Inside Bipolar Podcast: Need Help Handling Agitation and Irritability?

Meet Your Inside Bipolar Podcast Hosts

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.

Episode Transcript:

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

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

Gabe 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: Week after week after week. We do the same thing at the same beginning. I say welcome. Hello, Hey. And then I say, My name is Gabe and I live with bipolar disorder. And then you say Dr. Nicole Washington, a board certified. It’s aggravating. It’s just it’s just aggravating. It’s the same thing over and over and over and over. And it just I can’t help but like, this is the worst part of the show for me because I want to make it better, but I can’t make it better. I know that it’s lame because it sounds the same. And you know, for the listener it’s even worse, because they’re like, you know, welcome to the Inside Bipolar. We got Gabe and Dr. Nicole, and then I’m like, Hi, everybody. And just yeah, just do you do you okay, I’m faking. All right? This is just how the show starts. But you talk to people who get that in their head and it’s we’ve already done ruminations on the show. It’s not a rumination, it’s aggravation, it’s agitation. They can’t get the words out. It’s not quite anger. It’s probably in the category of anger, but they’re they’re agitated. Dr. Nicole, what’s that? What’s that like?

Dr. Nicole Washington: So it’s a little scary. It’s a little unnerving, I think, for the person on the other end, regardless of the reason for the agitation or whether it’s the doctor or a family member or a nurse or whoever, because I know that at the point a person is agitated or I know that that could go to very dark places.

Gabe Howard: From my perspective, from the patient perspective, it seems like that’s a warning sign. Things are about to ramp up and get worse, but we’re not quite there yet. So agitation is scary and it’s frightening. But if you can I don’t want to say solve the problem at that level. You’re going to save yourself a problem later. For both sides, for the people who are working with the person with bipolar disorder, and of course for the person with bipolar disorder, for example, if you are extraordinarily agitated and somebody can stop you from leaving your house, stop you from driving your car, stop you from going to have that conversation with your boss. Dr. Nicole, I think of looking back when I would get agitated at work. That is not the time to sit down with my coworker or my boss and explain to them that they’re annoying me because it it comes out well, like the example we used at the beginning of the show and anybody listening to the example at the beginning of the show would think, What is he talking about? What is his actual concern? It just it just sounds concerning and nobody’s focusing on, of course, the actual concern.

Dr. Nicole Washington: Right. And there’s a certain tone, like I’m convinced that there’s a certain tone that we hear from other people. And then we check out

Gabe Howard: Yeah.

Dr. Nicole Washington: And we no longer actually hear what they’re saying. We just are focused on the anger, the agitation, whatever you want to call it. We’re just focused on that. So we even lose our ability to even try to figure out what’s going on.

Gabe Howard: When we talk about everybody has a normal range of emotions. I’ve often thought that this is a problem with treating bipolar disorder and that we share words. Like depression could mean, hey, my grandma is leaving and she’s been here for a week and I had a really good time with her and I’m going to miss her because I’m not going to see her again until Christmas. Right. And people are like, Oh, you’re depressed, your grandma’s leaving. But depression is also major depression, which could mean suicidality. It could mean unable to care for yourself. It’s a diminished quality of life. And we say them both. I believe that agitation is another one of those issues. When we talk about agitation and bipolar disorder, which is, of course, the focus of this show, we want everybody to understand that it’s not I’m agitated about work or my kids or my spouse or traffic. This is this is another level. And the advice that works for stereotypical agitation or common agitation isn’t going to work over here. Dr. Nicole can not just come in and say, Oh, you’re agitated, calm down and listen to me. That does not work. It’s more. So that begs the question, Dr. Nicole. All right. You can hear it. You can spot it. You’re a doctor. You’re in charge of treating me. You see this giant red flag warning sign as I’m sitting there in your emergency room or your office. . . What do you do?

Dr. Nicole Washington: I try to notice it before it gets too bad. So it’s just kind of, you know, brewing and brewing. They kind of start slow and then they ramp up. So you notice the signs if you’re paying attention. You notice that they’re clenching their jaw or clenching their fist or starting to pace or being more restless in their seat. Like you see all those things if you’re paying attention, right? Unfortunately, what happens is a lot of times, you know, emergency room waiting rooms crowded or the ER is just busy or the inpatient unit, there’s so much going on, it might get missed. And then all of a sudden you’ve got somebody who’s seemingly out of nowhere blows up. But chances are it probably wasn’t out of nowhere. There were probably signs there that we just didn’t see because there’s 50 million things going on.

Gabe Howard: And to be fair, I don’t think most people go to the emergency room or even call their doctor or make an appointment when they’re agitated because they don’t know that it’s a warning sign. They don’t think that it’s a warning sign. And and often I know from myself, the people around me never saw it as a warning sign either. The people around me were just like, Gabe’s in a mood. And that’s I you know, it’s so hard. It’s so hard. Dr. Nicole, if I can just just just pause for a moment. I don’t want everybody to think that every mood I have is a sign that that that badness is coming. Could you imagine if I was sad or if I was upset or if I was annoyed or if I was tired every single time and somebody rushed me to an ER? Right. Just just every single time. Every single time you saw me watch a romantic comedy, a Hallmark, I start to cry. People are like, that’s depression. And ER, I went like, that’s not fair.

Dr. Nicole Washington: Right.

Gabe Howard: But man, it turns out so poorly when. When I miss the warning signs and when, when other people miss the warning signs for me because and this is my point, we end up in the emergency room long past all those warning signs. You see us after we’ve thrown the vase against the wall or after we’ve screamed or after we’ve charged out of the house. And unfortunately, maybe the police have pulled us over for ranting and raving in a convenience store about what politician we hate. That’s that’s got to be tough on you.

Dr. Nicole Washington: I like to separate the differences between being irritable and being agitated. Because sometimes you’re just going to be a little irritable, right? You’re in traffic, somebody cuts you off. You know, you’re irritable. You might give them a special hand signal. You might say some four letter words in your car. But you’re you know, you’re irritable, because you’re already running late for work. And then all of a sudden there’s traffic and then this person cuts you off and then there’s an accident, like all these things, like you’re irritable, but that doesn’t always lead to agitation. Now, if you chase that person down and follow them to work and then you’re like physically really agitated, you might be in danger of hurting that person, right? So that would be agitation. So I think we got to figure out that there’s I mean, sometimes people are just angry about something or they’re irritable. Right? That doesn’t necessarily equate to being agitated. When I think of agitation, I just I tend to think of like a like a physical manifestation of I’m agitated, like I can’t sit still. I am restless. I am I am so angry, I’m about to explode and I am moving and giving people all the signs. Can you be angry with bipolar disorder? Yes, you can. But you know what? If somebody asks you, have you had your meds today, you’re irritable, that might lead to some agitation. Right? Because you are done. You are done. Right. I mean, I’m sure you’ve had that happen.

Gabe Howard: What a super annoying question. I just. Have you taken your meds today is. It’s such an annoying question, right? It’s like asking a woman if it’s her time of the month. You’re not actually trying to get any data, you’re just trying to insult the person using medical terms. Sincerely, I wish more people would realize, Hey, did you take your meds today? There’s not exculpatory evidence from the answer to that question, just to be very clear.

Dr. Nicole Washington: No, absolutely. And I mean, some people are I will say I’ve met people who I will describe them as angry nuggets. Like we all know people like that. You know, you come in the hospital and you’re agitated. That more severe form of irritability, you’re physically maybe aggressive. And then we get you down to irritable, right? And people will say, oh, I don’t I don’t know, like, can we let him go or can we let her go? She’s irritable. I’m like, well, I think maybe, you know, they’re an angry nugget at baseline. Like, maybe that’s just where they live, right? And who knows why that is? Because I got this illness and I have no control and people always telling me what to do and I always feel crappy and this medicine sucks. And like, maybe they’re just pleasantly irritable? We know those people. They’re pleasantly irritable, but agitation is very different. So you’re right. They don’t go to the E.R. to say, Hey, I’m agitated, but usually they go to the E.R.

Dr. Nicole Washington: for some underlying thing that is causing them to feel that way. The problem is I can’t get to the root of the issue if someone is yelling and threatening and, you know, punching holes in walls like I can’t get to the issue. And so sometimes that just further fuels the agitation. Because you come in and you say, well, I’m coming in and this is what’s going on. And then, you know, we’re all worried about your agitation and the fact that you’re punching walls and we give you more medicine. What if the medicine is the reason you’re agitated? What if a side effect from the medicine is making you feel restless and uncomfortable and you can’t stop moving your legs and you feel like you’ve got to keep moving? And you showed up to the E.R. because you want to help with that thing. And what did we do? Give you more medicine because you punched a hole in the wall. So it it’s tough. Like, it’s very, very tough. But the agitation does sometimes get in the way of us figuring out why is it even there in the first place?

Gabe Howard: And it’s not just about violence. Punching a wall is really the top level. That’s the most extreme. I think about my own agitation and I. I screamed the most hurtful and painful and emotionally damaging things. The woman who I was married to at the time, I screamed, I hated you. You’re trying to kill me. And the the four-letter words were flying. And whenever she would try to defend herself, that agitated me more. You’re making excuses. You’re not listening. This was the cycle that was coming out of my. This is what was happening. I was not giving anybody else a chance to talk. And whenever they would try to speak, try to explain, try to help. I saw that as a personal attack. And what do you do with that? Clearly the person who is agitated thinks that you’re not listening and you’re not trying. Is there a way to break that cycle? What are your techniques?

Dr. Nicole Washington: Sometimes I will say in the most extreme cases, there is nothing I can do in that moment, and I have to be okay with that. Like, I’d love to figure out, like, why is this person so angry? Can we de-escalate? Like, what can we do to help the situation? And sometimes if you just listen, they will give you the answer. Like a lot of times, if you just listen to people, they’ll tell you what’s wrong. So even in that rant, as long as I don’t feel like I’m in danger because let’s face it, there are going to be times where I do feel like I’m in danger.

Gabe Howard: Right.

Dr. Nicole Washington: And during those times, I’m not going to stay in the situation, especially if the person has a history of physical aggression. You know, I’m a firm believer that the reason a lot of like mental health workers and stuff get hit is because they don’t have enough sense to get out of the way because we are so compassionate and want to help our patients especially if we feel like we have rapport with somebody or we just want to try to get to the bottom of it, like we can see they’re hurting and we want to try and sometimes we just won’t move, right? Because we’re like, But I think I can get to them. I think I can get to them.

Dr. Nicole Washington: And we’re making it worse. So I think you have to be astute enough to be able to tell like, is this escalating? In my attempts to de-escalate am I making it worse? If there is somebody else on the team that can get more information than me, I will gladly let them go do it. I will let nurses bring information back to me if I’m a trigger for that person. Trying to figure out, does this person have some rapport with somebody or do they seem to be responding better to someone other than me? Because in the moment I may not be the one like they just may not want to see me because I’m the doctor. They don’t trust doctors, they don’t trust me.

Gabe Howard: When you were talking about like, a doctor comes in and maybe you’re not the one, maybe they could get somebody else. I was really happy that you said that because, one, this is an excellent opportunity for peer support, peer supporters, certified peer supporters, people living with mental illness, addiction or trauma that have been specially trained and certified and work alongside medical staff. They really do wonders because like you said, Dr. Nicole, that some patients just don’t trust doctors. The minute you walk in and they see Dr. Nicole, they’re like, I don’t trust you and having somebody vouch for you. This is an excellent example of where peer support can can really lubricate those conversations, can really tear down a lot of barriers because they’re like, you know what? I’ll tell Gabe, not Dr. Nicole. So they tell Gabe, and then Dr. Nicole hears it. Right. And then Dr. Nicole said something like, I don’t trust that. And I’m like, you know, she she’s speaking some sense. Oh, okay. Well, if Gabe agrees and on one hand, you think, why does that work? We don’t know. But it does. And the Dr. Nicole’s of the world who are humble enough to accept that, look, it’s about the patient, right? And I want to be honest with everybody. Not every doctor, not every practitioner is okay with certified peer supporters. They’re like, No, I’m in charge. I’m in charge, I’m in charge. I’ll do it. I don’t need them. They’re not trained. They don’t like it. And it’s it’s getting better. Things are moving forward. But listen, we all have to practice some humility here because it’s about the person we’re serving. And I want to say that to all of the caregivers, patient advocates, parents, loved ones.

Gabe Howard: So often I talk to people and it’s most often moms and dads, and they’re like, look, it’s my child and I’ll fix it. And I say, you can’t. You can’t. You need to step out of the way. And this was a difficult thing for my family to do. My mom and dad had to step out of the way and let my grandparents step in. And this this changed the trajectory of my life because the relationship was so damaged by untreated bipolar disorder, by the mistakes that my parents made, by circumstance, by mental illness. Mental illness broke my mom and dad and Gabe’s relationship, but it hadn’t broken my grandparents and they learned they learned. Listen, when my grandparents took me in and helped raise me, they got all the information from my mom and dad. There’s there’s still the heroes. They really are. But they were smart enough to ask for help. And and I talked to so many family members and I’m like, can you step out of the way? Can you get to grandma and grandpa? Is there a favorite aunt and uncle? Is there is there a sibling? Is there just anybody else who you trust and who you can work with that can take over the frontline duties because it makes a big, big difference. Dr. Nicole, thank thank you for bringing up that stepping out of the way is sometimes the smartest and best option for people who are experiencing agitation because maybe they’re not so agitated or so confident or so comfortable or so sure or so mistrusting of the next person in the room.

Dr. Nicole Washington: Sometimes the person that is typically the one who would act in that in that instance is maybe not the one who needs to. So, there are times I’ve had to make the decision, like, I’m not going to put myself in front of that person today because it’s not the best thing for them. You know, I’ll observe from afar. I’ll have the nurses or the tech who they respond to go ask them questions. We’ll figure it out, you know, But at the end of the day, we got to do what’s best.

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Gabe Howard: And we’re back discussing the symptom of agitation and bipolar disorder. I want to address something real quick. So often when we think of people who are agitated, who are ranting and raving, who are maybe punching a hole in the wall or leaning forward or screaming, I hate you. They’re just they’re suffering all of the symptoms of agitation that we have just talked about. I don’t know. Society just thinks of television. Well, all you have to do is throw them in a straitjacket and put them in the padded room or give them that shot in the butt or there’s just there’s so many misconceptions that it’s just super easy to just walk up and inject somebody with something. Is agitation. The level that doctors look at for the I know the padded room in the straitjacket is not actually a real thing. It’s but is the restraining to the bed is the isolation is the shot in the butt is agitation that level you’re looking at or are we still at the beginning stages and hoping to avoid that and still in a position where we may be able to avoid it? Because I know that many people listening, including people with bipolar disorder, are just like, no, no, no, no, no, no. Dr. Nicole is just coming at me with that butt shot. And and I hate her for it. And I believe that most of that, if not all of it, is just the stuff that makes for great television and great movies, but it isn’t in practice.

Dr. Nicole Washington: Some people have a very low threshold for when they will involuntarily medicate somebody and, you know, start begin a seclusion protocol. And some people’s threshold is a little bit higher. But I think the environment plays a part to. Right. Like if it’s a unit where it’s a very tight space and there’s no real way to protect other patients from, you know, that person because it’s a tight space, we may have to have a lower threshold. So we may have to for the you know, for the safety of the other folks that are on the unit, especially, you know, people are ramping up. Do we have the luxury of waiting for them to, you know, pop up people before we before we do something? We may not. Right. If we don’t have that ability? Flip that, if you’re on a unit that’s pretty large and you can kind of give that person a piece of the space to be in and kind of get some of that out and kind of see if we can de-escalate. That happens. You know, maybe we don’t need to jump so quick. We can try a little bit more. I think by and large, we are always trying to de-escalate.

Gabe Howard: The bottom line is living with bipolar disorder is extraordinarily messy and people are, one, going to do things that traumatize us. That is just reality. We are going to do things that traumatize others. That is just reality. We are going to traumatize ourselves. And sometimes it’s better to say, okay, here’s where we are now. I’m not quite sure what happened over there. And that’s okay. We we have to sort of be okay with the ambiguity sometimes. And that’s that’s hard for a person like me because when I’m firing on all cylinders, I want to be in control. I feel like I’m supposed to take responsibility for my actions. Part of taking responsibility for your actions, unfortunately, is also taking responsibility for the things that you did when you were episodic for the things that happened. And I can almost guarantee I can almost guarantee that a lot of the narratives that we tell each other in our heads after episodes is not 100% true. Now, that does not mean that bad things didn’t happen or that it’s not worth investigating. It’s not worth checking out the footage. As Dr. Nicole has said in other episodes, there’s cameras. Go look at them. Go ask if you feel that something bad happened. You are absolutely encouraged to report it to a patient advocate. Tell the head doctor,

Dr. Nicole Washington: Yes.

Gabe Howard: Tell a case manager. Nobody is telling you to sit on this, this misconception by yourself. Just be open to

Dr. Nicole Washington: Right.

Gabe Howard: The idea that maybe it didn’t happen the way that you remember it. That’s all I ask. I’m not telling you that all doctors are right and all people with bipolar disorder are wrong. Just be open to the idea that the story is in the middle.

Dr. Nicole Washington: And be open to the idea that we can do something about it. Right. I mean, I keep coming back to medication being a cause of the agitation or, you know, other things being the cause of the agitation. If you’re someone who experiences a lot of agitation, talk to your doctor about it. Like just in a very practical way. I do think, like I said, when the tone comes out, sometimes it’s hard to hear you, but I think if you can muster up the ability during a less agitated time to say, Hey doc, this is the deal. I have this agitation all the time. Like, I just feel like I’m about to explode all the time. And then I suppress it, suppress it, suppress it, and then bam, there it is. And I’m having these moments, and I need help with that. Like, I need help with that as much as I need help of preventing my depressions and my manias. And I need help with that. And I think if you can have that kind of conversation with your doctor, then you all may be able to come up with something to help. There are medications out there that can help. We just have to know that it’s an ongoing thing.

Gabe Howard: There’s a lot of research into agitation as a symptom of bipolar disorder and new medications are coming out. A new medication just came out in the last few months. It’s I don’t want to call it exciting because it makes me sound like a bipolar groupie, like, yay, new meds. But if people are looking into it. But I like what you said there, Dr. Nicole You know, so often agitation hit. Agitation doesn’t always lead to an E.R. visit. Agitation doesn’t always lead to you getting fired from your job. Agitation doesn’t always lead to you doing anything. But if you notice it, whether you notice it or somebody else notices it and you’re not reporting that symptoms to your doctor, you’re doing yourself a great disservice. And sometimes the reason that we don’t want to report the symptoms is because of what happened while we were agitated. I personally never reported agitation to my doctor because, one, I was not aware that it was a symptom. I thought it was a personality flaw. And two, I didn’t want to tell my doctor that I told the woman who I was married to, lived in a house with and was trying to build a life with that I hated her and that she needed to get the F out. And and it’s even hard for me to say now. I mean, I yelled this at a woman whom I married.

Gabe Howard: I just it it’s this has been years ago. This woman and I are no longer married. It’s been it’s been 20 years. It’s been 20 years. And I still carry the regret of the things that I said to her. So you can imagine a week after I said them sitting across from a doctor and saying, Look, I think there might be a problem. I told my wife I hated her. That’s that’s a lot. But listen, if you have done this, if you have if you have told somebody that you hope they die, if you have told somebody that you hate them, that you want them gone, If you if you have told somebody bad things, if you have told off a boss, a coworker, it’s or if you have punched the wall or gotten in a bar fight or a restaurant fight or a fight at Home Depot, you need desperately to report these to your doctor that it’s vital information to avoid an even worse outcome. And let’s face it, the outcomes you already have, they’re in the little list. They’re already pretty bad. But I can tell you they can get a lot worse. That is a symptom worthy of reporting. For whatever reason, people do not believe that agitation is a real thing or a symptom of bipolar disorder are worth discussing. Unequivocally, that is wrong.

Dr. Nicole Washington: And you will never say anything to your psychiatrist more than likely that they’ve never heard. The whole like, well, I’m embarrassed to say I did this thing, I’m embarrassed you. There is very little that anyone walking this earth can say to me that will surprise me or shock me or like or even move me, period. Like, there’s very little that can happen. I have seen, I have heard I have smell things that I’m telling you like nothing is going to surprise me anymore. Nothing. So don’t have to worry about being embarrassed or me thinking different about you. Just get it out there.

Gabe Howard: Absolutely get it out there. And if you need to get it out in an email, email your doctor ahead of time, put it in their voicemail, write it down in a letter and hand it to them. Tell somebody and bring them with you to your appointment. If it is too much to look your psychiatrist or provider in the eyes and say, I did this. Use any of those methods or listen, send up smoke signals. Dr. Nicole, can you read smoke signals?

Dr. Nicole Washington: I

Gabe Howard: Okay. Apparently, she can’t read smoke signals just from, from the look of horror on her face.

Dr. Nicole Washington: [Laughter]

Gabe Howard: What about Morse code?

Dr. Nicole Washington: I can figure it out.

Gabe Howard: Well, what is the Morse code for agitation?

Dr. Nicole Washington: I don’t know. I don’t know Morse code. I do not. But I will say those are great ideas. I think if we send a note ahead of time to the nurse, writing it down and giving it to the nurse. Honestly, if. If you live with someone and they keep talking about it, have them write their concerns down and give it to the nurse when you come in. Right. That sometimes is a really great way because you don’t always want that person coming with you because you don’t want them to hog your visit. Sometimes you’re a little skeptical of what they might say, so it’s nice to have them send a note, but you’ve got to be willing to turn it in. So if it’s you, if it’s a loved one, if it’s leaving a voicemail like Gabe said. Any of those things, any of those things work.

Gabe Howard: The final thing that I want to say about agitation is often we can’t see it in ourselves. We don’t know. We just think it’s our personality. We don’t realize how bad it is because it’s coming from us. And when we reflect backwards, we have this tendency to diminish our flaws and our mistakes. If you have people in your life whom you trust, people who you love, whether it’s parents, spouse, grandparents, even your bestie, your best friend, the people that you play darts with or go bowling with, who you will not call friends, but you see every Tuesday. If they think that something is wrong, if they think that you’re experiencing agitation or that you’re irritable, or they use words like you’ve been a jerk lately, you’ve been an ass lately, you’ve been whatever, Please, please, just report that or ask them to report it for you. It is super hard to be introspective, especially when you’re newly managing bipolar disorder.

Dr. Nicole Washington:So I think that people just aren’t always the best historian for their own story when it comes to agitation. And I do think it’s also very important to remind people that you can get into a lot of legal trouble, even, you know, if your agitation leads you to physically harm a staff member or another peer or destroy property, there are some facilities that will press charges. And I you know, I mean, that’s a that’s always a sore subject and a sticky subject. And, you know, some people are on the side of, I get it, you know, you committed a crime, you know, And other people are like, well, but they weren’t really thinking all that straight. And whichever side you fall on, I just think it’s important for me to everybody listening, if you are prone to agitation, if you’ve done that before, if you’ve had to be involuntarily medicated, if you hit someone or destroy property, it really is in your best interest to speak up before we get to this level, because the last thing you need on top of everything else that you’re dealing with is, you know, a court case because you assaulted somebody.

Gabe Howard: Dr. Nicole is not wrong. Thank you, everybody, for listening to this week’s episode of Inside Bipolar. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” You can grab a copy on Amazon because, well, everything’s on Amazon, but if you want a signed copy with free stuff, go to gabehoward.com and buy it directly from me.

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 myself both travel nationally. We can travel separately; we can travel together. We can do whatever you want. Your next event will be better. If you contact one of us, you can find out more information on our respective websites. All right. And now listen, this is the most important thing I’m going to tell you. We need your help. Wherever you downloaded this podcast, please follow or subscribe. It is absolutely free. And tell a friend, put us on social media, text it out, email us, mention us in support groups. Do not make inside bipolar podcasts the best kept secret on the Internet. Sharing the show is how we grow. We will see you next time on Inside Bipolar.

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