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Whenever medication is discussed as it relates to bipolar disorder, someone will bring up medication compliance. Generally, it’s posed as a question, “Why aren’t people with bipolar disorder med compliant?”

In this episode we discuss the phrase “med compliant,” what it means, and why it’s not as straightforward as “just take your meds.”

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 also hosts Healthline Media’s Inside Mental Health podcast available on your favorite podcast player.

To learn more about Gabe, please visit his website,

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

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

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

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

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

Gabe Howard: I have the song. It’s like 40 years old by Twisted Sister. We’re Not Gonna Take It in my head.

Dr. Nicole Washington: We’re not gonna take it.

Gabe Howard: Yeah. We’re not gonna take it.

Dr. Nicole Washington: No.

Gabe Howard: No. We’re not gonna. That’s all the singing I’m going to do. Otherwise, people are going to stop listening. But you know why I have this song stuck in my head?

Dr. Nicole Washington: I do. I do. And I could actually play that song. Maybe patients should just walk into the room with that song on their boom box. So let me know upfront that they’re not going to take their medicine, since that’s what we’re talking about today.

Gabe Howard: Right. Right. So we are talking about reasons that people with bipolar disorder don’t take their medication.

Dr. Nicole Washington: You know, I’ve been doing this for a little bit, and there are very few things that are more kind of frustrating to a visit than a person who is taking their meds. And then all of a sudden, they come in and they say, Oh, by the way, I quit taking my meds.

Gabe Howard: Actually, that’s like the best-case scenario, right? I mean, if you’re going to stop taking your medications, to tell the doctor that you stopped is actually, like, really good.

Dr. Nicole Washington: It is good. But I would like to add for those of you out there listening, if you’re going to drop that kind of bomb on your doctor, can we do it at the beginning of the visit? Right. So

Gabe Howard: Not the end.

Dr. Nicole Washington: Let’s not get through the whole visit. And then I say, okay, well, let’s go ahead and continue your blah, blah, blah, blah, blah. And you go, Oh, and you, you hit me with a BTW’s, like oh by the way,

Gabe Howard: I stopped taking that two months ago.

Dr. Nicole Washington: I haven’t been taking that. Yeah. So that is a little frustrating. So if you’re going to tell me, hit me at the beginning.

Gabe Howard: Before we get too deep into this, I want to say you should absolutely take your medication as prescribed. And if for some reason you don’t want to and I don’t care if it’s a good reason or a bad reason, just any reason you want to stop taking your medication, you should call your doctor. There’s. It’s a big deal just to stop taking medication, cold turkey. There’s all kinds of side effects, issues, problems that could happen. It’s not a good idea. So I’m not judging you for wanting to stop. But stop smart.

Dr. Nicole Washington: Yeah.

Gabe Howard: Call your doctor and say, hey, I ain’t doing this anymore and make sure you’re doing it right.

Dr. Nicole Washington: And your chances of having a really quick mood episode right after are going to be a little bit less if we taper them down, maybe as opposed to you just kind of stopping your meds cold turkey on a random Wednesday.

Gabe Howard: So we’ve got a couple of questions here, right, that we’re trying to tease out. Like, one, why do people stop taking their medication?

Dr. Nicole Washington: Yes. So I need to know one. Why? Why do you do this to us? I know you’re not doing it to us. I know it’s not to me personally. I know that 100%. But let me tell you something. It can feel that way sometimes, like, why are they doing this to me? Why is he not taking his meds? I just need to. I need you to tell me what reasons you can come up with as to why.

Gabe Howard: So obviously I don’t speak for the entirety of the bipolar population. Everybody has their personal reasons. But, you know, I did some quick unscientific polling, and the number one thing that rose to the top? Sexual side effects, right? They were moving along. Everything was fine. Suddenly libido drop, their penis stopped working, whatever. And we’ve talked about that on the sexual side effects episode. So we’re not going to delve into that too much. But I know that you can understand that, right?

Dr. Nicole Washington: Yeah.

Gabe Howard: I mean, anything that messes with your sex life is enemy number one.

Dr. Nicole Washington: Listen, I’m the first person to tell people when they get a bipolar disorder diagnosis or we’re talking about medications and going through potential side effects. I am very upfront and I share with them medication side effects to the great majority of meds we use for bipolar disorder are not very sexy, and we have to focus on the potential to get better and the potential to feel stable and have a better quality of life more than we focus on these side effects because they sound terrible. There is nothing sexy about me telling somebody your hair might fall out, you might get acne, you might gain a lot of weight, your liver might fail, your blood levels might drop so low that you end up having to go in the hospital. I mean, like, that doesn’t sound sexy, right? And I have to be honest about the side effects, right? I have to make sure that they know what the most dangerous of the risks are. And sometimes that’s a tough sell. I feel like a used car salesman sometimes. I get that point right. Like I get why it’s resistant. I don’t feel great. Like, I don’t like how I feel. I mean, I get that. But why won’t you tell me that? Why won’t you just say, this is what I’m experiencing and this is what I need you to do about it?

Gabe Howard: Because there’s a power differential. But I’d venture to guess that the average 50 to 60-year-old person who has been stable or managing bipolar disorder for many years has the same cold turkey stopping their medications problems as, say, a 20-year-old or a 25-year-old or somebody newly diagnosed.

Dr. Nicole Washington: You know, I think most of my patients who are in that age range, they get it. They’re like, hey, I’m going to keep this train going. I will say there are some people who never really get the fact that they have bipolar disorder. Right? Like they just they’re never really going to accept that they have it. So we do this up and down rollercoaster of I’ll take them. I feel okay, but because I feel okay, I quit taking them, which is a whole nother thing. The whole I feel better, so I’m going to stop taking my medicine. And I don’t.

Gabe Howard: Yeah. Big, big problem in the bipolar community. Yep,

Dr. Nicole Washington: I don’t like that.

Gabe Howard: Yep. I’ll take them when I’m sick, but I’ll stop when I’m well. Why are you well?

Dr. Nicole Washington: Yeah.

Gabe Howard: Well, it’s not the medication that made me well.

Dr. Nicole Washington: Exactly.

Gabe Howard: But you were sick when you weren’t taking them. And now you’re better? Yeah, it’s.

Dr. Nicole Washington: Right.

Gabe Howard: It’s almost like a mental disorder, like the way that people think about this.

Dr. Nicole Washington: It happens, right? Like it happens in all kinds of mental health disorders, not just bipolar disorder, but man, when people come in and they’re like, oh, yeah, I felt so good. The blankety blank was working so well. I felt the best I’d felt in years. And I quit taking it two weeks ago because things were going so well. I

Gabe Howard: Yep.

Dr. Nicole Washington: On the inside, I mean, I keep the same outside, but on the inside, I’m just jumping up and down like, why would you do that? Why?

Gabe Howard: So first and foremost, it’s important to point out that this is a bad idea.

Dr. Nicole Washington: Yes.

Gabe Howard: Right. If you become stable on medication. I understand. I want everybody to know I understand. These are thoughts that have entered my consciousness. And I’ve been stable on medication for well over a decade, well over 15 years. And sometimes I wake up and I think, you know, I don’t want it anymore. I’ve had a good run. I haven’t had any symptoms in ten years. I don’t need these medications

Dr. Nicole Washington: Right.

Gabe Howard: And I have to fight through that. I personally have had to fight through this as recently as last year because I think to myself, you know, I’m 45 years old. I’m starting to get to the point where I need to be put on other medications that are interacting with my medication. So now I’ve got to change medications. I’m starting to get libido issues just because I’m middle-aged. Right. This isn’t even if I had zero bipolar disorder, a 45-year-old man does not function sexually the same way as a 20-year-old man. That’s just the reality of aging. And I want to hang on to my youth, so I get it. But it’s a really, really bad idea. And I have to remind myself of that. I have to remind myself of how far I came. So, Dr. Nicole, I want to boil this down to like a straight answer. I believe that the number one reason that people stop taking their medication when they’re well, meaning they’ve reached recovery with bipolar disorder. Bipolar disorder is not a big factor in their life anymore. They’re going to Hawaii, they’re working their job. They got their kids, their spouse, their car, like everything is perfectly normal except for this one thing. Every morning and every night or as prescribed, they get this reminder, this tactile reminder in the pills. They get this taste reminder when they put them in their mouth, they swallow them. They got alarms on their phone. They’re being reminded of it. And the younger you are, you’ve got nobody to commiserate with.

Dr. Nicole Washington: Yeah.

Gabe Howard: My mother never does well on these things, so I just want everybody to know that. But the meanest thing my mother ever said to me when it came to bipolar disorder is she said, Gabe, your pill minder is bigger than your grandmother’s.

Dr. Nicole Washington: Oh. Oh.

Gabe Howard: And she didn’t mean it.

Dr. Nicole Washington: But I’m sure that cuts you deep, right?

Gabe Howard: It cut me so deep and it was an accident. Like, my mom knows this. She’s heard this story and she’s like, I didn’t mean anything by it. I just meant that your pill minder was bigger than grandma’s. I’m like, Yeah, you told an egotistical, vulnerable man that he was taking more pills than an old-ass lady. That’s what I heard it. It cut me to my core. I wasn’t in the mindset to hear that. I wasn’t at the age to hear that. This was still back at the time where if somebody would have said, Well, she’s 65, I would have said, Well, that’s old.

Dr. Nicole Washington: Right. The older you are, the younger that feels.

Gabe Howard: Sixty-five is not old, but at 29 it’s like, well, she’s 65. That’s pretty old.

Dr. Nicole Washington: Yeah. So I get that right. Like I get the medications aren’t sexy, I get their side effects. But this is one thing I don’t get and I don’t think I’ll ever get. And I’ll preface this by saying, we know that people with bipolar disorder, there is also a substance use disorder with about anywhere from 30 to almost 60%. That’s a pretty big range. But that’s what we know, even if it’s at the low end, right, the 30%. And that’s a pretty high number of people. Right. So what I don’t understand and I do see this fairly frequently, people who will not take the medication that’s FDA approved for bipolar disorder, but they will fill in the blank. Drink to manage their mania, smoke a little weed, buy some benzos off the street, they’ll take some Xanax, they’ll do all these things, but they won’t take the medications for bipolar disorder. And that is also very maddening for a psychiatrist who is out here doing the Lord’s work, trying to help you be stable. For you to say, well, I’d just rather smoke a little weed. I don’t trust your drugs, but I do trust the marijuana that I buy from the drug dealer because he’s very trustworthy.

Gabe Howard: I always joke that the biggest problem that the medical community has is that they’re constrained by fact, right? You have to tell the truth. Whereas the holistic health movement, the vitamins that you can buy at your local drugstore,

Dr. Nicole Washington: Right.

Gabe Howard: The stuff that you can, you know, the little packets that you can order online or of course, illegal drugs or even alcohol. They’re not constrained by fact.

Dr. Nicole Washington: Yeah. Yeah.

Gabe Howard: There isn’t a commercial out there, as far as I know, for any bipolar medication that shows a bunch of, like, young, sexy people at the club dancing. Take their bipolar medication and then go in and, like, tear it up. Right. Walk out with, like, all the beautiful people. Right. But that’s the average alcohol commercial.

Dr. Nicole Washington: Yes.

Gabe Howard: It’s always young people looking sexy, you know, just with all their friends feeling good. So if I am impressionable and one path has, your hair might fall out, your sex drive is going to shoot to hell and you might get fat. And the other side has like real hot people dancing to boots and pants and boots and pants and boots and pants and boots and pants. Yeah. I mean, that’s. Come on. Of course. Of course. I’m going to go the route of self-medication. Of course, I’m going to go the route of the really cool YouTube video I saw from D.J. Weed-N-Stuff. I hope that’s not a real person. I’m now terrified that I just gave a shout-out to a real YouTuber. It was like, Hey, man.

Dr. Nicole Washington: DJ Weed?

Gabe Howard: DJ Weed.

Dr. Nicole Washington: DJ Weed.

Gabe Howard: So I want to say to all the people living with bipolar disorder out there who are like, Whoa, yeah, that makes sense. Yeah, listen, it doesn’t.

Dr. Nicole Washington: It doesn’t.

Gabe Howard: It doesn’t. Facts are never going to be as good as marketing.

Dr. Nicole Washington: No.

Gabe Howard: They just simply cannot be.

Dr. Nicole Washington: You don’t even know if it’s all weed that you’re getting. You don’t even know when you buy something, whether it’s, you know, oh, I think I’m buying Xanax. You don’t know that it really is that. I can’t tell you how many people I’ve seen in the E.R. who thought they were buying one particular drug from somebody off the street, yet they were buying something else. I’m like, Yeah, who knew you couldn’t trust a drug dealer? Who knew?

Gabe Howard: Yeah. Who knew?

Dr. Nicole Washington: I mean, that’s not an uncommon thing, but I can’t do that. I got to tell you the truth.

Gabe Howard: You’re constrained by facts. Forget about bipolar disorder for a minute. Let’s just talk about regular old people. Right. The get rich quick scheme still, still permeates our culture because listen, one cell is you give me $200 and you’ll be rich in a week. The other cell is you get a job and you work 40 hours a week and parts of that job are going to suck. Maybe parts of it you’ll like, you’ll be able to build your way up. You’re going to save some money, you’re going to buy some real estate. You’re going to work really hard. And day in and day out, you’re going to churn, you’re going to churn, you’re going to churn. And you know what? One day you’re going to wake up and you’re going to be 40 and you’re going to own a house and you’re going to have money in the bank, and you’re going to be able to go to Hawaii and your kids are going to be in a good school, and you will have built a nest egg and you will have a 401K. Oh, my God. Doesn’t that sound awful? That just sounds absolutely awful. Especially if you’re at the beginning of that journey. That other guy said, if I gave him $69, he would mail me a packet that’ll make me rich in real estate investing by the end of the month. I’m going to go with that plan. So if people are falling for this that don’t have mental illness, that aren’t sick, that aren’t vulnerable, that aren’t scared, that aren’t out of their mind, right? They’re not suffering. If regular people are falling for the get rich quick scheme, it’s not really a big leap to think that people are falling for this. It’s the get well quick scheme.

Dr. Nicole Washington: Yes, it is. But let’s just talk about the long term, right. Because I need you to think beyond the right now,

Gabe Howard: Okay.

Dr. Nicole Washington: Which is the big problem. Right. Like you’re thinking about the right now. But what if I drink to manage my mania? Right. I see that fairly frequently. People drinking alcohol or taking benzodiazepines, things like Xanax, Ativan, Klonopin, things like that. I see it fairly frequently, especially in the hospital setting, because you see people who say, well, I haven’t been taking my lithium, but I was able to get some Xanax. Long-term effects of drinking can be really terrible for your whole body, like heart disease, increased risk of certain cancers, liver damage, all kinds of things. Right. But let’s just talk about the brain effects that drinking long-term has. You’re going to have trouble remembering stuff. You’re going to have trouble with focus and concentration. How is that long-term better than us trying to work together to figure out how it is that we’re supposed to get you feeling stable? I could see how in the immediacy it feels like, Oh, this is going to be good. But no, it is not good and don’t even get me started. I’m in a state where we have a medical marijuana law and I just want everybody to hear me say, I don’t feel like we know enough in general, but because I feel like we don’t have enough information, I lean toward the no.

Dr. Nicole Washington: We’re just in recent years getting to the point where we’re really, really putting effort and money into studying marijuana. But we do know a couple of things, right? I do know that young people who use marijuana regularly, they’re at increased risk of psychosis. Not that the marijuana caused it necessarily, but if you have these genetic predispositions to these things, it might flip a switch that we were not trying to flip. And if you think about the people that you know who smoke marijuana frequently, right. Like just visualize in your mind, what does a person look like who smokes a lot? Apathetic, right? No motivation. Some strains of marijuana can cause you to have increased anxiety. Like none of these things sound helpful. As a matter of fact, most of them sound counterproductive to what we’re trying to accomplish. So then when you say, well, I just rather take this, you have to see why your psychiatrist dies a little bit on the inside.

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Dr. Nicole Washington: And we’re back to talking more about why people just won’t take their meds.

Gabe Howard: But let me ask you this, Dr. Nicole. Let’s say that I sat down in my appointment with you who’s been diagnosed with bipolar disorder. I believe that I have bipolar disorder. And you say to me, all right, Gabe, I’m going to put you on these two pills. There might be weight gain. And I look you right in the eyes and say, I’m not going to take these medications. I’m going to use alcohol and weed. What do you say?

Dr. Nicole Washington: I will tell you that you are an adult, that you have every right to make every bad decision that everybody else does, but that I think that’s a really terrible idea and that I can’t support you in that plan.

Gabe Howard: Now, will you still see me? So often when people sit down and they’re like, Look, I want to go the bad route, they end up losing their psychiatrist, losing their therapist. I understand it from a business perspective, but I got to tell you, that person’s there, being honest, telling you what they want, and you’re like, Oh, you didn’t agree with me. You’re gone. And this causes two problems. One, you now lose the opportunity to change their mind.

Dr. Nicole Washington: You’re right. I mean.

Gabe Howard: So it’s problematic.

Dr. Nicole Washington: Me personally, would I still see them? Yes, I would to a point. I probably would see them longer than a lot of other psychiatrists might, because I get it. And so I would try to continue to use the rapport that I have with that person to work with them and to try to see if we can come to some conclusion. Right. Can we try one thing at low dose and can we very slowly increase? And can we you know, we talk about all the things that we can do, but really the first conversation needs to try to figure out why are they so resistant? Like, what is the reason? Is it that they don’t like taking the meds three times a day? Is it that they forget? Is it that they don’t like people knowing they’re taking pills? Is it the side effects? Like what is it? Because maybe that can play into how we can come up with a better plan. But if they’re just flat out saying no, I will see them, but I’m going to play the other side. Right? The doctor who says, I’m not going to see you.

Gabe Howard: Okay.

Dr. Nicole Washington: Right. The doctor who says, I’m not going to see you. You are not adherent to what I am recommending.

Gabe Howard: You’re not med compliant.

Dr. Nicole Washington: You’re not. You’re not willing to do anything I recommend to you. Right. So one, I mean, it’s frustrating, right? Like, why come to me if you’re literally not going to take my advice? Are you going to take your car to the mechanic and they tell you what needs to be fixed and you just leave it there and say, no? No, you’re not going to do that. You came to a professional, at least be willing to listen and try to work with them.

Gabe Howard: I’m always fascinated by the juxtaposition of this person needs a psychiatrist because they have bipolar disorder and they’re not thinking straight and they made a decision. We can count on that decision. They logically made it. They’ve done the wrong thing. And here’s the consequence. And this is what’s going to happen. It doesn’t flow right? We’ve already acknowledged that this person is mentally impaired. There’s something

Dr. Nicole Washington: Yes.

Gabe Howard: Wrong with their brain, their functioning, the way that they see things, and then they’re not immediately adherent to what the psychiatrist says.

Dr. Nicole Washington: Yes.

Gabe Howard: And the medical establishment is like, Well, you made the wrong decision. I guess you’re out. Wow.

Dr. Nicole Washington: Yeah.

Gabe Howard: You mean that somebody with a mental illness thought about this incorrectly and came to the wrong conclusion? You don’t say.

Dr. Nicole Washington: This happens in all of medicine, right? This isn’t exclusive to psychiatry. Nonadherence to a point of dangerous behavior, it is an acceptable reason for dismissal from your practice. Right. And I don’t know if we’ve thought through the differences between someone who has their illness causing them to do this, versus like the person who has uncontrolled, poorly controlled diabetes or heart disease and won’t take anybody’s advice and is on the verge of death because they won’t. I don’t know that we think about those different. I do, which is why I keep those people a little bit longer and try to reason with them. But even for me, you know, there has come a space where things were getting so dangerous that it started to feel like I was almost an accomplice to what was going on. Right. And at that point, it was time to cut ties because clearly that relationship was no longer beneficial. I leave the doors open. This is what I have to offer you. And if you are ever agreeable to try to work with me on this plan, call me.

Gabe Howard: And here is where I really advocate for the It Takes a village approach. They come in and see Dr. Nicole and they’re like, Look, I’m not taking any medicine. I’m not listening to you. I’m not doing anything that you want. No, no, no, no, no, no, no. And Dr. Nicole says, Hey, I get it. You’re not ready for me yet. But you know what? My colleague, Dr. Smith, a clinical psychologist, wants to talk to you about boom, boom, boom, boom, boom. And I’ve seen this I have seen this work in clinics and hospitals around the country. Extraordinarily few and far between. People come in and they just start going to support groups like that’s it. And then when they get, like really comfortable with the, you know, the check in staff, the parking lot, whatever, and they’ve gone to this support group. Then after a while, the people in the group are like, you know, I really like the therapists here.

Dr. Nicole Washington: Yeah.

Gabe Howard: Really? Okay, so now you’ve got, like some buy in from your peers, right? So then you make an appointment with a therapist and then that therapist, after you’ve built some rapport, learn some coping skills, you’re like, you know, maybe you’re starting to make some progress. And then

Dr. Nicole Washington: Yeah.

Gabe Howard: Then they walk into Dr. Nicole and we haven’t even hit on case management. You know how hard it is to be med compliant when you don’t have a place to live or food in your belly?

Dr. Nicole Washington: I 100% get this. So when I completed my residency training and was ready to get my first big girl job as a real psychiatrist, not a trainee. My first job was with an assertive community treatment program, and we did home visits. We did community visits for the SMI, Severely Mentally Ill, population. So these were people who really struggled with staying out of the hospital. So they had multiple admissions back to back. They had trouble with medication adherence. They were on the verge of homelessness because of their illness or they were on the verge of serious legal issues or because of their illness. This is a group that was not very medication adherent and they did not want to be. There was significant drug use among this population. We had case managers and therapists and nurses and me, and we had peer people and we all were this person’s team. And we met every day and talked about every last one of these 75 people that we had. And we talked about how we could fix it and what we could do. And we’d come up with creative ways to work with people. And we had harm reduction discussions about, well, if you’re going to do I.V. drugs, let’s at least make sure the needles are new and clean if you’re going to. That was fantastic, which is probably why I hold people in my outpatient world a little bit longer, because I had the luxury of starting my career off in an environment like that. Not everybody gets that. These clinics are overrun. They don’t have enough people. They’re managing too many people with too few staff. They don’t have the time because what you’re describing takes time.

Gabe Howard: Right and money. What I’m describing takes time and money and effort

Dr. Nicole Washington: Yes.

Gabe Howard: And people and coordination. And it’s something that people with mental illness don’t often have a lot of.

Dr. Nicole Washington: Right. Sometimes it is a time factor.

Gabe Howard: Right.

Dr. Nicole Washington: I could see a doctor saying, listen, I am churning people out every 15 minutes and they’re still double booking me one patient an hour in case of no shows. I literally don’t have the time to deal with you not taking your meds and wanting to use drugs and alcohol instead of medicine. I got way too many people waiting to see me to deal with this, and then on top of that it might increase my liability. It’s a no for me, dog. That’s what they’re saying. It’s a no.

Gabe Howard: Yeah.

Dr. Nicole Washington: It’s a no.

Gabe Howard: If there is anything that I want people to take away from the Inside Bipolar Podcast, it’s that the problems that we living with bipolar disorder face do not boil down to individuals. This is a systemic issue. There is not enough resources, funds, understanding, time, energy, money. We’re just not meeting people where they are. And I love that the mental health. Don’t you hear that all the time, Dr. Nicole? We need to meet people where they are. Okay, are we? No.

Dr. Nicole Washington: No.

Gabe Howard: But we need to.

Dr. Nicole Washington: No. We don’t have the time, we don’t have the money. We don’t sometimes have the energy because there’s too few of us to truly meet people where they are.

Gabe Howard: Dr. Nicole, I want to swing back all the way to what started this podcast off, which is why don’t people take their medicine? Why don’t people listen to doctors? What is the problem? Why are we here? And the answer is huge misunderstanding and mistrust. There’s no camaraderie, there’s no understanding, there’s nothing but fear. And all of this is happening while our brains are messed up.

Dr. Nicole Washington: Yeah.

Gabe Howard: So when you ask why people aren’t doing it, that’s why for many of us. The reason that we’re not med compliant or taking our meds might have less to do with disagreeing with the Doctor Nicoles of the world. It might have way more to do with whether or not we can afford it or whether or not we can even get a ride to our psychiatrist appointment or whether or not we have food in our bellies. There is a huge poverty component

Dr. Nicole Washington: Absolutely.

Gabe Howard: To having severe and persistent mental illness and

Dr. Nicole Washington: But if you never tell me, I’ll never know.

Gabe Howard: And we never tell you. But listen, I will also put the onus back on you. If you never ask us, we don’t know that we’re supposed to tell you. Many people who are diagnosed with bipolar disorder are young and again, not thinking clearly.

Dr. Nicole Washington: You’re right. I get that. No, I agree. It’s a very complicated system, you know. I won’t know if you don’t tell me. And sometimes, honestly, it’s hard to have the time to dig through all of that, especially if you wait till the end and hit me with the BTW, I hadn’t been taking my medicine, so more reason to go ahead and let’s get that out early so we have time to figure out what’s going on. And I’ve learned that there are lots of reasons which I always knew there were, and none of them include because you hate me and want to ruin my Friday afternoon. So got it. Duly noted.

Gabe Howard: Dr. Nicole, I love you saying that. And listen up, everybody living with bipolar disorder, remember to tell in the beginning. Be honest. Write it down if you need to. One of the things that I do before I see my psychiatrist every single quarter is I take a note card and I write down my top three. Here are my top three things, and here is everything that I want my psychiatrist to know. Here’s the side effect that’s pissing me off, the medication that I want to quit. I do advise not to quit your medication without letting your psychiatrist know because it limits your options. And finally, the last thing that I want to say to the bipolar community is you are not hurting your doctor. You are not hurting the medical establishment. You are only hurting yourself. So as much as you think you are taking the power back, I want you to know you are not. The way you take the power back is to be present when you are in these appointments, when you are in these meetings, to advocate for yourself professionally and honestly and openly and continuously. Self-advocacy never ends. All right, everybody, that is our show. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon because like literally everything is on Amazon. But if you go to my website, you can get a signed copy with free swag. Just head over to

Dr. Nicole Washington: And I’m Dr. Nicole Washington. 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 Howard: Dr. Nicole and I do travel nationally or internationally. You can find information on how to book us on our respective websites. And wherever you downloaded this episode, please follow or subscribe. It is absolutely free. And finally, do us a huge favor, tell people about this podcast. Sharing our show is how we grow. We will see everybody next Monday on Inside Bipolar.

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