectly stable on all the medications. As far as I was concerned, at 30, these were the medications that I was going to be on forever.

Dr. Nicole Washington: Right.

Gabe Howard: And I thought in my mind that was a very reasonable thing. Then one day I hit 40 and now I’m ten years older, I’m 40 years old, and I started to have sexual side effects. And I’m thinking, this is this is very weird. I resolved the sexual side effects years and years ago. Why are they cropping up? And I went to my psychiatrist and I said, look, I’m having sexual side effects from bipolar disorder. And without missing a beat, she said, no. One of the side effects of one of your medications is sexual side effects. And I said, Well, but I’ve been on it for ten years. She goes, Yeah, when you’re 30, your body could compensate. When you’re 40, your body can’t. And now I’m having to change medications not because the medication stopped working, but because my body aged it. And there’s a million examples of this. I use sexual side effects because it’s very relatable. But there’s also high blood pressure.

Dr. Nicole Washington: Yes.

Gabe Howard: I know people who are in their fifties who suddenly they have high blood pressure, very common, and their blood pressure medication is not compatible with their bipolar medication. So suddenly you can’t have high blood pressure, but you also can’t have untreated bipolar disorder. So now you’re starting to make decisions. Are these the challenges in treating the aging bipolar?

Dr. Nicole Washington: Yeah. The aging bipolar. That sounds so terrible. I don’t know about that. I mean, I think when we think of like the older person who has bipolar disorder, there’s two camps. There’s the person like you who was diagnosed when they were younger. And then they live a ripe life and they live into a ripe age of whatever that’s going to be. And then there are people who are diagnosed with bipolar disorder later in life. And so we definitely have to make sure we’re hitting those. But for you and anybody who was diagnosed early and then they’re living later in life, your body is just going to go through changes, whether you have bipolar disorder or not. I mean, it’s like you just say it. But the thing is, we don’t always associate because I keep saying over and over again, sometimes when you have a disorder that’s as huge as bipolar disorder is to your life, you wrap every single thing that happens in your body to your bipolar disorder, right? Like every single thing. So we sometimes have to tease out, like, what’s just normal aging, like what is just normal for a 45, 50 year old man to deal with versus a 20 to 25 year old man. So sexual side effects are one. The blood pressure one is huge. You mentioned that because there are certain medications that we use frequently for bipolar disorder that do interact with certain medicines. But it doesn’t mean like, oh, I can’t treat my bipolar disorder with this or I can’t treat my hypertension with that. Really, it just requires more coordination. So as you get older, the need for coordination between your specialist and your primary doctor becomes more important because of those things.

Gabe Howard: I was very lucky that my primary care doctor and my psychiatrist are like buddies. I’m not like in real life, but like medical buddies. They both work interchangeably there. The records are exchanged.

Dr. Nicole Washington: Oh, wow.

Gabe Howard: Nobody’s fighting. Everybody is super happy to help Gabe be the best person that he can be. I did not realize that that was not just status quo. I thought that just made perfect sense. I am one person. Therefore, all of my doctors should treat me like one person. I learned as a mental health advocate that this is this is extraordinarily rare,

Dr. Nicole Washington: Yeah.

Gabe Howard: This this cohesion of care. And I’m sad by that, because, again, if you treat one thing and something else goes haywire, you’re not living your best life. And if you treat one thing that interrupts another thing, it’s like, hey, he’s physically healthy and he has low blood pressure, but he thinks demons are under his bed and a dragon is chasing Elvis. That’s not your best life. Being physically fit and mentally ill is not good. Being mentally healthy and being physically unwell is not good.

Dr. Nicole Washington: Also not good.

Gabe Howard: I can’t stress that enough because you’re right. As people age, they start to become aware, for lack of a better word, that they’re not invincible, that the things hurt that didn’t used to hurt, and that things creak that didn’t use to creak, and that things that they used to be able to do that they can’t do. And many people begrudgingly, begrudgingly go see their physical doctor. They start to, start to learn the new normal.

Dr. Nicole Washington: Right.

Gabe Howard: But for reasons that I don’t quite understand it, oftentimes that doesn’t include the reality of your mental health is changing as well. Bipolar disorder is changing as well. Do you get pushback from your patients, Dr. Nicole, where they’re just like, look, I’ve been bipolar for 20 years. I know what’s going on.

Dr. Nicole Washington: No. I actually believe that once people get a little bit older, they tend to listen to you a little bit more. So we used to think that like once you got to a certain age, your bipolar disorder would just kind of fizzle out and you’d burn out and, you know, quit having episodes and not have as much impairment. And now we know we’re wrong, like we’re terribly wrong because we know that as much as 25% of the bipolar disorder population is 60 or older because people are aging like we’re older. I mean, you think about a 60 year old today versus a 60 year old when you and I were kids. Those are very different people.

Gabe Howard: I think that The Golden Girls really illustrates this well, because I was surprised to learn that the Golden Girls were between the ages of 45 and 55. When you watch this show, they like today. When I watched it then they just looked like old people.

Dr. Nicole Washington: Yes.

Gabe Howard: I watch it today and it’s just like, how old do you think they are? I don’t know. 65. 70? No, they’re in their fifties. They’re in their late forties. I. They dress like they’re 100.

Dr. Nicole Washington: Yes,

Gabe Howard: But that was what age looked like

Dr. Nicole Washington: Exactly.

Gabe Howard: In the eighties. But I want to touch on that. You said that the belief is no longer that as you age, bipolar disorder gets easier because there are many, many people in the bipolar community that believe that as they get older, the symptoms of bipolar disorder naturally lessen. And they use this as justification to stop taking their medication.

Dr. Nicole Washington: Yeah.

Gabe Howard: They say, I needed medication when I was 25, 35, even 45. But I no longer need medication because and I quote, bipolar disorder doesn’t impact a 60 year old the way that it does a 20 year old. I hear this a lot.

Dr. Nicole Washington: Okay. Well, then let’s, let’s use some numbers, let’s use some facts to kind of go through that. So I think with age comes wisdom, right? Like I think that as you get older, you fight less. For the most part, right? There’s still those who are still raging against the machine. Right. They’re still they’re still raging. But for the most part, I think people, they settle in a little bit. They’re more accepting of their illness than they were in their twenties and thirties. They realized like, okay, this thing isn’t going away. Like, let me manage it better. They do a better job. But when you look at numbers and percentages, right, so we start thinking about like what are the numbers? And if we’re going to use older age, that’s older over 60.5 to 1% of people in the community. Right. Have bipolar disorder of that age group, outpatient geriatric visits, 6%. So people who are going to a geriatric psychiatrist or just reaching out for services in that age, it may not be a geriatric psychiatrist because you may not even have one in your area. So you’re just going to see your general psychiatrist, 6% on the inpatient side when you start looking at like hospitalizations and who’s going in the hospital over 60, going into a mental health hospital, about 10% of those, up to 10% of those are for bipolar disorder. That’s still quite a bit. I mean, when you think about it, I know we tend to think of, oh, it’s a Jerry psych admission. It must be dementia, it must be this, it must be that ten up to 10% are going in for an episode related to their bipolar illness. So, you know, that’s something to think about.

Gabe Howard: To be clear, if you had a 10% chance of getting in a car accident, if you drove on a certain road, most people would be like, well, is there a way to avoid that road? Oh, yeah, there’s many alternative routes. All right. Well, I’m not going to drive on a road with a 10% chance of getting in a in a in a car accident when there’s other methods of handling this. And that’s really what I was thinking as you were talking. Some people were like, well, 10% is very low. Well, but it’s really not I mean, 10% is a big number.

Dr. Nicole Washington: And if you can try to prevent it, why not? And then we know that like up to 17% of elderly in the psych emergency departments with bipolar disorder, I mean, so the numbers are going up as you go into the more acute setting, right? So the more serious the setting, those numbers are going up. So it means you’re not out of the woods just because you’re collecting Social Security. Taking care of your illness doesn’t stop when you start collecting Social Security like you got to do that. Got to, got to, got to.

Gabe Howard: I want to pick on your profession, Dr. Nicole, and not psychiatrists, doctors.

Dr. Nicole Washington: Oh. Okay.

Gabe Howard: I tabled the question as older people, people, 50, 60, 70, they go off their bipolar medications because they believe that they don’t need them anymore because, hey, after all, they’re old and they won’t have manic symptoms, they won’t have depression or they’re beating it or they’re better handling it. In other words, I tabled the question as a person with bipolar disorder, makes the decision in a vacuum to stop taking their medications because of their age. But there’s another factor, right? And that’s that lack of coordination of care. Some people, especially the 60 and above crowd, they’re going to their physical health doctors. They’ve been managing their bipolar disorder for years. And the physical health doctor, I’m not saying intentionally,

Dr. Nicole Washington: Mm hmm.

Gabe Howard: But inadvertently it’s like, well, you can’t take X pill. So my advice is to treat your high blood pressure because there is a large contingent of physical health doctors. And again, I know that’s not their technical name, but physical health doctors who unfortunately don’t take mental health as seriously as they should. And then you enter this belief that, well, I’m 60 years old. Am I really going to climb up on the roof again? Am I really going to do these manic things? I don’t have the energy for that. And then there’s this persistent belief that as you get older, mental illness, for whatever reason, subsides, which you’ve just disproven but nevertheless exists in the community, and all of those things converge to where the person with bipolar disorder believes that they are making the best decision for their life, because now they’re prioritizing physical health over mental health, which is absurd, but it’s not entirely their fault. They’re getting, unfortunately, mixed messages from the medical community.

Dr. Nicole Washington: Yeah. I mean, I can’t I mean, guilty as charged. I can’t I can’t argue with that. I have zero argument for that. So it’s just important, really. It’s important that you have good medication list with you when you go to each doctor. I can’t tell you how many times somebody comes to me and they’re like, Oh, my doctor put me on a new blood pressure pill. And I go, Oh, what was it like? Oh, do you have it with you? No. So just keep a list, keep a running list, hold all your bottles with you. Do what you need to do. But you are absolutely right. That is not uncommon for a patient to be told conflicting information by their doctors because they’re not talking to each other. They’re not in communication with each other. Our system is so broken, it really makes it difficult to communicate. Our electronic health records don’t always talk. There’s a lot broken about our system. So what can you do is be empowered, right? Have your med list with you, have your medications with you. If you need to take notes and go back to your other doctor yourself, if you can ask like, Hey, do you mind calling my primary care doctor or do you mind calling my psychiatrist? Because they’re telling me this medicine is very important and you’re telling me this medicine is very important and I can’t take them together? Like, can you all have a conversation? Because this is above my pay grade. I can’t do the in between and just share with them how impairing that is for you and see if you can get them to communicate with each other.

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Dr. Nicole Washington: And we’re back discussing bipolar disorder and aging.

Gabe Howard: I love that you mentioned how shitty the health care system in America is because I could do that all day. I agree there’s so much fixing that needs to be done. And as a mental health advocate, I really feel like the biggest holes are on the mental health side because in many ways we’re cared about the least. Budgets get cut; funding gets cut. There’s just a lack of resources. We’re not meeting people where they are. Again, I could do this all day, but I want to be clear. Doing this all day doesn’t get me the help that I need.

Dr. Nicole Washington: Mm hmm.

Gabe Howard: It doesn’t get me the care that I need. I think it is super important to understand the deficiencies in America’s mental health care system and in our health care system. And I think it’s really important to be an advocate to fix those things. And it’s okay to be angry, get together with your friends, your family, other advocates, and just have yourself a good old fashioned anger fest. But if you want good care to live well with bipolar disorder, it’s really important to do the things that Dr. Nicole said, bring your medical records, sign all the hip releases, bring your pills with you to the appointments if you need to. Hell, they’re probably in a bag in your house if you’re anything like me. Actually, mine are in like a giant Tupperware. Just pick up the Tupperware. Walk into your physical health, doctor, and sit it right down. Just be like, Hey, this is what I’m doing. And again, advocate, I really want to turn all of you into advocates, but don’t advocate at the expense of your own mental health and your own physical health because that’s not helping anybody.

Dr. Nicole Washington: Right.

Gabe Howard: Right. Self-advocacy is advocacy.

Dr. Nicole Washington: Yes, yes, yes, yes, yes, yes. And we’ve talked before about like, how do you advocate for yourself? A lot of times people don’t feel heard, but that is often because you’re frustrated. And so maybe those words don’t quite come out as kind as you would like them to come out.

Gabe Howard: Are you saying people yell at you, Dr. Nicole?

Dr. Nicole Washington: Yell curse, call me names, talk about my hair, talk about my weight, talk about my mama. Like, whatever, you know, people just are not always kind when they are frustrated. And I know it’s coming from a place of frustration. I get it. But advocating for yourself and just taking a breath and explaining why you are asking for this to be done.

Gabe Howard: The big takeaway is to make sure that your mental health care and your physical health care are coordinated and the common denominator is you. That means that you listening, managing bipolar disorder, you’ve got to take the reins on this one. I know it’s not fair. We always get emails on this.

Dr. Nicole Washington: Yeah.

Gabe Howard: They’re like, Well, you’re making me responsible for the broken mental health system in America. And I always kind of want to respond back, sort of. Nobody else cares. What is it? I wish somebody would do something about this. You’re somebody.

Dr. Nicole Washington: Yeah.

Gabe Howard: It is difficult. I understand the pain and I understand the frustration. I have certainly been there and I want to both acknowledge how shitty it is and say that there is just this element of, so what if you want to live your best life? Here are the rules here. Here is here’s what we have now. And as soon as you get to your best life, you will be in an infinitely better position to help change these deficits. That’s half of what this show is about. We want to turn people into advocates. But for the moment, Dr. Nicole, now we’ve got people coordinating their own care. We’ve got them empowered. We’ve given them permission to be angry. We have validated that the whole thing is screwed up. But up until now, we’ve been talking about people who have been managing this for a long time, people who are diagnosed, you know, 20, 30 years old and then hit 60. Right. They’ve got a decade, two decades, three decades of experience. Let me pose this question to you. Somebody walks into a psychiatrist office, sits down, and they are 60 years old because we’ve decided that’s the number that we want to use. And they get diagnosed with bipolar disorder for the very first time in their entire life. What’s that like?

Dr. Nicole Washington: Well, it’s complicated. It’s complicated, right? Because what do you think you know about bipolar disorder onset?

Gabe Howard: I mean, I knew nothing at 25. Bipolar disorder was something that happened to somebody else. It happened to bad families. I knew everything that I believed on the Internet.

Dr. Nicole Washington: But how old do we typically think of a person at their first episode? Like what are we thinking typically?

Gabe Howard: Oh, we think they’re young.

Dr. Nicole Washington: Yeah,

Gabe Howard: We think they’re so young.

Dr. Nicole Washington: Yeah,

Gabe Howard: Right? They’re just.

Dr. Nicole Washington: Yeah.

Gabe Howard: Yeah. Everybody diagnosed with bipolar disorder is like, like 20, right? And usually wild, usually standing on top of a roof or a bar or like the picture, like a rave. And you’re the person on top of the rave.

Dr. Nicole Washington: Yes. There in the college campus library, naked in the middle

Gabe Howard: Yeah.

Dr. Nicole Washington: Of the night. You know, first episode, like we’re thinking of that, right? Like. That’s what we’re thinking of. We’re not thinking of the 55, 60-year-old who comes in and they’re like, Hey, this is what I was doing. And it looks like mania and it smells like mania and it walks like mania, but you’re like, Wow, but this person’s 55. Like, wow, it’s mind blowing. And it is still mind blowing. Like, I still have to pause, right? Even more than a younger person now, I have to take into consideration, hmm, is this really a new onset bipolar disorder or a new diagnosed bipolar disorder? Right. Like it may not be new onset. So let me just say that up to 10% of people with bipolar disorder will be 50 or older when they have their first manic or hypomanic episode.

Gabe Howard: I want to stop right there for a moment because that blows my mind. I cannot even imagine getting to 50 years old, never having had a manic symptom and then at 50 mania. That’s wild.

Dr. Nicole Washington: Yeah.

Gabe Howard: Is that true? Are there people who have their first manic episode at 50 or 60 or even older? It doesn’t sound possible.

Dr. Nicole Washington: Well, I’m not making it up. I’m not making it up. And it’s actually a fact. But, yeah, the data that’s put out there by National Institutes of Health up to 10%. So that’s just not something that we think about. And honestly, it’s not something I ever think about. I’m always like side eyeing that, that scenario when I hear about it, I’m like, Oh, are you sure? Are you sure it wasn’t something else? So it is possible, right? That’s not a large number, but it’s possible that the person sitting in front of you or your loved one or you who didn’t have your first mania or hypomania until you were in your fifties. It’s not the likely scenario that we see, but it is possible. And so why is that? Sometimes we think, maybe this person had a lot of depressions before, but they just never had a manic episode. Like maybe they just had a lot of depressive episodes and then all of a sudden, here we are, bam! The right combination of bad juju occurred and here we are right there, 50 plus new onset. Sometimes though it was missed. It was missed. Let’s say you have bipolar two disorder and let’s say you have these hypomanic episodes which are kind of flying under the radar because they’re not quite as impairing. You’re not in the hospital, you’re not in jail. You’re not like, you know, we’re just missing it. And so it takes new set of eyes or somebody who’s seen you for a long time.

Dr. Nicole Washington: And they say, you know what, maybe all this while you’ve had bipolar disorder and we just missed it. So that is also possible when we talk about that diagnosis. But you know what else happens when you get older? Your brain changes, especially if you had high blood pressure or high lipids, cholesterol, things like that. You might get some vascular changes in your brain. So sometimes we think that that’s why maybe a person has like a later onset of bipolar disorder, maybe it’s about more brain pathology, structure, function, things like that. So there’s lots of things that can go into play. We shouldn’t pretend like it doesn’t happen, which I think sometimes we do pretend like it doesn’t happen, like it’s just not possible. I’ve seen people get poo pooed like, you know, you’re not having your first manic episode at 50. Come on now. And we used to believe that that was the case. But I think we have to we have to admit that it is possible and that will help, because I can only imagine being 50 and having your first manic or your first hypomanic episode and being terrified or being the loved one or someone who I’ve been married to for 30 years. And now all of a sudden this is how they’re behaving and I can’t figure out what it is. I can see that being very distressing. So I just want people to hear that it is possible.

Gabe Howard: There’s this phrase that everybody likes to use and they say the best predictor of future behavior is past behavior. And it is true. It is the best predictor, but it’s still a bad predictor. People change all the time. There’s this idea that when you’re diagnosed later in life, it’s like, Well, I’ve known this person for 30 years and they’ve never done this. This has to be a one off. It doesn’t have to be a one off. It might be a one off, it could be a one off. But in this case, the best predictor of future behavior is, in fact, not past behavior. It’s current behavior. And it’s really important for people who are older and are learning about mental illness for the first time and have this this long history of maybe even stability or at least what they consider stability to be open to this idea. I think it’s also important on the Dr. Nicole side to be open to the idea that it is a one off or it is circumstances. This is what makes mental illness and bipolar disorder just so incredibly difficult to diagnose and treat, because I’ve basically just argued both sides of the coin here.

Dr. Nicole Washington: Yes.

Gabe Howard: And Dr. Nicole, is that difficult? I imagine that a lot of people 50 years old hearing that they have a mental illness, they have a lot more agency than a 20 year old who hears it, and they’ve achieved a lot more and they have a lot more just oomph. I hear about the average 20 year old being diagnosed with bipolar disorder and many of them still live at home. They haven’t held down a job. And somebody’s like, look, something’s really wrong. And they look at their life and they’re like, Yeah, I’ve quit everything that I’ve ever done. I can’t maintain relationships and I live with my parents. You’re right. Something sounds like it’s amiss, but maybe with a 50-year-old, you’re like, Look, I’ve raised three kids. I’ve had a job for 25 years; I own my own house. And now you’re telling me I have mental illness? This does not track at all. I understand that logic. Do you have a problem convincing people that the diagnosis is correct and getting them to take it seriously?

Dr. Nicole Washington: I mean, I think they tend to be, in my experience, a little bit more aware that something’s wrong, whereas the younger person I see a lot more denial, like, no, like that’s not no, it’s this, it’s that. It seems like to me the cases like this I’ve dealt with, the individuals have just been much more aware that, oh my gosh, something’s wrong. Like this is not me. And maybe that’s because they have more equity in their relationships at that point, because you’re 50, you probably had people in your life for a long time so you can believe them. And if they tell you like, Hey, you did this or this is not like you. You know, maybe they believe them more. You know, I don’t I don’t know. I hadn’t really thought a lot about why I think that is. Maybe it’s just because they’re a little bit older and wiser and maybe they’ve lived a little more. Maybe they’ve known people with mental illness. Like, I don’t know what it is, but they seem in general to be a little more accepting. Now initially. I think there’s the fear, right. Because any decent psychiatrist, if somebody comes in at, you know, 50, 60 with mood changes or personality changes, which is how people will describe it initially, you’ve got to do a medical workup. We need to make sure there’s not like something medically going on. Nothing in your brain that shouldn’t be there. We got to do our due diligence in working you up. And once we’ve ruled all those bad juju things out, then we can come back and say, okay, with some level of certainty. We feel like this is very likely to be bipolar illness and this is what this is. I haven’t had difficulty nearly as much with that age group as I have with like the younger people.

Gabe Howard: I want to take a quick moment and be honest with our audience when this topic was proposed, I thought, well, why? I mean, is it everybody who’s diagnosed young and then they get care and then they go on and live a good life. And if they can’t get care, then it’s just bad forever because it never works out. They’re just this this is what we see and hear about with bipolar disorder time and time again. It impacts young people. If treatment is available, they get better and then we never hear about it again. And even in doing research for the show, everything seemed to be tabled along this idea of this early diagnosis, treatment, living in recovery. The other common thread was early detection. No care whether it’s because the person with bipolar disorder refused it or because they couldn’t access it. And then lifelong problems. And Dr. Nicole, you raised the point that, look, people are being diagnosed at all ages for any number of reasons and it’s not being discussed. And we don’t even have what we do have data on it. It’s largely from retrospective studies, people going through medical charts and seeing the age of diagnosis, the age of admittance. There’s not really like a robust study, you know, following around 60 year olds who are newly diagnosed. And I really think that some of this is the stigma of bipolar disorder.

Gabe Howard: And I think that some of it is what you alluded to earlier. We tend to think of bipolar disorder and mania as something that happens to young people. We really get this, you know, this college party, this rave, this concert like atmosphere, the person standing on the bar screaming. And this really does leave people who are diagnosed later in life out. It also makes people who are 50, 60, 70 years old think, well, this isn’t what’s happening. They think that something’s wrong. Maybe they even think that it’s bipolar disorder, but they think, well, that doesn’t happen to my age group. And I hope that just like I was corrected, all of you listening to this, the biggest takeaway is if you suspect that it’s bipolar disorder, no matter what age you are, go see a psychiatrist, talk to your general practitioner, find your Dr. Nicole. Get help. And I am certainly sorry for being one of the people who put out this idea into the world that bipolar disorder is diagnosed between 18 and 24. While that is the most common, that is an incomplete statement. You can be diagnosed at any age and from here on out, I will be saying that when I give that stat. So thank you, Dr. Nicole, you have made me better.

Dr. Nicole Washington: Oh, you’re welcome.

Gabe Howard: Thank you everybody for listening in. Wherever you downloaded this podcast, please follow or subscribe at is absolutely free. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” You can get it on Amazon because well, you can get everything on Amazon, but if you want to sign copy with free swag, head over to gabehoward.com.

Dr. Nicole Washington: And I’m Dr. Nicole Washington, and 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 us a favor? Tell a friend or a family member or a colleague about the show. Sharing the show is how we grow. We will see everybody next Monday on inside bipolar.

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