Inside Bipolar Podcast: Mania Stay and Depression Go? Treatment Options for Bipolar Symptoms

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

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

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: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: One of the questions that I get asked all the time, and I’m in no position to do anything about this because I am not a psychiatrist, but it’s very accusatory. And it is why will doctors try to get rid of my mania and they won’t leave it alone and they’re always attacking mania. I only want them to get rid of depression or suicidal thoughts or anxiety. Like I just want them to get rid of the bad symptoms and leave the perfectly good symptom of and I’m making air quotes here because it’s still a symptom of mania alone. The specific question, Dr. Nicole, is why are you so mean to mania? Why can’t you leave mania alone and only remove the, quote unquote, bad symptoms of bipolar disorder?

Dr. Nicole: We’ve talked on episodes ad nauseam about all the bad things that come with mania and how it’s not that great. And I do just agree to disagree with people who say, but I love my mania. Like, well, good for you. Um, we’re not going to go there today. But no, mania is not great.

Gabe: I’m in your camp. I think mania has the best public relations people ever. But I don’t want to fall down that rabbit hole.

Dr. Nicole: Yeah.

Gabe: But. But seriously,

Dr. Nicole: Yeah.

Gabe: Go listen to the other manic episodes of Inside Bipolar. We had lots to say.

Dr. Nicole: Yes.

Gabe: But specifically, why can’t you leave it alone? You don’t have to agree with it. Why don’t you just leave it alone? Just you work for us. You work for us. Do what we say.

Dr. Nicole: Oh, if I had a nickel for every time someone yelled at me that I worked for them and their insurance or their paying me to do my job. Oh, my gosh. Anyway, depression. So, it’s part of it. It’s all wrapped together. It’s intertwined. Like they’re BFFs. They live in the same house. You can’t just get rid of one without probably affecting the other. If I said to you, Sure, let’s just use an antidepressant, let’s just target your depression. Let’s not even worry about mood stabilizers. Let’s not fool around with pesky mood stabilizers, because that’s the question I get. People will say, well, why are you, why are you continuing to offer me mood stabilizers? Why do you keep wanting me to take anticonvulsants and antipsychotics and drugs like lithium? Like why do you keep offering me those things? Every time I tell you I’m depressed, you offer me those things because you’re so worried about me getting manic. And so, they want me to just give them an SSRI, for example.

Gabe: What happens if you just give somebody an SSRI? In my mind, that seems to work, right? They’re depressed. They want to get rid of depression. That’s an antidepressant. It’s right there in the name. Can’t that work? I know you don’t like it, but can’t you do that? Isn’t that an option?

Dr. Nicole: I could do that. Could it be safe? And nothing happened? Maybe. I mean, there are people who have bipolar disorder who have taken antidepressants for years before they really find out they have bipolar disorder. No big bad juju has happened to them, but they weren’t stable. Not consistently. They may feel better for a brief moment. They may feel better for a period of time. It’s not sustained. It’s not not sustained. It’s not sustainable. So, it’s just not something that will keep them stable. And then there are the subset of people who, if they take the SSRI and then they’re manic as all get out, that’s really not good. That’s where the big bad juju comes in. We don’t have time for that either, so I don’t necessarily think that there are a lot of psychiatrists out there who will tell you, Yeah, sure, I’ll just give you an SSRI.

Gabe: Early on in my mental health journey, I worked for a company that had an EAP program, the Employee Assistance Program, where you could see a therapist six times absolutely free. And I was a young adult. I was in my early 20s and I was married and I just wasn’t. Life was not treating me the way that I thought it should treat me. And somebody said, hey, you know, you seem unfulfilled. You’re not happy. Maybe you’re having an existential crisis, whatever it is, we have a program for that. We have a work life balance program. You can see a therapist for $0. And I thought, okay, this is fantastic. I can talk this out with somebody and find ways to enjoy life. I’m pointing this out because I went there and all I told that therapist was, Look, I think life is boring and bland and I’m not happy and I want to be fulfilled. And the therapist worked with me a little and gave me some things to try. Et cetera. And one of the things that that therapist said is, hey, this could be depression. You know, an antidepressant could clear this right up and give you that extra oomph. Why don’t you talk to your general practitioner? And I thought, all right, the magic of pharmaceuticals, this is I take a pill and I’m happy.

Gabe: Who doesn’t want to sign up for that? I went straight to my general practitioner. I told them the exact same story that I told the therapist, which you all just heard. General practitioner was like, Yeah, we got a pill for that. That is no problem. Gave me the antidepressants. I took them religiously and within a short period of time full-blown mania hit and it lasted about a year, largely driven by the fact that I kept taking the antidepressants. And I want to be honest, at first it seemed awesome. I thought, hey, these antidepressants are really working. Do you have any idea how happy I am? But of course, as we talked about ad nauseam, being that manic for that long causes a lot of damage. And that is what started to happen to me. And ultimately, I ended up very suicidal and committed to a psychiatric hospital within 12 to 18 months. It all sort of glosses together a little bit. But with the advantage of hindsight, I now know that being prescribed that antidepressant, which is exactly what I asked for, drove the mania which drove me to eventually the crash, which had me committed to a psychiatric hospital, which is ultimately where I was diagnosed with bipolar disorder. Am I describing something that’s common?

Dr. Nicole: Yeah.

Gabe: Am I a unicorn? Am I an outlier, or is this something that can happen with frequency?

Dr. Nicole: Mm-hmm.

Gabe: Am I an unusual case? I guess is what I’m trying to ascertain, Dr. Nicole.

Dr. Nicole: Not at all. Um, so your instance was not intentional. The doctor didn’t realize they were doing something that would be dangerous. You didn’t realize you were asking for something that could be dangerous. That is how it happens a lot. That’s really how it happens a lot. So, while I said I don’t see a lot of psychiatrists saying, hey, yeah, I’ll give you an antidepressant, I don’t care that you have bipolar disorder, sure, I’ll just focus on your depression. I don’t see that happening. I do see this happening quite a bit, you know, and in this case, I think it’s interesting because your therapist didn’t screen you for hypomania or mania. They just said, oh, it sounds like depression. Your primary care doctor was like, oh, yeah, that absolutely sounds like depression. And it was, they were right. It was depression. But nobody should ever just diagnose somebody with depression and treat them for it without even a brief screen for mania because that changes the game. It just changes how you look at it, what you do. And that’s where the danger or bad juju stuff comes in because if you don’t do that screen, then what happened to you is likely to happen. Because you were in a depressive episode at that time. You weren’t actively showing any signs consistent with mania or hypomania or else maybe your primary care doctor would have said, hmm, I don’t know about this. This might not just be depression, but they have to screen you for it. And that’s where it all fell apart and where, honestly, it still falls apart from time to time.

Gabe: I want to focus on the direction of people who know they have bipolar disorder. So, you have been diagnosed with bipolar disorder. You believe you have bipolar disorder. You have accepted that you have bipolar disorder and you are upset with your Dr. Nicole, because she keeps prescribing stuff that gets rid of the mania and maybe is not so effective on the depression. One of the things that I have felt and that the bipolar community has felt for a long time is that mania seems very easy to get rid of with medication, whereas depression seems very difficult to get rid of with medication. And while I recognize that this isn’t like a concerted effort on behalf of all the Dr. Nicole’s, pharmaceutical companies, et cetera. You can see where from our perspective, it seems really it’s the best way that I can describe it. For somebody who doesn’t live with bipolar disorder. I was untreated for a long time, and when I looked back at any happy moment, mania was standing right there. And then somebody says, hey, I want to get rid of mania. And all I can think of is, well, but mania was there when all my happy moments were there. So, what I hear is I want to get rid of any chance you have to be happy. And I become very protective of that

Dr. Nicole: Mm-hmm.

Gabe: Because suicidality, depression, severe anxiety, delusions, everything that can come with bipolar disorder. Very scary, very damaging. But for whatever reason, the happy moments, mania was either right around the corner. It was present. So, you can see why we, people with living with bipolar disorder, are very protective of it.

Dr. Nicole: First of all, mania is just more amenable to being wrapped up a little bit quicker with medication. It just is. I mean, I have no control over that part, too. We don’t want you to not be happy. I don’t want you to be excessively happy. I don’t want you to be so happy that you think you could jump off a building and not get hurt. I don’t want you to be so happy that you think I’m just going to take all my clothes off and go streaking down the street happy. Like I want appropriate happy. Not we’re streaking happy. I want happy that is nice and feels good for you and everyone around you. I don’t want happy that lands you in jail or in the hospital. So, it’s the excessive that I’m worried about. But you’re right, because if you think about it, aside from the big bad stuff that happens with mania, the jail, the bad stuff, mania can be kind of endearing. It can be kind of cute and fun. And depression to a lot of people is much more debilitating than their mania is. So, I definitely understand. Like I’m not sitting here telling you I think something’s wrong with you because that’s your desire. What I’m telling you is it’s a dangerous thought process and we have to figure out how to get you to happy without doing something that could also cause you more harm.

Gabe: In the early days when people talked about getting rid of anything mania related. I really did have a very visceral reaction to this. And while I was pliable and while being committed to a psychiatric hospital, realizing the damage that I did with my family, the support that I had around me, then finally admitting that, Yeah, Gabe, we didn’t like you very much. The reason that we didn’t invite you places is because, frankly, you were just a problem. These all helped me realize that, hey, maybe mania wasn’t serving me in the way that I thought that it was. But backing that off just a little bit, I still thought, you know, look, I. I suffered for years. I couldn’t get out of bed. People often describe depression as staring into the abyss. And I don’t like that analogy because if you can stare into an abyss, you’re still active. You’re doing something that’s a hobby. I’m staring into the abyss. Right? You’re standing there. You got yourself to the abyss. You’re actively participating in this, staring in the abyss. I, I, I just, you’re doing something. Staring into the abyss is not a good analogy for me. It’s worse than that. You don’t know where you are and you’re all consumed. And later on, you try to figure out what’s happening.

Gabe: The mania was our savior, an abusive savior, I’ll be the first to admit, but a savior nonetheless. Y’all got rid of that quickly and then you struggle getting rid of the depression. And now I can’t even count on even a flawed hero to save me because that hero is gone. It is unfair to blame this on pharmaceutical companies, medication, Dr. Nicole’s, therapists, coping. It’s unfair, but who else are we going to blame? Where are we going to direct this and do we have the words? So that’s what I want to say to you, Dr. Nicole. Here are the words that I’m using. Mania, while deeply flawed, did provide a protective factor. Depression, also deeply flawed, did nothing, and in some cases is the last thing that people will feel before they die from bipolar disorder. And all of a sudden you got rid of the thing that was flawed but had some heroicness to it. And you’re struggling with depression. Can you see that from our perspective? And how can you help us understand how this is part of the journey and not just some you know, it’s it’s hard to find words in these moments,

Dr. Nicole: Some vendetta.

Gabe: It does kind of seem punitive,

Dr. Nicole: Some vendetta?

Gabe: Like you’re forcing us to suffer.

Dr. Nicole: Yeah.

Gabe: And it’s not fair that we put that on

Dr. Nicole: Yes.

Gabe: You. But I’m telling you, you can see how we get there.

Dr. Nicole: I absolutely can. I mean, my heart goes out to anybody who has had depression that we just cannot get control of. I completely understand what you are saying, but I do think it’s important for you to remember that psychiatrists are not at conferences sitting in a room going, How can we make people with bipolar disorder more miserable? And somebody is at the microphone going, I know, let’s just not treat their depression very well. Let’s just focus on their mania. That’s not what we’re doing. I would absolutely love it if all of my patients could have a normal mood state forever and ever. Amen. And we just never had to worry about it. That would be my desire. But my magic wand is broken, so I am stuck working within the system that we have. And you also are stuck working within the system that we have. Do we wish we had drugs that would just snap you out of that depression like it crashes you down from that mania? Absolutely we do, but we don’t. So then I would encourage you to take the energy that you’re putting into being angry with pharmaceutical companies and angry with me and angry with your therapist and just angry with the world and put that into getting better, like focus on the things that you can actually affect. You can’t change what meds I have to give you. You can’t change what the standards of care are. You can’t change evidence-based medicine, which is what your psychiatrist should be following, but you can change you and what you do. So I just think I always encourage people to take that anger and put it into your recovery. Not so much focused on what we don’t have.

Gabe: One of the things that I hope we talk about on all episodes of Inside Bipolar is there’s no magic cure. You say magic wand a lot. You can’t just take a pill and get better. You can’t just go to a therapist and get better. You can’t just join a peer support group and get better. You need all of these things. And by going to support groups, people are like, you know, it wasn’t the same. Was it as exciting? No, but here’s where some magic happened. When I was manic, all of the feeling was contained within me. And now that I’m not manic, the excitement and the feelings are shared with the people around me. And is that a different feeling? Absolutely. Is it as high up on the scale? I guess not.

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Gabe: And we’re back answering the age old question of why psychiatrists can’t treat depression and leave mania alone?

Dr. Nicole: Let me ask you a question. So is the happiness that you experience with mania, is it better than the happiness that you experienced during kind of a normal mood or without the mania being present?

Gabe: In a lot of ways, that’s a trick question, because if you hold me to the exact question as you said it and don’t allow me to expand on it, then I would have to be honest. The mania all alone, the happiness with mania feels better than quote unquote, regular excitement or happiness or giddiness, etc. Because it doesn’t last. In that moment, right in the moment of mania, happiness, it’s such a high and intoxicating feeling. And there’s the keyword there. It’s an intoxicating feeling. As soon as that intoxication wears off, there’s rubble. Nobody’s around. People are mad at you. You realize you’re all alone. A lot of it’s not true. So if we go over to quote-unquote, normal happiness, I don’t know what normal is. I’m just, normal, normal mood state. I believe that the word that you use. Is it as high up in that moment? No, but it lasts. That moment lasts. Yes, it does last longer, but it’s also shared. People around you are also happy. Nobody’s mad at you. And here’s the best part. Here is where time is a really, really big factor in recovery. When I look back at my manic moments, I don’t feel happy anymore. When I look back at my excited and happy moments now, I still feel joy. Sometimes we’ll be sitting around with my friends and family like Gabe, Gabe, Gabe, Gabe. Remember that time at the concert? And I’m like, Yes, yes, I do. Oh my God, that was so much fun. And then I get to relive that happiness. Mania is not sustainable. Mania is like, poof,

Dr. Nicole: Yeah.

Gabe: And then it’s over.

Dr. Nicole: So, I think that’s one thing to think about is, is happiness. Even when your mood is normal, you’re not happy all the time. It is perfectly normal for you to just kind of take life as it comes. If something happens that I would typically experience happiness in, I can do that. If something happens that would make me sad, I can take that sadness off the shelf, play around with it like a Rubik’s cube. And once I’ve processed through it, I set it back on the shelf and keep it moving. Somebody cuts me off in traffic. I get mad. I might flip them off, but I put that back on the shelf. Keep it moving. Like that’s a normal mood. That is contentment. That is sustainable. Happiness is never, never, never a sustainable feeling. So, it is also very important, I think, for people who have bipolar disorder to remind themselves that happiness is always fleeting. Happiness is never the goal. I am never working with somebody to maintain happiness. I am always working with them to have the ability to feel happiness when the situation calls for it, but to also be able to kind of experience all those emotions appropriately without them being dangerous. Right? Because mania can lead to dangerous things which can lead to criminal records and ongoing legal issues. You know, you can do stuff while you’re manic that could lead you to lose your life. So, mania is definitely not sustainable.

Gabe: And that’s really the crux of this, right, Dr. Nicole? What you are trying to get us to is, is the, I hate the word normal, but the average, the typical the baseline mood type and a baseline mood type has happiness, excitement, but it also has sadness, annoyance, regret. And I think that’s what people don’t understand. They want to know why you can’t just, like, pick and choose, like, wipe stuff out. Like why can’t you get rid of the depression but keep the mania? Because like it or not, I don’t want to get in a manic debate. Mania is a symptom of bipolar disorder. Whether you like that symptom or not doesn’t change the fact that it’s a symptom. And what you’re trying to do is get us to a sustainable point. And I really think here’s the keyword, that we can maintain. See, a baseline mood is maintainable. Yeah, you might be annoyed or you might be happy or you might be angry or you might be excited. But all roads lead to sustainable maintainable and control. I don’t know of anyone who says they can control mania. It’s always described as ride the lightning, ride the fire. It just. But yeah, the reason that you use those sort of analogies is because, you know you can’t actually ride lightning and people think that that’s exciting and yeah, I suppose it is exciting. I’ve read all those books. I like the posters, but it’s dangerous. Whereas that stereotypical, that baseline, you can control it and you can’t treat one without treating the other because of that interconnectedness. That’s my basic understanding of it. The reason that you can’t keep mania and wipe out depression is because your goal isn’t to remove symptoms. Your goal and every psychiatrist’s goal is to help us maintain all of our emotions. And that means all the extreme emotions have to go,

Dr. Nicole: Mm-hmm.

Gabe: Not just one.

Dr. Nicole: Right. So, I don’t know that I feel like people always know what they’re asking me for. So, they say to me, well I just want to be happy. Like I just, when I was manic, I was just very, very happy and I get that. And so, I will ask them, well who name somebody who you, who you think, oh, I’d like to have a mood like that person, you know, And they’ll give me somebody, a friend who’s kind of life of the party, somebody who tells jokes a lot, somebody. And I ask them, Do you think that person ever gets sad? Do you think they ever get angry? Do you think they ever are frustrated? Do you think their feelings get hurt? Like, do you think they’re happy all the time? And then they’ll say, well, no, I don’t. I don’t really think they’re happy all the time. And so then we talk about, okay, so you don’t want to be happy all the time. So. So what does that look like to try to get it around to what are you really asking me for? And really, they’re just asking me to not be depressed. They’re not necessarily happy, excessively, you know, high all the time. It’s a tough place to be. I mean, it really is tough. And for anyone who has bipolar disorder, I think this is the hardest part about the illness is the fact that the depression is so debilitating, but it’s so hard to get you out of and it takes longer to come out of it. You know, you can kind of pop out of a manic episode pretty quickly, but it just takes time. It just does. Like it’s just the way our brains and bodies were built.

Gabe: I don’t want to miss out on an opportunity to point out the interconnective nature of working with your therapist, your psychiatrist, support groups, your support system in your own families, and how all of those things are interconnected. And if you just pulled out one thing, you might not get to the recovery. And of course, that’s exactly analogous to why can’t we just attack depression or why can’t we just attack anxiety and leave mania alone? I understand why we wish we could, but I think that everybody listening understands the connective nature of all of the things that they’re using to develop their coping skills and to lead the best life possible. And knows that if any of those things were removed, it would absolutely impact all of those other things. So it’s the exact same way over there.

Dr. Nicole: The other thing that I think is important, too, is unfortunately, there is somebody out here listening who said, I just don’t feel the same after I was diagnosed with bipolar disorder. My normal is just not what my normal was before I was diagnosed with this illness. This is what I was like before I had bipolar disorder. This is what I’m like now. It is not the same. And unfortunately, that is some people’s reality. Is that who they were before they were diagnosed with bipolar disorder, who they were before they had their first depression or their first manic episode is just not who they are now. And that is hard because you grieve kind of that person you were before and you grieve the mental health and stability that you lost because you may not ever get that back again. And that’s a tough spot to be in. And I do see that quite a bit. And not just the patients themselves, their family members. So then their family members are mad at me because they’re like, well, this is not this is not him. Like he this is not him at all. Like, you need to get his meds right because you’re doing something wrong. This is not him at all. And having to have conversations about expectations and new baselines and new normals and those are really hard conversations to have because I could see how it would sound like I was giving up on somebody and how I was saying, Well, this is just it. Like, this is who you’re going to be. But, that’s also a hard place to be, and that is a lot of people’s reality.

Gabe: I never miss an opportunity to point out how people living with bipolar disorder are just like everybody else and suffer the same issues as everybody else suffers. And I have so many examples. People who retire and they’re not adjusting to retirement will struggle and they grieve the life that they had. Empty nesters, lots of documentation about the kids leaving home and these parents who have been raising kids for 18, 20, even longer, all of a sudden they’re like, why is the house so quiet? What’s going on? And they’re not adjusting well. There’s all kinds of data on people getting out of the military, the armed services, moving to civilian status after being soldiers and they’re not adjusting. So it is absolutely, unequivocally so reasonable to end up in this position where you’re just like, this is different and I don’t like it. And this is one of the ways the pandemic did us a solid. First off, we’ve got the new normal, right? I think everybody understands the concept of the new normal. It’s not a hot take. I’m not going to explain it. But this is your new normal, medicated, treated, coping skills, in recovery you is the new normal and you’ve got to adjust.

Gabe: My wife works out in the world and I always worked from home and I work from home now and I travel and that’s just my job. And then the pandemic hit, and suddenly my wife had to work from home and I hated it. I hated it. Every day I saw her and I was like, Why are you here? This is my space during this time and you are in it. And, you know, we had some growing pains as many people in America did, and we finally work that all out. We moved her office to the basement. We implemented some rules and we got everything worked out. And the pandemic drug on for 2 to 3 years, right? And then one day it was over. Everything was lifted. They told her she could come back to work. And suddenly I was like, Why aren’t you here? What’s going on? I’ve got to have lunch alone? What are you doing? I yelled podcast and nobody answered. I brought a coffee and nobody was here. I can’t believe you left me because I got used to it.

Dr. Nicole: Right.

Gabe: And then that just became the thing. It became the routine.

Dr. Nicole: Yeah.

Gabe: People with bipolar disorder, we many of us, really, really love our routines, even maladaptive routines, maladaptive coping skills, things aren’t serving us. There’s a comfort level. So sincerely, if you are not adjusting to the new normal, to the medication, to the coping skills, to the what you see and what you feel. Congratulations. It’s working. You are not alone and you are experiencing humanity and that is fantastic. And you have to give yourself some time because it’s going to take time to get used to it. I don’t think that people with bipolar disorder hear that enough. When they say that they don’t like the way the medication feels or they don’t like the new coping skills or they don’t like the way they feel, I think people give them the it’s for your own good or that’s how you know it’s working or I never thought I’d hear you say that you’re upset that you’re no longer making your mom cry. We often get those types of lectures instead of Congratulations. You did it. The last thing I’ll say, and I have to say, could you imagine if every single time a mom said, I’m sad that my kids left home, they said, Well, of course they left home. They wanted to get away from you. I can’t believe you’re trying to hold them back. You don’t want your kids to get jobs and have their own lives? No. Nobody says that. They give the mom a big hug and say, I know it’s quiet, isn’t it? It goes by so fast.

Dr. Nicole: As a mom of young adults, I might fight you if you say those words to me.

Gabe: [Laughter]

Dr. Nicole: As a mom of young adults, if you poo-poo my sadness that my babies are growing up and leaving? Those are fighting words.

Gabe: Exactly.

Dr. Nicole: Those are fighting words.

Gabe: Exactly, exactly. Dr. Nicole. And if you poo-poo my sadness that I’m feeling differently and I’m experiencing emotions differently and my whole life has changed, those are fighting words for me, too. But unfortunately, when you say it, people are like, Yeah, don’t mess with mama bear. But when I say it, people are like, ooh, that’s a symptom of bipolar disorder. We got to call his doctor. He doesn’t know what’s best for him. I’m worried. It’s okay. It this should feel, this should feel different. Because it is.

Dr. Nicole: Yeah, it should. And we have to help people get to that place. Like, I don’t. I don’t need you to tell me like, Oh, but you raised your children to leave the house. That’s what you raised them to do. I know that. I’m aware of what I raised my children to do. I was the one raising them for however many years. I don’t need you to tell me that. So I see that. But I think we need to let people get to their acceptance in their own time. And we need to realize that it’s not something that just because we say the obvious, because we state the obvious, all of a sudden they’re going to go, You’re right. What am I thinking? Like, of course. Why was I even sad about it? Let me wipe this tear from my eye. That’s not what’s going to happen. So I think we have to figure out how to let people get there in their own time. And it’s okay if it takes you time to get there. So if I say to you, okay, we’ve tried every medication, every one. We’ve tried every mood stabilizer, just about. You don’t like the way any of them make you feel. Now what? Like, you know now what? That’s a real conversation to have. That’s a good time to start talking about what is your expectation for treatment? What are your goals? What’s your expectation for what your mood is going to actually be like? What were you like before? What are we grieving? What have we lost? Why for you do you feel different? And do you feel like you won’t be the same? For some people it may be medication.

Dr. Nicole: They may say that I don’t care what I take. I always know I’m taking something and I always just feel different because the medicine is just different. I can’t argue with that. Side effect profile for most of the medications for bipolar disorder, not sexy at all. List as long as your arm. Not sexy. Weight gain, involuntary movements. Like none of these things sound like anything that any of us would sign up for. But yet, when it comes to people with bipolar disorder, we’re like, Well, just take it. Just deal with it. You worried about your mouth moving or are you worried about being manic all the time? Like what? What? What do you want? That’s not the way to do this. So for some people it is medication. For some people it’s just their brain is different. Just their brain chemistry is different after their bipolar disorder diagnosis. It just is what it is. And it’s not something that we we know or we can affect. It just is what they tell me. Um, for some people it’s different because they now have to deal with their own self internal stigma of I have this thing and it’s like a weight around their shoulders. They can’t move without thinking about, Oh yes, I’m carrying bipolar disorder. They can’t, you know, make a decision to stay up late and study or stay up late and party without thinking, okay, but how is this going to affect my mood? How is this going to affect my bipolar disorder? Like they’re just not the same because they have to, they’re carrying this thing around with them all the time. So there’s a lot of reasons why a person may not feel the same.

Gabe: I think it’s really fair to say that one of the primary reasons you can’t pick and choose which symptoms to treat is because you have to treat an entire person. It would be nice if we could just like, you know, the game Operation, like if we could just like reach in and pull things out and, but we’re all connected. And that’s really what it boils down to. We can’t remove something without impacting something else.

Dr. Nicole: That is 100% accurate. We are. We are a whole body. And what you really want is your doctor to take a holistic approach to see you as a whole person. You don’t want your psychiatrist to just focus on one thing. You want your doctor to be able to kind of step back and get a 50-foot view and go, Oh, I see how all these things interact with each other. The doctors that you think of that you probably like the most were ones who could do that. So that makes all the sense in the world.

Gabe: Thank you so much, everybody, for listening in. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a public speaker who travels nationally. You can get a signed copy of my book or figure out how to hire me by going over to gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych. And, y’all, I’ve been on TikTok.

Gabe: You’ve been on TikTok? That one’s new.

Dr. Nicole: Watch out, world. I’ve been on TikTok lately. Watch out.

Gabe: TikTok. Check that out. It’s @DrNicolePsych?

Dr. Nicole: Uh huh. Uh huh.

Gabe: All right. After you check Dr. Nicole out on TikTok, I need you to do me a favor. I need you to recommend this podcast to all of your friends. Put it on social media, send an email, send a text message, mention it in a support group, because sharing the show is how we grow. Thank you, everybody, for tuning in and we will see you next time 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.