We discuss the common complaint from people with bipolar disorder of feeling emotionally blunted or like a “zombie” due to their medication. Gabe expresses the people’s frustrations when their concerns seem dismissed in favor of highlighting symptom improvements. Dr. Nicole emphasizes the importance of providing specific examples and patience because medications take time to stabilize. They conclude that to effectively address this issue, people need to clearly communicate their experiences, and psychiatrists need to balance symptom management with quality of life considerations.

Cold Open Transcript:

Dr. Nicole: But feeling like a zombie and not having that passion, to me, those are still two very different things. That’s where the disconnect is. So, did you feel like a zombie or were you just less passionate about things?

Gabe: So, once again we get back to where we started, which is that telling your Dr. Nicole you feel like a zombie is just a recipe for misunderstanding. . . And probably not getting what you want.

Gabe Howard
Gabe Howard

Our Host, 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.

To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com. You can also follow him on Instagram and TikTok at @askabipolar.

Dr. Nicole Washington
Dr. Nicole Washington

Our host, 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: Hey everyone, welcome to the podcast. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: We want to remind everybody that we love to get your questions and feedback. You can hit us up at our email address, which is show@psychcentral.com. Or you can follow us on TikTok and Instagram. Dr. Nicole is @DrNicolePsych and I’m over @AskABipolar. We are great followers and listen, you can watch clips of this very show.

Dr. Nicole: Okay, Gabe. So today’s show was born from all these emails that we were receiving about people complaining about the blunting that they feel from their medication, and rightfully so. It’s terrible. Nobody likes it. And it’s probably the number one thing that people come to me if they’re going to fuss about the medicine, that’s usually the number one gripe.

Gabe: I can certainly understand why people are writing this in, and this is not going to reflect well on you, Dr. Nicole and all the Dr. Nicoles of the world, but we’re often ignored. We come in and we say, hey, I feel like a zombie, and we get hit with, well, hey, but at least the mania is better. And I say, well, but I feel like a zombie. Well, at least the suicidal depression is better. Well, but I feel like a zombie. Well, hey, at least fill in the blank symptom is either gone or better or reduced. The medication is working for its intended purpose, but this is kind of one of those. The cure is worse than the disease moments. We’ve replaced one thing with another. Yes, it is true. Whatever symptom, it has improved. We’ve seen vast improvement. We usually have to concede that point, but it’s been replaced with something that we find equally objectionable and often a lot. I hear this a lot in the patient community. The doctor, Nicole’s of the world are like, well, it’s not our job to make you funny. It’s not our job to give you personality. We’ve reduced the thing. And maybe this is just who you are now. And that’s very frustrating to the patient community. What’s your view of that?

Dr. Nicole: So basically what you are saying is that we aren’t listening.

Gabe: I don’t want to say that you’re not listening because you make a valid point. You have successfully treated the symptom, but where you’re not understanding

Dr. Nicole: Mm-hmm.

Gabe: Where the disconnect is coming in is we fully acknowledge that the symptom has improved.

Dr. Nicole: Mm-hmm.

Gabe: We don’t like the side effect of the medication. And in this case, the side effect is this bluntness of emotion or this zombie-ism.

Dr. Nicole: Yes. And I will say patients who have come to me after they’ve seen someone else and have received a response like that, I guess they haven’t really said that person wasn’t listening to me as much as they felt like that person didn’t care that I was not doing well, I was better, but I still didn’t feel like myself. So I guess that’s the thing. Everyone wants to go back to feeling like themselves, and that’s where the disconnect is.

Gabe: We want to feel good. We want to feel awesome. We want to feel happy. We want, we want all the improvement. And we’ve talked about this on this show before, Dr. Nicole that the goal isn’t symptom reduction. The goal is recovery. The goal is to lead your best life. The goal is to go to Hawaii.

Dr. Nicole: The goal. The goal is recovery. But I think we also have to go back to who are you? Who are you? No one is happy all the time. No one is walking around just smiling and telling jokes and on top of the world all the time. Yet I will say a lot of times when people come to me and they’re complaining about their blunting, I think they don’t have the right words. So I think that’s where the disconnect comes from. So they come to me, they don’t have the right words. We’re not speaking the same language, so I don’t have the right words to communicate with them. They don’t have the right words to communicate with me. And then we end up not being able to come to a common ground because we’re not speaking the same language.

Gabe: Are you saying that when somebody comes to you and says, I feel like a zombie, you don’t know what to do?

Dr. Nicole: [Laughter]

Gabe: I mean, it’s so specific. We told you we feel like zombies.

Dr. Nicole: I’m saying.

Gabe: It’s it’s it’s all inclusive.

Dr. Nicole: If someone says I feel like a zombie, yet they are sitting in a room with me, having range of affect and able to change their facial expression and smile politely and say, hi, how are you doing? I mean, and do all those things. Then I have a hard time with. What does zombie then mean to you? Because when I hear zombie, I’m thinking something totally different. And I have seen patients who have been blunted to the fact that I would agree, like they have no effect. They do look like a zombie. They have none whatsoever. But that’s not always what I’m seeing. When the person is sitting in front of me and saying, oh, I feel like a zombie, so I need more than I feel like a zombie. Like I need to know specific instances where you felt like you had a lack of emotion, or a decreased range of emotion, and how it affected you. Those are the things I need to hear.

Gabe: I can certainly understand how I feel like a zombie is not enough, especially if we’re seeing an improvement in symptoms because we don’t want to go back to the original problem in order to save the side effect. Based on what you’re saying, I think what patients need to do is give you an example. Like, for example, if I told you that I just won the lottery and I felt no joy, I just, I just want $1 million. And I didn’t get excited or I just got engaged and I didn’t feel excited, or I used to feel very strong feelings towards XYZ and now I don’t care.

Dr. Nicole: Mm-hmm.

Gabe: And it’s worrying me. I used to be very passionate about this and now I could care less, or I’ve noticed a drop off in my hobbies, or I’ve noticed a drop off in seeing friends and family. And of course, it’s also very helpful when those same friends and family are giving you feedback. You know, Gabe, you’re just not acting like yourself to. To put it in my personal words for a moment, I have a very exuberant personality, and when I felt like a zombie, I just sat quietly in a corner. So when I gave that to my doctor, Nicole, hey, I just, I just kind of sit around and stare at the ground. Now my, my, my Dr. Nicole became very concerned and actually expressed like, oh my God, I imagine that that’s very, very difficult for you because, you know, I never shut up.

Dr. Nicole: Right. And it also matters probably how long you’ve known your psychiatrist. Do they know you at a stable place? If it’s someone that I’ve seen for years and years and I’ve seen them in normal mood episodes, and I’ve seen them in this kind of blunted phase. It’s a lot easier for me to see that. But if you’re new and you’re bipolar journey and this is a new relationship, they have no idea what you are normally like. They may not know what you’re like normally, they may not know what kind of ranges of expression you have. They may not know that. Gabe, you’re an exuberant personality normally, so it is important to do the comparison for them. Them very firm examples of what you were like normally when your mood was in that quote unquote normal place for you versus how you feel now.

Gabe: This sort of reminds me of a semantics argument, right? Where people are generally on the same page, but they’re getting hung up over a word. What

Dr. Nicole: Mm-hmm.

Gabe: We’re talking about is a spectrum argument. I’m saying that I am blunted enough that I describe myself as a zombie, and you’re saying, hey, look, I’m interacting with you. I’m talking to you. You can’t be happy all the time. And also not for nothing, especially with bipolar disorder. You might be thinking, well, yeah, I bet going from full blown mania or even hypomania to a normal mood state makes you feel very much like a zombie. So much in the same way that a semantics argument is getting hung up on a single word. I think this is a spectrum argument. When does it become zombie versus when is this now? Your new mood state?

Dr. Nicole: Yes, but Gabe, that is a very good point as well. When you come from mania to a normal mood, whatever that looks like for you, it can very much feel like you’re blunted because you were so high. You were so on top of the world. You were over the moon. You were so high. Of course, normal feels like a zombie. Normal feels restricted in some way. So we have to figure that part out too. Which is why I need firm examples, because sometimes as a person is trying to give me firm examples, they’re falling short. They struggle with coming up with those firm examples. Sometimes they’re able to give me great examples, but either way it can point me to like what is the problem?

Gabe: You know, it’s also worth saying with mania. Mania lies. People who listen to this show have heard me say, mania has got the best public relations team in the world. So it’s possible when you’re reflecting back on that elevated mood state and all the great personality traits that you had and all of the amazingness, you’re actually still that same person. Mania is just no longer revamping it in your brain. So you’re like, well, normally when I tell a joke, everybody laughs, and now I’m just kind of getting some chuckles. There is some non-zero chance that maybe you were just getting chuckles before, but your mania interpreted it as hysterical laughter, and that’s how you’re remembering it. But all that said, it’s still disturbing. I do want to be clear, even if it’s quote unquote all in our head, it’s disturbing, and I don’t think that we get enough support when we say, look, our personalities have altered to the point where we don’t recognize ourselves. We’re not interacting with the world in the same way. And we are scared. We are scared. What do we do? And then we’re met with a, well, here’s the good news you have better symptom reduction. I know that psychiatrists aren’t therapists, but where can we go to address this? Because we can’t just leave it hanging.

Dr. Nicole: Yeah, and I don’t. Well, I can’t say that some people are not being dismissive. I can’t speak for every psychiatrist in the world, but I would like to think that most of us are not being dismissive. I think that what we’re trying to do is maybe be a glass half full in this situation. So we don’t want to focus on all of the bad things. I do want to know what’s better, what is actually better, what is actually going well, so that we can figure out what we need to do based on what’s going well versus what’s not going well. So if you come to me after I’ve started you on a new medication and you say, I feel blunted, I feel like a zombie, I feel blah, blah, blah, blah. If you are having no improvement in symptoms, my plan is a whole lot different than if you are having great improvement in symptoms. But then we have this bluntness over here on the side. The plan is different and I’ve told you all before, a lot of times we’re thinking five steps ahead.

Gabe: You’re playing chess, and we’re playing checkers.

Dr. Nicole: Well, I mean, I am thinking five steps ahead. So as you’re telling me what you hate about your medicine and I’m saying okay, but it has helped with A, B, C, D and E, right? I’m not dismissing what you’re saying, but I’m also thinking about the end of the visit and what recommendations I can make to try to help with the situation. And it is going to hinge on if you’ve seen symptom control or not. So it may not be dismissive as much as it may be when my thinking brain is on, sometimes I’m not able to carry the warm and fuzzies and the oh my gosh, that must be terrible for you. And acknowledging that because I will admit I do get locked into okay, but how am I going to fix that and what’s going on? So it may not be that we’re just being dismissive and that we are just unkind people and don’t care, but our visits are relatively short for the time that we really need to hash through things sometimes. And so sometimes it just requires me to be thinking ahead, and it might feel like I’m being a bit dismissive.

Gabe: I was a real estate agent for a number of years, and what you’re describing reminds me of the differences between home buyers and home sellers. Home sellers see every beautiful, perfect thing about their house. You know, the upgraded carpet pad, the new insulation, the the the modern ceiling fan, whereas every buyer sees oh, this room’s going to need repainted. That carpet is dated. I don’t know if I like how this faucet works. They’re both looking at the same damn house. It’s the same house, but they’re looking at it through two different lenses. But it’s the real estate agent’s job to get them on the same page. So just out of curiosity and I’m going to I’m going to think really outside the box. Should patients bring real estate agents to these zombie appointments?

Dr. Nicole: [Laughter] Gabe, absolutely not. Absolutely not.

Gabe: [Laughter]

Dr. Nicole: But you know, but you know what they should bring?

Gabe: A family member? A friend? An advocate?

Dr. Nicole: [Laughter]

Gabe: [Laughter]

Dr. Nicole: They should bring with them. Very specific. Instances where they felt blunted. They should bring with them accounts from people who they hang around enough to say, oh yeah, I noticed this about you, or I noticed that about you. And that can be their third party. The person doesn’t have to be there, but they can bring in. My mom said, my wife said my husband noticed, you know, somebody at work randomly said to me, you don’t seem like you want to be here today. And the person that wasn’t feeling like they didn’t want to be there, but that’s people’s impression of them. And that’s not how they usually carry themselves. I want examples like that. So if you feel like I’m being blunted, I feel like a zombie. I want you to start looking for very specific examples to bring with you.

Gabe: All right, Dr. Nicole. So we’ve convinced you now. We got our accounts from our coworkers.

Dr. Nicole: Okay.

Gabe: We brought in our family members. We’ve given you specifics. We’ve done everything right. Right. We are now at the part of the episode where Dr. Nicole is like, all right, I’m agreeing with Gabe. He is feeling like a zombie, and we’re going to address this. What magic do you have to address it?

Dr. Nicole: What? Magic. I don’t know if it’s magic. I don’t have magic. Although I wish I did, because I know that people come to me wanting really big results. And I do wish I had a magic wand that I could just wave and make everything okay. But I don’t have that. So one thing we can do is we can talk about decreasing the dose of the medicine. That is a conversation that comes up. It is sometimes the truth that when you’re in that manic episode, it may have taken a little bit more medicine to bring you back closer to normal than it will take to keep you at normal. So maybe that means we keep you on the same medicine, but we try decreasing it a little bit. Teach by teach just to see if we can still maintain control of your symptoms, but also help give you some relief when it comes to that restricted, blunted feeling. So that is an option for some people. Now, if the medicine isn’t working all that great for your symptom control, decreasing doesn’t seem like a good idea. So that is when we would have a discussion about are we going to change the medicine to something else? And that’s when we get down to the what all have you taken before, what’s left? What can we do? And that’s a whole different conversation. But there are things we can do.

Gabe: Obviously, I know there’s nothing magical that you can do, and I know that it’s going to take some sort of med adjustment, which is where you shine. But I want to kind of flip the script a little bit and talk to my folks with bipolar disorder who try to fix this on their own, because I’ve heard all the time they’re like, oh, my Dr. Nicole is not listening to me. So I just stopped taking that med. And I’m like, well, but did you did you tell your Dr. Nicole? Nah, they weren’t listening to me anyways. But the problem with that method is there’s lots of problems. There’s just so many problems. I can’t believe that I have to say them, but I’m gonna. The problem with that method is, is that your Dr. Nicole, believes that you’re still taking that medication. So is there a valuating you is there watching over you? They’re like, well, he’s on this medication, this medication, this medication. I want to prescribe this medication, but it interacts with the medication that hey, it turns out you’re not taking. It’s not a good method. I’ve also heard about people trying to take what they call drug holidays. Also a very bad idea where they just decide, well, I’m going to a party and I want to have my A game, so I’m not going to take my medicine on Saturdays and they call it a drug holiday. It’s a very bad idea. And I know this from personal experience, because I was having a sexual side effect from a medication. I was going away for the weekend with my new girlfriend. This was 20 years ago, and I decided not to pack my medication because after all, I wanted to make sure that I was in tip top shape. It

Dr. Nicole: Mm-hmm.

Gabe: Turned out extraordinarily poorly, and I think about that a lot because I did not do that in conjunction with a doctor. It’s just some hairball scheme that I came up with completely on my own. And it was very dangerous. It was very dangerous and very problematic.

Dr. Nicole: Yeah, you absolutely need to make sure that your Dr. Nicole knows if you are taking these holidays or you’re making these decisions to do this. I guess the other thing we should bring up is that I often see people who will turn to stimulating substances to try

Gabe: Oh,

Dr. Nicole: To help with this.

Gabe: So they’re trying to treat their own with different substances that I imagine that they also don’t tell their Dr. Nicole about.

Dr. Nicole: Yes. Or that can also come with really bad juju. So sometimes people might decide to take this into their own hands and they will use stimulating drugs. A lot of times that means illegal things. A lot of times that means amphetamines, that means cocaine, that means drugs that are going to be uppers, so to speak. That can be terrible, especially for somebody who has bipolar disorder, because that is just a manic episode waiting to happen.


Gabe: And we’re back discussing feeling like a zombie because of your medication. We’ve talked about a few different ways to get over feeling like a zombie, but one of the things that we haven’t talked about is patience. I remember once I went to my doctor, Nicole, and I said, I’m feeling like a zombie. And he told me, he said, you know, that’s pretty normal for the first couple of months you’re on this drug. I said, I’ve only been on the drug for three weeks. You’re telling me I got to wait another month, another month and a half before I’m going to feel relief? And he looked me dead in the eyes and said, yeah, your body is adjusting to this medication. And in fact, it may get worse before it gets better, but it is treating your symptoms. I don’t want to pull you off of this, and I, I want to see where you are in 2 or 3 months. It’s one of the reasons why we talk about it taking so long to get stable with bipolar disorder. Because you might have to fight your way through this. But I got to tell you, I’m an impatient person and I really did not like that. I ultimately did it, but I can easily see this going the other way, even in my own life. Whereas if I was in a different place, if I had, you know, if I was just in a stubborn mood that day where I was like, you know what? No, I’m not feeling like a zombie for the next month and a half and hope it works out. Just FYI, it did work out. I became stable, I got my personality back, everything was good. The patients for me did pay off. Am I aberrant in that or

Dr. Nicole: No,

Gabe: Was my Dr. Nicole firing on all cylinders that day?

Dr. Nicole: [Laughter] I think that’s how it works out for a lot of people. From what I see on my end, if we can just give it time and I get it, the manic part, everything moves so fast. Everything moves so fast, so quickly. Everything is intense, everything feels like a roller coaster. And then you get to the recovery phase and everything feels so slow. So yeah, it takes a while for your brain to recover. Your body’s recovering. The medicine brought you down really, really quickly, and now we need to give it time to level you out. And that all takes time and patience. And I, you know, I love y’all, but you know you

Gabe: [Laughter]

Dr. Nicole: Know I love y’all. You know you know I love y’all. But my bipolar peeps do not always excel in the patience arena. Like you want to feel better and you want to feel better now because mania felt so great, depression felt so horrible, and you just want to feel good. Like you just want somewhere in the middle. And your idea of what is middle sometimes misses the mark just a little bit. So just be patient. Be patient with yourself. Be patient with me. Be patient with the medicine. And most of the time we can come to a great place.

Gabe: Patience is a virtue. I cannot agree more. And again, this is a long process that I feel a lot of people, especially newly diagnosed people with bipolar disorder, are just not prepared for. We tend to think it’s like pop culture where you just be made compliant, follow your doctor’s orders, and in a couple of weeks you’ll be fine. And again, it took me four years from the time that I was diagnosed until I reached recovery. It just takes a long time to find the right combination of medicines, the right coping skills, learn the right therapy, get the right supports in place. It’s just a very, very long process. Now you’re ebbing and flowing. I don’t want anybody to hear that you’re equally sick on day one as you are. You know, on day 300 or day 500 or day 700. There’s steady improvement. I don’t want to freak anybody out, but it still takes time to learn all of this stuff, and it takes time to find the right medications. So I’m just curious when you say be patient, the medication takes time. Is there is there a little tomfoolery going on, or are you just are you

Dr. Nicole: [Laughter]

Gabe: Just hoping that that that that we just adjust? I mean, is there is the medicine actually is our body adjusting or is just our personality adjusting or our expectations adjusting like from a medical standpoint, what’s the mechanism that makes month three better than month one?

Dr. Nicole: It takes time, Gabe. It takes time. And I don’t always have the answer of how long it’s going to take either. That that’s not always something that I can specifically give you. What I can say is I will be there with you every step of the way. We will keep checking in once a month. We will keep a record of how you’re doing. You will keep record of specific situations you were in, where you felt blunted, where you didn’t feel like yourself. And we will figure out, is that really the medicine? Is that you having to adjust to this new normal for you? What does that look like? Was your idea of what normal used to look like, a little hypomania or mania? So we really have to think about like what is normal? What does normal Gabe look like? What is Gabe’s normal when Gabe is just in a normal mood, what do you look like? How do you respond to things? How do you react to things? What does that look like that can kind of help us out? I think one of the places that we get lost in all of this is it’s very difficult for people to remember what they were like before they were diagnosed, like, what was I really like? Because so often they spend so much time fluctuating between depressions and mania that they don’t even know what a normal mood looks like for them anymore. So then it’s very difficult for them to draw back on what their normal is. So it does take time. It takes time for you to establish what is your normal. It takes time to let the medicine do what it’s going to do.

Dr. Nicole: It takes time for your brain and your emotions and symptoms to level themselves out to get to that space. It takes time and honestly, for some people. It may just take time for them to say, you know what, I’m okay here. Like, I’m okay here. I don’t know that everybody always gets to a place of like, yeah, I feel fantastic, I feel amazing. I have people who have bipolar disorder who tell me, I don’t know that I ever felt like the me I felt like before I started having episodes, I don’t know, like, I don’t feel like I respond to things the same way. I don’t feel like the old me and I don’t really have an answer for them, because then we have to have a discussion about, is it worth the risk then? And that’s a very individual question. Is it worth the risk to you to then start making medication changes, knowing that we could potentially lose the great symptom control if it’s there to try to chase after this? You that used to be. For some people the answer is yes. For some people the answer is no. And they say, you know what? It’s probably okay that I’m not responding as extreme or as passionately or with as much emotion to different situations, because that’s usually my first question. When somebody comes in and they say, oh, well, I was at this place and normally I would have gotten very passionate about this thing and I didn’t. And I said, is that a problem? Like, is that okay? I don’t know that that’s a question that only you can answer.

Gabe: It really reminds me of what side effects we’re willing to tolerate. But I do want to touch on something you said about you don’t get as passionate and I’m making air quotes because all I could hear is like flying off the handle. I, I think about before I was diagnosed and somebody would do something to me and I just had all of this passion about whatever happened, but it usually devolved into me being upset. It

Gabe: The passion almost never served me. It. This is how I got the nickname Wrath of Gabe that people heard about from my mother’s episode, because I would just fly off the handle. I would be so passionate about the outcome that it was perceived as anger, even though for me it was legitimately just. I was passionate about the subject. So I got to tell you, feeling like a zombie and not having that passion was actually a huge, huge payoff to me. And it allowed me to build more stable relationships that allowed me to have better boundaries. And again, this is why we talk about where you are on that spectrum. A little bit less is good, but I don’t know that we would describe that as zombie.

Dr. Nicole: But feeling like a zombie and not having that passion. To me, those are still two very different things, and I think that it takes us back to that’s where that’s where the disconnect is. So did you feel like a zombie or were you just less passionate about things? When you think about it?

Gabe: So, once again we get back to where we started, which is that telling your Dr. Nicole you feel like a zombie is just a recipe for misunderstanding

Dr. Nicole: It’s [Laughter].

Gabe: And probably not getting what you want.

Dr. Nicole: It is a recipe but I but it I think you have you have shown us like you said, yes I was less passionate about things. And to you that immediately was like, I’m like some kind of zombie. Like I can’t feel anything. But that’s not true. You were still feeling things, just not as passionately, not with as much emotion. And my question as always, is that a bad thing? Like, is it a bad thing? So if a person tells me, well, I just used to cry all the time and now I hardly ever cry, and I’m left thinking is, is that a bad thing? You know, a good example of that is I have a person I’ve been working with, and we had had this question for months of am I blunted or is this just I’m not responding as intensely to things as I usually do? And we’d gone back and forth because I had a really hard time understanding why was it bad? Because the person kept saying, well, I just I don’t cry like I feel like I don’t cry.

Dr. Nicole: I’m usually a very emotional person, like I feel my emotions really hard and I just haven’t been crying as much. And that’s just not like me. And I don’t know if I like that. And we went back and forth about, well, is that a good thing and all the stuff. Well then this person had a loss. Someone very close to them died, and they came to me and they said, okay, I am certain that I am blunted. I lost someone I really care about. I love them deeply. I wasn’t able to cry like I was at the funeral and I was just there. And while I rationally, cognitively can say, yes, I am sad, I miss that person. I couldn’t feel it. I just couldn’t feel it the way that I normally feel emotions. And that’s how I knew I was blunted. So then the conversation shifted to, okay, it sounds like you’re blunted. That sounds like that must have been a very unpleasant space to be in, where you could cognitively say and rationally say, yes, I am sad I missed this person, but I can’t express it. That sounds like you’re blunted now. What in the heck do we do about it? Because if we go ahead and make changes, we run the risk of your symptoms getting worse. And we had to talk through what that looked like, what was what that looked like for them, what was important to them. But that’s an example where I think we can see a well-defined, blunted situation where we can define it and we can say, yes, compared to how I used to be and why it was so uncomfortable. That’s a great example of that.

Gabe: Up until now, we’ve been talking about the Dr. Nicole being dismissive, but you know, the Dr. Nicoles aren’t the only ones. We say this to friends, family members, coworkers, colleagues, and they’re just like, well, whatever, you are so much better than you used to be. And on one hand, it’s kind of a backhanded compliment, right? I’m glad that I’m so much better than I used to be, but

Dr. Nicole: Mm-hmm.

Gabe: It sounds like what you’re saying is you’re glad I’m no longer a problem. You’re not saying that you’re glad that I’m thriving. You’re not saying that you’re glad I’m living my best life. You’re saying that I’m no longer causing you issues. I get that I want to say to all of our family members, friends, caregivers, support staff, I understand. I understand why you feel this way, but this isn’t a good trade. You don’t want us to be zombies for the rest of our life. You want your loved one in their full glory, thriving, happy, living their best life. And I don’t think a lot of family members, friends, support people, understand why this is such a big deal. And I’m having trouble coming up with an analogy for this. I truly, truly am trying to explain it to the uninitiated.

Dr. Nicole: You. You know, the loved ones. They get scared. They’re afraid. So, yes. They see that you’re not at risk of being incarcerated, and they see that you’re not at risk of the police being called. And they see that you’re at less risk of them getting called in the middle of the night saying your loved one is in jail or in the hospital. So yes, they are thrilled that you are closer to middle. They are they’re ecstatic that you’re closer to the middle. But they also can’t see the blunted. Sometimes they can’t see it. It may be because at the forefront of their mind is manic you, and they can’t get that image out of their head that they’re just so happy. You’re not that person, that they just can’t see that you’re still not great. It may be that they just don’t have a great understanding of what the goal is of treatment for bipolar disorder. Heck, you may not even have a great understanding of what the goal is for treatment of bipolar disorder. And early on that is 100% accurate. Nobody knows the person with bipolar disorder, the loved ones. Nobody really has a good feel for what is even the point of being in treatment. All of those things affect them. But to my loved ones out there, because y’all are always emailing me, it’s always y’all. Y’all are always emailing me. If I can give you a bit of advice.

Dr. Nicole: Just like when a person comes to me and they say to me, hey, I feel blunted, I feel like a zombie and they feel dismissed when I start talking about all the positive things that have happened. That same thing happens when you start saying, but oh my God, you’re so much better. You haven’t been in a hospital in three months, and before that you spent so much time, they don’t want to hear that. So the best thing you can do is say nothing and just listen and just ask them to explain to you what that means. I think honesty is important. I think it’s perfectly fine for you as a loved one to say, yikes, that sounds terrible. I would hate to feel that way. I spend a lot of time with you and I’ll say honestly, I didn’t pick up on that. Like, when I see you, I don’t see a zombie. What are you feeling that makes you feel that way? Just learn more, ask them more, ask them to learn. But don’t just talk at them about how they’re so much better and dismiss those comments. So I would say, just don’t make statements. Just ask questions and genuine questions of how you can learn more about how they’re feeling so that you can help them. Because sometimes you’re their best ally in communicating with their Dr. Nicole.

Gabe: I really think the biggest takeaways for this episode are it takes time, it takes patience, it takes real world examples. It takes more than just saying I feel blunted or I feel like a zombie. And I think another takeaway is that it is real. I do think there’s a lot of people in the patient community who, when they say they feel like a zombie or they say they feel blunted, they’re absorbing the message that it’s not real. So before we close, Dr. Nicole, I’d like you to address that. This is a real side effect of bipolar medications, and it’s worthy of being addressed. We just need more than I feel like a zombie. We need specific real-world examples, and we do need us, the people living with bipolar disorder, to have some faith in the process and be a little patient while it’s happening.

Dr. Nicole: Yes, it is absolutely real. We know it happens. We know it can be a medication side effect. We know that we also have to balance your symptom control with those side effects. And we have to be patient. But nobody says it’s not real. I don’t I don’t think you have psychiatrists out there who say, oh, that doesn’t happen. It’s not a real thing. We definitely know it’s real. It’s just one of those very subjective things that sometimes it’s hard to quantify and hard to be able to know what to do with it all the time.

Gabe: As always, thank you so much to all of our listeners for tuning in. And remember, you can hit us up with your ideas and feedback at show at PsychCentral.com. We also need a favor from you wherever you downloaded this podcast, please follow or subscribe. It’s absolutely free and you don’t want to miss a thing. And listen up. Do us a favor like a big, big favor. Recommend the show to people you know. Bring it up in support groups. Share episodes that you like on social media. Have discussions around it. Don’t be shy because sharing the show is how we’re going to grow. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which is on Amazon because everything is on Amazon. But listen, if you want some free swag and a signed copy, just head over to my website at gabehoward.com. You can also follow me on TikTok and Instagram @AskABipolar.

Dr. Nicole: And I’m Dr. Nicole. You can find me on all social media platforms @DrNicolePsych to see what it is I’m getting into in these social media streets at any given moment.

Gabe: And we will see everybody next time on Inside Bipolar.

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