Bipolar disorder advocate and podcast host Gabe Howard explains how to talk with your doctor about switching medications when you have bipolar disorder.
If you have bipolar disorder, getting treatment is essential for managing the condition and reducing your risk of a mental health crisis.
Multiple types of medication and psychotherapy are available to treat bipolar disorder. Many people have to try more than one treatment to find a combination that works well for them. Additionally, your treatment options may change over time as your health needs shift or new treatments become available.
To learn about the process of changing treatments, Healthline spoke with Gabe Howard — an award-winning podcast host, author, and speaker who received a diagnosis of bipolar disorder in 2003.
Read on to learn what Gabe had to say.
This interview has been edited for brevity, length, and clarity.
It has changed so many times.
In the beginning, I was put on seven medications for bipolar disorder.
They can’t start you on seven medications all at once because if you have a problem, how will they know which medication to adjust? So, they put you on one or two at a time.
In a perfect world, it takes 6 weeks for a medication to go from day one of taking it to full efficacy.
If your doctor gets it right every single time, they’re incredible — because there’s always an adjustment. Maybe it’s the right medication but not the right dose. Or, maybe you try a medication that works like gangbusters in making you not depressed but has a side effect that you can’t live with. You have to dial in on all these things.
For me, it took 4 years to make the adjustments. And that was just the beginning.
We haven’t talked about hitting middle age when suddenly, the medications that have worked for years stop working or cause new side effects because your anatomy changes. Or, your doctor says, “Hey, you know that psychiatric medication that you’ve been stable on for 20 years? That’s a great medication, but now you need medication for high blood pressure, and those two medications don’t get along.”
It’s a process that continues throughout your life.
I’ve been pretty fortunate. I was been able to go in and say, “I don’t like this,” and my doctor was open to the conversation.
I don’t want to say it’s been perfect because these are tough conversations to have. It’s hard to tell a doctor that they’re wrong and you want something different. Sometimes, I would get pushback that may or may not have been appropriate, such as, “Maybe that’s not the most important thing to focus on right now, Gabe.”
All this is happening while you’re mentally ill, and the rest of the world is like, “Why don’t you make better decisions? Why don’t you follow reasonable directions? Why don’t you listen?” That adds to the burden.
But I did feel reasonably assured that I could get the care I needed if I advocated for it — because of my socioeconomic status, my gender, my race, and because I lived in a big city with lots of doctors.
Unfortunately, that’s not the case for everyone.
My smartass answer is, don’t be poor and unemployed. It’s unfortunately true that the healthcare system hasn’t been designed for people who are poor, unemployed, and sick. People get better care when they have resources.
Any other advice is duct tape, but let’s figure out how to make the most of that duct tape.
First, the buddy system helps. If you have family support or somebody else advocating for you and they know how to advocate well, that helps. Unfortunately, not everyone has that.
Next, it’s important to understand what’s reasonable and to be willing to compromise. Your doctor may say, “OK, I know you’re having side effects, but can you continue this treatment for another 6–8 weeks to see if everything levels off?” You may need to tolerate some short-term loss for long-term gain.
If you’re in a position to find a doctor who you feel heard by, that’s great. But I know many people aren’t in that position. They’re like, “I’ve got one doctor who’s willing to see me every 6 months, and you told me to shop around? Must be nice.” It’s very nice when you can do that, but not everyone has that option.
You may need to make some compromises that are unfair but ultimately serve you.
Finally, be honest about everything — even the hard things. I recognize that it may be embarrassing to talk about certain things, such as dry mouth, tremors, sexual dysfunction, and anal leaking. The potential side effects aren’t sexy, but you have to report them to your doctor if you want them fixed.
If it helps, write it down. Put it on an index card, walk in, and hand it to the doctor. Leave it on a voicemail, send it in an email, or put it in the portal. Practice talking about it in front of a mirror.
Trying to fix things behind the scenes without telling your doctor will only hurt you.
I really think doctors need to provide more information, and here are the phrases and questions I’ve been recommending to people to get that information: “Doctor, I want to understand this thing better. Where can I find more information? What do you recommend that I search for online? Is there an article that you can forward me to read?”
Doctors are becoming more and more savvy, and you may find they have a list of resources or links ready.
I’ll also say that patient communities are fantastic for support, but they’re not bound by facts and evidence. If you’re only reading or listening to other patients and accepting information you already agree with, you’re doing yourself a disservice.
It’s difficult and scary.
And many of the examples that you see online are shortened social media versions, including mine. I don’t want to bum my audience out, so I tell my story in this empowering and exciting way.
I want to motivate people and give them hope, but sometimes the reality may get lost in that. The reality is that I was terrified, wondering if each treatment was going to work.
Talk with people who are going through it right now. Hit up support groups and say that you’re scared. Work with not just a psychiatrist but also a therapist, and tell them you’re scared. Acknowledge and accept those feelings.
Hope that a treatment works, but prepare for the fact that it might not — so you have the reserves to move on.
I want people to know that it’s difficult — but they can do it.
It’s natural to need to change your treatment. It’s natural for it to take a while.
The only thing you need to focus on is to keep trying, keep moving, keep going. If you’re doing that, you’re wildly successful. You’re incredible.
Gabe Howard is the host of Healthline Media’s Inside Mental Health podcast, author of “Mental Illness is an Asshole and Other Observations,” and an award-winning speaker. He received a diagnosis of bipolar disorder in 2003 after being committed to a psychiatric hospital. He lives in Central Ohio with his wife, Kendall, and a miniature schnauzer that he never wanted but now can’t imagine life without.
Gabe Howard is the host of Healthline Media’s Inside Mental Health and Inside Bipolar podcasts, author of “Mental Illness is an Asshole and Other Observations,” and an award-winning speaker. He received a diagnosis of bipolar disorder in 2003 after being committed to a psychiatric hospital. He lives in Central Ohio with his wife, Kendall, and a miniature schnauzer that he never wanted but now can’t imagine life without.