Inside Bipolar Podcast: Off the Meds: Navigating Treatment Challenges

Inside Bipolar Podcast 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: Hey, we’re glad you’re here, everyone. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: Dr. Nicole, I am curious, in your practice, just for people with bipolar disorder, how often do you hear I want to go off my meds. Help me do it?

Dr. Nicole: More. More than I’d like. I tell you that more, more, more than I would like to hear.

Gabe: Why is it more than you’d like to hear? And I want to tip my hand a little bit. I would think that you would be ecstatic to hear that question, because it meant they didn’t do it on their own.

Dr. Nicole: That is one way to look at it, I guess. I’ve never thought about it that way. I should be happy that they thought to have the conversation with me on the front end. So from here on out, I can promise you that what I’m going to do is I’m going to say thank you for sharing that information with me and not just stopping it on your own. I’m gonna I’m gonna reframe how I, how I respond to to that happening. So I appreciate that. Thank you, thank you, thank you. But the reason for me that I more than I like is because honestly, it is usually the people that I don’t think should stop that are the ones asking me. So it’s not usually the ones that I think, oh, that’s a great idea. Let’s talk about how to do that safely. It’s usually the person who I think, oh, this, this cannot, cannot end well for either of us. Those are the ones who are who are asking me the most.

Gabe: Is there anybody with bipolar disorder like you? They have bipolar disorder.

Dr. Nicole: Mm-hmm.

Gabe: You’re positive in your diagnosis. You’ve evaluated them over the course of many years. They’re stable on their medication. And they come to you and say, hey, I want to go off my medication. And you’re happy about it? Is

Dr. Nicole: No.

Gabe: There is there ever a case where you’re like, yes, you’re an excellent candidate to stop receiving treatment?

Dr. Nicole: I mean, I’m not happy about it. I’m not. I’m not happy about it. But I’m not happy. I’m not thrilled. I mean, I would say bipolar disorder is one of those illnesses that we recommend that people stay in treatment for life. We do there, there are no suggestions, recommendations that if you have bipolar disorder, that you should just stop taking medication and that you’ll outgrow it and you can just stop it. And we expect things to go well. That’s just not how we think about the illness of bipolar disorder. We don’t think that way about schizophrenia, for example, as an illness. We just don’t think that way about illnesses like that. Having said that, there are people that come to me asking me to help them do this, and then I have to decide, am I going to be a part of this thing that I don’t agree with?

Gabe: All right. That that that I for the audience who can’t see I have now scrapped the script because that’s incredible. You just the. Hang on. You’re telling me that even you would help somebody go off their medication, even if you were positive that the outcome was going to be bad?

Dr. Nicole: It depends on the scenario. If it’s a person who has had very, very severe episodes, just complete disruption of life as a result of, you know, recurrent mania, recurrent depression. There are times when I say, I’m sorry, I’m not the person to help you do this. I cannot help you do this. And I have had people leave my care for that reason because they did not. They just did not feel they could keep going on with me, because I made it very clear that I was not going to be a part of that. So I have told people flat out, no, but there are also people who have convinced me, based on their history, the way that the plan they have in place in case symptoms return, they’ve been able to plot out a reasonable enough argument that I’m willing to at least try and start the process to see where we land.

Gabe: So in preparation for this episode, I googled. Google is where I get all of my best information.

Dr. Nicole: Hmm. Yes, the best medical information comes from Google. The best.

Gabe: The greatest medical information comes from Google.

Dr. Nicole: The best. The best.

Gabe: I know.

Dr. Nicole: [Laughter]

Gabe: I know, I’m rolling my eyes. We all know that it comes from Healthline.com. [Laughter]

Dr. Nicole: [Laughter]

Gabe: I just googled should I stop taking my bipolar meds? That’s it. That was the phrase that I googled,

Dr. Nicole: Okay.

Gabe: Because that seems like something somebody in my position who’s living with bipolar disorder,

Dr. Nicole: Yeah.

Gabe: Who has become uncomfortable with their meds might Google

Dr. Nicole: Mm-hmm.

Gabe: And in in 0.4 seconds. I love how Google tells you how long it takes to compile this data. It came up with 68,300,000

Dr. Nicole: Wow.

Gabe: Results. And of course, page one is just filled with stuff from, of course, the National Institute of Mental Health,

Dr. Nicole: Mm-hmm.

Gabe: LA Times reporting, high end psychiatrists and, and, and therapists weighing in on that. I compiled this data for you so that you don’t have to. Here’s what everybody pretty much agrees on. Don’t do it. It never works out. It’s a very, very bad idea. None of them would say for 100% it won’t work out for you. But what was said over and over and over again is if you truly have bipolar disorder, your chances of managing it without medication are slim to none. But then this raised this thought in my head. Why did they qualify it with? If you truly have bipolar disorder and that that is that is sort of what I want to talk about. Because this idea that people with bipolar disorder want to go off their meds, if we assume that they actually have it, then yeah, yeah, it’s a losing case. And I can see Dr. Nicole where you would not want to help people hurt themselves medically. She’s not in her head. She’s like, yeah, I don’t want to help people hurt themselves mentally.

Dr. Nicole: No, no.

Gabe: She’s it turns out she’s aligned with that. But

Dr. Nicole: It turns out I indeed try not to do harm to people. Yes.

Gabe: Yeah yeah. See, I knew I liked you

Dr. Nicole: Yes

Gabe: I got, I got to stop spreading rumors about that now, though.

Dr. Nicole: You should. You should.

Gabe: I should I know, Dr. Nicole, you’re the awesome one. But, but I thought about this for a minute, and here here’s what it did to Gabe. How many people were diagnosed incorrectly? How many people got diagnosed by an overzealous therapist? How many people were diagnosed by a general practitioner? How many people were diagnosed while in crisis from drugs and alcohol? But it got attributed to bipolar disorder because it was easier to get the health insurance to pay for a mental health issue versus an addiction issue. How many people just straight up diagnosed themselves and just believed it for years? And there’s also this this other subcategory of how many people were diagnosed as children because their parents told them they were bipolar when mom and dad never actually took them anywhere anyway, but just told everybody that and they believed it well into their 20s. And now all of a sudden they, they’ve, they’ve got this diagnosis. I’m making air quotes. And now they want to stop their taking their medication for it. But they were never bipolar disorder in the first place. It’s a mess. I even asking the question is a mess. What do you do with those people? Because I think they’re mucking it up for the rest of us.

Dr. Nicole: [Laughter] Yeah, they’re mucking it up for the for the.

Gabe: They’re mucking it up for the rest of us.

Dr. Nicole: For the true bipolar populations.

Gabe: But you can. You can see why I say that though, because they don’t actually have it, but they believe that they have it, that their circle believes that they have it. They stop taking their medications. Everything is fine. And this is what enters everybody’s frontal lobe. Bob had bipolar. Bob stopped taking his meds. Bob is just fine. But Bob never actually had bipolar. You see what I mean by mucking it up for the rest of us?

Dr. Nicole: I see what you mean. That they are. They are murking the waters, right? Like things are cloudy I.

Gabe: Mucking it up for the rest of us.

Dr. Nicole: Yes yes yes. Mucking it up for the rest of you, you know. Yes. So I do see people on a regular basis. I do a lot of new evaluations in certain settings, and I see people regularly who tell me, oh, I have bipolar disorder, because that’s one of the questions I always ask, what have you been diagnosed with before? And as soon as they tell me that, I say, okay, tell me what kind of behaviors you were exhibiting that made whoever diagnosed you think that you had bipolar disorder? Some people give me the classic, you know, oh, I have these times where I’m like, I’m not sleeping. I’m up redecorating while my family’s asleep. My wife or my husband says, I, I talk really fast and I can be very impulsive during those times. I don’t normally spend money. I’m kind of frugal, but during those times, man, I am. I am always looking to go on elaborate trips and da da da da da. They can give me a story that sounds so classic that I’m like, yeah, that that’s that sounds that sounds pretty accurate.

Gabe: There it is.

Dr. Nicole: Whoop! There it is.

Gabe: Whoop! There it is. Dr. Nicole’s aligned.

Dr. Nicole: And then I may have to ask about substances and if they tell me, well, oh yeah, I used to have a meth problem when I was having those episodes. Then I have to question everything. Right. But if I’d never asked that question, I still may have thought, oh, that person for sure. That sounds 100% like bipolar disorder. You gotta ask the right questions. So I don’t know if the initial person asked the right question. So I have to go through the thing over and over again with people and trying to figure out, did we get the right history in the beginning? What else was going on? Sometimes the answers I get are very clear that this this, if it walks like a duck, quacks like a duck, like it’s a duck. It’s very this is what this is. And I have very little doubt otherwise. And then there are times that I questioned, I don’t know, like I don’t know if this was actual bipolar disorder. Was this a result of your substance use? Was this a result of trauma? And you were having trauma related anxiety with the mood swings and the ups and downs? Is there a personality disorder present like all these things I have to think about? Those are the people, though, that I’m a little bit more inclined to say, okay, let’s see what happens. Let’s try it. Let’s see how you do if we start tapering off those traditional mood stabilizers. Let’s see how you do. Those are the ones that I’m more willing to give it a shot with than the than the ones that that truly, truly feel like, okay, this really sounds like you actually have bipolar disorder.

Gabe: And the people that know them, know them as somebody who was living with bipolar disorder, stopped taking their medication and is just fine. So it sort of gets pushed out. The misinformation, the disconnect that other people with bipolar disorder hear is, well, hey, remember Bob, turns out he didn’t need his meds. Well, Bob has bipolar. Yes he does. They’re not reading through Doctor Nicole’s notes. I just wanted to bring that up, because I do think that for somebody like me, somebody with bipolar disorder, when I lay awake at three in the morning, I’m like, this is a lot of drugs. This is a lot of drugs. I take seven a day. My pill minder is the same size as my grandma. Maybe I don’t need this. And then I find Bob and Bob and all of Bob’s friends. They’re telling me how he didn’t need his medication, and I start to think I’m a lot like Bob, except I’m not a lot like Bob because I’m not comparing apples to apples.

Dr. Nicole: Well, I mean, also, I will tell you this. I think all people are manipulative. I don’t think I don’t think that I’m, I

Gabe: Dr. Nicole trusts no one.

Dr. Nicole: I don’t. I don’t, I really don’t I’ll be honest with you, I, I, I don’t I am suspicious of everyone. And this has nothing to do with mental illness or otherwise. I am suspicious of everyone’s stories all the time. So I think most people are manipulative. I think that in general, most of us kind of paint things in the in the way that makes us look the best to help us meet our needs. So the person who’s been diagnosed with bipolar disorder who really thinks, like, I don’t, I just I hate this medicine. I’m not really convinced that this is what I have. They will do what they need to do to not have to do this horrible thing. We’ve talked before psych meds, especially when you get into the mood stabilizers and the antipsychotics. These are not sexy drugs. They have side effect profiles that are just not pleasant. Sometimes you feel medicated. I can 100% see why a person would want to have someone tell them, you don’t have to take this. They could very easily just decide that they just aren’t going to take it and quit. But that’s just not the answer for everybody. Some people are rule followers. They need somebody to tell them it’s okay not to. They have to have someone of authority say, yeah, that’s okay.

Dr. Nicole: I think that’s a good idea. They need someone to cosign this very bad idea because they feel better about it in the long run, because even at the end of it all, if they crash and burn, they can say, well, but Doctor Nicole told me that I could go off the meds. I didn’t really do anything wrong. She said I could. Sometimes they need a cosigner because their loved ones are hovering over them, going, you absolutely cannot stop your meds. But if I’m a young adult and I live with my parents, or my parents are still very much involved in my care, I need a Dr. Nicole to say it’s okay for you not to take your medicine because I think like, well, my wife, my husband, my parents, my grandparents, my siblings, whoever those people are for me, they’re not going to argue with her. They’ll argue with me, but they’re not going to argue with the doctor about it. So I need those people to cosign. Sometimes you need it because you have legal things going on, and you need that doctor to say, oh, Mr. and Mrs. Probation Officer, he or she doesn’t need to be on this medication so that you can have a reason to not take it. So there are reasons why that are manipulative that people will present to get this done. But largely it’s not because they’re really just bad people trying to get over on the doctor Nicole’s of the world. But they, they feel like their backs are against the wall, and they really just hate the thought of medicine or the feeling of the medicine or whatever it is. And we are human. We will do what we need to get our needs met.

Gabe: It makes it really difficult to do a topic like this, because the general resting point when I pull society is that people with bipolar disorder are so stupid, they go off their meds. And I hear that time and time again, well, you’re you were unstable and then you started taking meds and then you were stable and you just quit. Idiot. And I keep trying to explain to people that it’s so much more involved in that. First off, they’re like, well, what do you care? What do you care if you take a bunch of meds? Yeah, I, I care a lot. I’m not going to go off my meds. I want to be very, very clear. I love my meds. Don’t take my meds. Cold dead hand and all that shit. But it does bother me, especially when I was 25, in 30 and 30. You know, now that I’m approaching 50, it’s not bothering me as much because all my friends have little pill minders too. But I back when I was in my, my, my mid 20s, I was the only one people made fun of me. Not even I. We talked about how my mom pointed out that it was that my pill case was bigger than my grandmother’s, and that to this day it hurts my feelings. It literally a throwaway comment. She doesn’t even remember it meant nothing by it. So this idea that you want to stop taking medication, it actually makes a lot of sense. And I think people with bipolar disorder don’t really get any support on that. We get a, well, it’s for your own good. We told you to do it. You’re better off now because of it. Why you complaining? Do you think Doctor Nicole. It’s a I’m putting you on the spot here.

Dr. Nicole: Mm-hmm.

Gabe: Do you think that more people with bipolar disorder would be aligned to continue taking their medication if the attitudes of those around them weren’t so? It’s for your own good?

Dr. Nicole: Maybe. I think that with all illnesses, though, you still have all those people who don’t want to take their meds. There are people who’ve been prescribed meds for hypertension who are like, well, I just don’t like taking all those pills every day. I don’t like the thought of me having to take pills. And I have people who say, well, I don’t want to take, you know, this. For this, I’d rather do something natural. I don’t want to take these pills. There are people with a variety of diagnoses who just don’t trust the pharmaceutical industry and don’t want to take anything, and that is just fine. You can you can be that person. I think part of the issue is that with bipolar disorder, it’s just because when you don’t, what we see is so damaging. And so the people around you are so much more intense about telling you how much they think you should take medicine. If you have high blood pressure and you just decide that you’re not going to take your antihypertensive, you’re going to walk around with a pretty high blood pressure for years before you have any big medical issues from it, before you have that stroke or before you have, you know, those big medical complications and you don’t look any different than anybody else.

Dr. Nicole: But when you’re not taking your bipolar disorder medication, you look very different. You’re having the depressive episodes, you’re having the manic episodes, and everybody else is having to deal with the fallout and the consequences of those episodes, and they are angry because they feel like if you would just take the dadgum medicine, then none of us would have to deal with this. You wouldn’t have to deal with this. And so there is a lot of intensity that comes. And I think the intensity then breeds intensity on the other side. So then they’re coming at you like it’s for your own good. Like why can’t you see this? Oh my god. And then you’re going, I’m grown. You can’t tell me that I need to do something like, I can do what I want. And I think it’s just because the consequences are just so much higher, and both sides are just completely irate by the time we get to that point. But yeah, I mean, I’m sure it does have something to do with that, but it’s a lot. The outward expression of you’re not taking medicine is so big for the people around you. That’s why they’re so intense and, you know, bothering you about it so much because they just it’s so much for them.

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Dr. Nicole: And we’re back discussing how stopping your medication can affect your bipolar disorder.

Gabe: Doctor Nicole just occurred to me that. That I told you everything that Google felt. And of course, all of the people that contributed to Google, all the organizations and psychiatrists and but I haven’t asked you your opinion. Do you believe that people with bipolar disorder can titrate off their medication and lead normal lives?

Dr. Nicole: I have never had a person who I thought this person 100% has bipolar disorder, who has made the decision to go off of medication, who has not, then had an episode at some point. That episode may not be a month after. It may not be two months after. It may not be six months after. Bipolar disorder is cyclical. We know you can have extended periods of a normal mood, but I’ve yet to see one who didn’t end up back in treatment in some way because of an episode.

Gabe: Well, Doctor Nicole, obviously, as you’ve told me before, I’m not a doctor, but I agree with that. I have personally never seen anybody with bipolar disorder go off their medications and lead a normal, stable life for a lifetime. I’ve seen people do it for six months. I’ve seen people do it for a year. I’ve seen people do it for a couple of years. And honestly, what I have seen working with a lot of people with bipolar disorder and support groups doing this show, speaking nationally, my email box, what I see is they go off their medication and they don’t tell anybody. They don’t make a production of it. They keep their mouth shut. They just go off their medication and everything’s fine. And then they have they crash, they have a crisis. Something very dramatic happens. They lose their job, leave their spouse, get arrested, end up committed to a psychiatric hospital, and everything starts over for them. And I, I’m like, what happened? And they’re like, I stopped taking my meds. And it is always a significant amount of time. Nobody ever comes to me and says, I stopped taking my meds last week. It’s always last summer. I stopped taking my meds. A year and a half ago, I stopped taking my meds when such and such happened that that’s two years ago.

Gabe: I stopped taking my meds and now it’s dramatic. It didn’t. It became a big, big thing. It’s not like they slipped a little bit and had the opportunity to get ahead of it. They went from feeling really, really well to crisis point, and they describe it as extraordinarily fast, which, again, if we’re all being honest with ourselves, that’s how we got into this mess, right? We generally describe feeling pretty good and then crisis. And then if we get diagnosed then we avoid that cycle. But for some of us, like me, I was feeling fine crisis. And then I was feeling fine again and then crisis. And then I was feeling fine again and then crisis. And then eventually, at 26 years old, I got help. So I don’t I don’t want to repeat that, but I can tell you my bipolar symptoms never, you know, casually slowly ramped up. It was all or nothing. So I just want to remind people of that. If you’re trying to make the decision like, no, no, I’ll look out for the warning signs. Yeah, yeah. There are no subtle, slow ramping up warning signs for bipolar disorder. There is. I’m fine and I’m not.

Dr. Nicole: And the not is usually pretty big. So yeah. No I yes 100%. The not, the I’m great. I’m doing okay. I’m killing the game to the game is killing me can happen very quickly. And in the whole conversation about I want to come off my medicine and while we’re trying to figure it all out, maybe our compromise might be that we don’t come off. Maybe the compromise is let’s lower some doses if side effects are the issue, if weight gain is the issue, if the sex drive is the issue, if you feel medicated, well, if it’s something like that, maybe we can talk about making some small changes that can help you achieve your goals, but can also have the ability to keep you stable. We can try that because it is always possible that the amount of medication that it took to get you stable is not as much as it would take to keep you stable. And so because that is a reality for some folks, it’s not it’s not the worst idea for us to consider some decreases instead of stopping altogether, because then if we do a little decrease, if you start to have symptoms creep back in, then we know, okay, well, now we’re having a whole different conversation. Either we’re going back up or we’re changing or what are we doing, but it just kind of gives us the benefit of monitoring kind of being a little safer, a little more careful as we’re trying to figure out what your pain points are at related to your medicine.

Gabe: The number one reason that people go off their bipolar medications is because they’ve reached stability and they don’t think that they need them anymore. And there’s this part of me that’s like, well, but don’t you see that one drives the other, right? Like, like, how did you not figure this out? But

Dr. Nicole: Mm-hmm.

Gabe: I want to just I want to talk to you about this for a moment, doctor Nicole, and point this out to our listeners as well. Many of our listeners are diagnosed between the ages of like 16 to 24. That that seems to be like the stereotypical age. Well, between the ages of like 16 and 24. Medication isn’t for life, right? You, you get an illness, the doctor prescribes you medication, you take it until you run out and then you stop for the vast majority of 16- to 24-year-olds,

Dr. Nicole: Mm-hmm.

Gabe: They weren’t diagnosed with something that is severe, persistent and a lifetime. So I have to say, whether it’s because of the bipolar disorder and they’re not in a position to understand whether it’s youth and they’re not in a position to understand their own mortality, or whether it’s the health care system in America or a dozen other complicating factors. I think the average person diagnosed with bipolar disorder does not understand it to be lifetime. I really, really don’t think they do. And also not for nothing. I think that the average person diagnosed with bipolar disorder is confused by the process of finding the right medications and how long it’s going to take, and they had a terrible, terrible struggle. And then they find out at the end of that struggle when they finally reach stability, there’s this belief that was allowed to persist because of lack of understanding and education about their illness, that as soon as they get stable, as soon as they get well, that they can turn to diet, exercise, lifestyle choices, etc. take their life back and put this whole thing in their rear-view mirror. This is my hard question for you. How much of that is your fault? Do you, the doctor Nicole’s of the world and I’m also picking on therapists, case

Dr. Nicole: Mm-hmm.

Gabe: Managers, general practitioners, etc. do you actually sit people down who are diagnosed with bipolar disorder, look them dead in the eyes and say, you will be on medication for the rest of your life. You will never go off of it. You have a severe and persistent illness that you will have until the day you die. Is that patient education included in in the onboarding process? If you were.

Dr. Nicole: So I think we’re pretty terrible at the onboarding process for these illnesses. I’ll pull from schizophrenia world for a second. There has been a real push in the last several years to have programs, government funded programs for people who have their first episode of psychosis, push to hit these people early on in their treatment because we know that they were getting lost. They were getting lost. They were young, they had poor insight. Things just weren’t going well. So these programs were developed to give them all the support and love that they needed to be able to face this illness and to hopefully have a more productive life because we caught them early on. I think we need something similar for that first break, that first manic episode, that first diagnosed with bipolar disorder. Now what? That that honeymoon phase. I think we need more intense services specifically for that, because I think you’re right. It’s everybody’s fault. The system is is horrible. We’ve already talked about how you go in the hospital, you get diagnosed, you have your first manic episode. So you go in the hospital, they get you all straightened up, buttoned up. They send you out to outpatient, probably in the hospital. There were groups about bipolar disorder. They were medication groups. Chances are those groups talked about how these are lifelong illnesses, and you need to take your medication a long time. But did you really remember even a fraction of what you heard when you were in the hospital during your first manic episode? Probably not. Did you did you do you remember any of that? No. You don’t.

Gabe: I remember being terrified.

Dr. Nicole: Yes.

Gabe: I just remember being scared. Terrified. I don’t I

Dr. Nicole: Yeah. You don’t remember what they said.

Gabe: I think that’s a terrible place to do it. For what it’s worth,

Dr. Nicole: Yeah. Yeah.

Gabe: That’s a terrible place to educate somebody about something. They’re

Dr. Nicole: But that’s where, that’s where that’s where a lot of it happens. It happens during that hospital stay, I can guarantee you. Because once you get to outpatient, where is it supposed to happen? In the 30-minute first visit? Where that person’s going over your discharge medication and making sure everything sounds right and tidied up? In the in the 10-to-15-minute visits you get every couple months after that? Like, when is that supposed to happen? So unless you’re at a place that has just really great educational foundations in place to make sure that those things are talked about and discussed, I think it falls through the cracks just in a lot of settings, because the inpatient team, you know, does a little bit of it, the outpatient team does a little bit. But I don’t know if any of us do enough. I don’t know if we do enough to talk about the illness itself. And I know that to be true, because people just get told you got bipolar disorder or they happen to see it on the paperwork. Take these pills, and people just don’t have a lot of education to fall back on. So I yeah, I mean, the system is not set up to allow these people to achieve success.

Gabe: This is one of the reasons why I do believe strongly in the lived experience voice. I do want to point this out. I think there’s a lot of things that certified peer supporters or even influencers, patient advocates speakers like me patient authors, bloggers, etc.. This is an area where we are, in fact, doing better, especially from the time that I was diagnosed until now, because there’s a lot more information out there than there was. And I do agree that there’s a none so blind as he who will not see kind of mentality. I don’t know of any of this was explained to me while I was in the hospital or not, because I wasn’t in a place to hear it. Even if they would have explained it to me. You know, I’m committed to a psychiatric hospital. I thought demons were following me, but I’m going to understand high level care? But I think there is a proof is in the pudding mentality. And this is why I want to talk about on a show dedicated to people with bipolar disorder. Because you got to ask yourself when you just want to quit your meds, have you really investigated this? And I’m using the word investigate, not research.

Gabe: Research is for doctors and is a whole other thing. I’m asking you to investigate it, investigate your feelings of why you want to do it, and investigate your goals that you’re trying to achieve in investigate the benefits, the pros, the cons, investigate who you’re asking and how you’re arriving at these conclusions. But I do want to say, I do think that people with bipolar disorder get let down a lot, and we make decisions based on the information. As we understand it, the decision goes poorly and then people start making fun of us. And I see it a lot where people are literally making fun of the sick. And I just think, wow, why? Why are we, as a society, just rolling our eyes at sick people who are making bad medical decisions? Is this where we’ve come that we’re just literally blaming sick people for their own poor outcomes? I got to tell you, more often than not, we blame people with bipolar disorder for their quote unquote stupid decisions.

Dr. Nicole: Mm-hmm. No we do. On the one hand we say, well, this person doesn’t have the insight to blah, blah, blah, blah blah, but then we expect them to have the insight to do a lot of things. And we don’t have systems in place to help guide that. And that’s what I mean. The system is the system is not set up to provide the person new bipolar disorder. Heck, long-term bipolar disorder get a great understanding of what it means to have bipolar disorder.

Gabe: I’m just curious, Dr. Nicole, do you ever wonder what leads your patients to make the decision that they just don’t want medication anymore? Have you ever considered it from their perspective? And I’m just curious as to how you feel about it from where you sit.

Dr. Nicole: I always ask the question. I always want to know why that particular person wants to stop. Because sometimes their reasoning for wanting to stop altogether, we can maybe come to a compromise. I mean, I feel like I’m always in a negotiation situation when it comes to I want to come off my medicine conversations. So I need to know why it is that you want to come off right. What is it that you’re concerned about? Sometimes the concerns I can dispel with just education. You know, the person may say, well, I want to come off these meds because I’m worried about the long-term effects. And then I can come back with him. Okay. But we have this amount of years of data for this particular medication. Nothing has come out that says, you know, you shouldn’t take this, but also I can then come at them with the long-term effects of untreated bipolar disorder, and we can talk about their episodes and what they were like and how severe they were and what kind of trouble they got into. And what are the long-term consequences of that kind of behavior? What are the long-term brain consequences of, you know, unchecked manic episodes repeatedly. And we can talk about that kind of stuff and then we can have a risk benefit conversation. So I need to know if that’s where the person is coming from. I need to know if it’s coming from a place of instability.

Dr. Nicole: So they probably are not in a great position to make this decision right now. So let me see what I can do to try to help, you know, get them what they need right now and we can talk about it. And sometimes I can, you know, get them to a little more stable place. Maybe I need to know if the person doesn’t want to take the medicine because the side effects are they upset because they’re having sexual side effects and they just don’t want to tell me? Or are they upset because they’ve gained 30 pounds and they just don’t want to tell me because they’ve read that all psych meds cause weight gain. There are all kinds of reasons that people don’t want to take medicine, but I’ve never thought that not nary a one of those people didn’t want to take medicine because they wanted to be unstable and just didn’t care. There’s always a reason. It’s just up to me to try to find the reason why and to try to come up with an answer or a solution for that problem.

Gabe: And I want to take a moment and talk to the wavering group, just for a second. I don’t think it’s bad that you’re wavering. I kind of like the wavering group. That’s what critical thinking is. You’re like, hey, I’m feeling some sort of way about this, and I don’t know what to do about it and rinse and repeat. Just keep doing the same thing that I’m told that that that’s not lining up for you. Here’s the part that I want to address though that doesn’t make the opposite true. Right. You’re feeling some sort of way. You don’t like it. That doesn’t mean stop. That means change. That does mean having the conversation with your Dr. Nicole. That does mean talking about the specifics that you’re bothered by,

Dr. Nicole: I will say that the wavering people make me nervous. Because I’m always concerned that between visits, they’re just going to get a wild hair and decide I’m going to see how I do. So I, I am always a little concerned about the wavering folks, but if that’s you and your you’re on the fence and you’re just not sure. I just don’t want you to make a decision on your own. I think it’s important to whether that’s talked to your reputable, reliable people or whether that is, you know, you have in that conversation with your therapist or your psychiatrist about, hey, I have really strongly been thinking about coming off my meds, but give them the reason why. Tell them what the concern is. And if you don’t know the reason why, put pen to paper. Do some journaling of your own and figuring out why. Do I care that I’m taking this medicine every day? Do I not like how it makes me feel? Or am I just not liking the fact that I’m 25 and I have to take pills every day? Like what is my block? Because that may also give you some good insight into does that does that make a lot of sense to you in the long run? Think about your episodes.

Dr. Nicole: Think about what the medicine has helped you with. Has it had benefit? Think about all those things you know in your wavering. You may need to have a list of all the reasons I should continue my medication, and just have it handy for those moments when you feel yourself thinking, I should just not take these pills and just go ahead and whip that list out and just read it and go, okay, okay, here I am. And I have people do that and they’ve been successful with those kind of strategies. So just, you know, if you’re wavering, just take a breath. Don’t make a big decision. Talk to your doctor Nicole talk to your therapist. Talk to your peer support group, talk to whoever those people are that can help you kind of come to a more rational decision.

Gabe: And I also want to say, before we go, I want to give like a PSA to all of my people with bipolar disorder who are using the internet to research this, because you are going to find an incredible number of social media posts, of videos, YouTubes, TikToks, Instagrams, Facebook, everything of these videos. And they are awesome. They suck me in, right? I know better and I’m watching people who are like, hey, I stopped taking my bipolar medication four months ago and I dropped 35 pounds and I have my skin is beautiful and now I’m mountain climbing and those are not lies. I want to be very, very clear. Those people are genuine and honest and telling the truth. But I want to remind you that bipolar disorder in nature is cyclical. Going off of your meds, it’s still in your system for a period of time, so it’s still providing some benefit. And again, even before we were diagnosed, treated or anything, we had periods of stability because of the cyclical nature of the illness. So all of those videos, I just I can’t go around and find them and say, hey, two years later, you’re still stable, you still live in your best life. Did you ever have a reoccurrence? Did you have a relapse? Did you die by suicide? Did you get arrested? Did you go back on the medication? And none of those people are pulling these videos down because they’re still getting likes and they’re being monetized and people are still watching them. And even if somebody did do the right thing and pull their video down and make a follow up video about how they were wrong, it’s just not going to have the sexiness to go viral.

Gabe: Like, I beat Big Pharma with yoga, right? It’s just it’s just not. It’s showing you what you want to see. It’s not reality. It’s not research. It’s not science. And it’s sexy for a reason because it’s not belabored by fact. It’s a comforting lie versus an inconvenient truth. Don’t fall for it. And with that, we want to say thank you so much, everybody, for tuning in. And we also want to ask a couple of favors of you. First, wherever you downloaded this episode, please follow or subscribe. It is absolutely free and you don’t want to miss a thing. And hey, leave us a review. We like five stars and we like reading your words. Next, please share the podcast. Whether it’s on social media, whether it’s in a support group, whether it’s on that super-secret Facebook group where all the cool bipolar kids hang out. Just share the show so that we can grow. My name is Gabe Howard and I am an award-winning public speaker and I could be available for your next event. And hey, if you’re nice, I’ll ask Doctor Nicole to come with me. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can buy on Amazon, but you can grab a signed copy with free swag or learn more about me just by heading over to gabehoward.com.

Dr. Nicole: And I’m Doctor Nicole Washington. You can find me on all social media platforms @DrNicolePsych or at my website, DrNicolePsych.com.

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

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