Speaking of Psychology - How to live with bipolar disorder, with David Miklowitz, PhD, and Terri Cheney

Episode Date: February 1, 2023

Up to 4% of people in the U.S. have bipolar disorder, but as common as this mood disorder is, it is also often misunderstood. Psychologist and researcher David Miklowitz, PhD, and writer and mental health advocate Terri Cheney talk about what it’s like to live with bipolar disorder; how it’s diagnosed; and what researchers have learned about effective treatments including therapy and medication. Links David Miklowitz, PhD Terri Cheney   Speaking of Psychology Home Page Learn more about your ad choices. Visit megaphone.fm/adchoices

Up to 4% of people in the U.S. live with bipolar disorder, what used to be called manic depression. But as common as this mood disorder is, it is also often misunderstood and misdiagnosed. Indeed, many people with bipolar disorder wait years between experiencing their first symptoms and receiving an accurate diagnosis. And the general public perception that bipolar disorder is always severe and untreatable is both harmful and out of date. For the past few decades, researchers have made great strides in understanding how to recognize, diagnose, and treat bipolar disorder with both psychotherapy and medications.

So what are the symptoms of bipolar disorder and how is it diagnosed? At what age do symptoms usually first appear? What does bipolar disorder look like in children and teens versus adults? What treatments are available? And is bipolar disorder linked to creativity or is that just a myth? Is it genetic or something that people develop as a result of trauma? And what are researchers learning about helping people with bipolar disorder manage it and live healthy, productive lives?

Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. We have two guests today. The first is Dr. David Micklewitz, a clinical psychologist and professor in the Department of psychiatry at the University of California, Los Angeles Semmel Institute. Dr. Micklewitz treats and conducts research with people who have bipolar disorder and their families. Much of his research focuses on family's psychoeducational treatments for childhood onset bipolar disorder. He's won many

awards for his research and has published more than 300 research articles and eight books, including guides to bipolar disorder for both clinicians and patients. His best-selling book, The Bipolar, Polar Disorder Survival Guide is in its third edition with more than 300,000 copies in print. Our second guest is writer and mental health advocate Terry Cheney. Ms. Cheney has chronicled her lifelong experience with bipolar disorder in three books, Manic, a memoir, The Dark Side of Innocence Growing Up Bipolar, and Her Recent Modern Madness and Owners Manual. A 2008 column that she wrote for the New York Times about living with bipolar disorder was adapted into an episode of the Netflix television series Modern Love.

Before becoming a writer and mental health advocate, she worked for many years as an entertainment attorney in Los Angeles. Thank you both for joining me today. Thank you. Thanks for having us. Thank you, Kim. It's great to be here. Let's start with the basics, Dr. McCliewicz. Could you give us an overview of how bipolar disorder is defined and diagnosed? I know there are several different subty.

in the diagnostic and statistical manual of mental disorders. What do they have in common and how are they different? Okay. Bipolar disorder used to be called manic depression. It's one of our oldest psychiatric disorders been recognized, really since the 1800s, perhaps even before. And it's characterized by very severe mood swings from what we call mania to depression.

In states of mania, people have a constant. people have a couple of weeks or maybe even months of having very high mood or extreme irritability. Their moods really are kind of out of control. With that is kind of a sped-up energetic feeling. They feel like they have lots of energy. They don't feel as much need to sleep. They could go nights without sleeping or sleep very little. Grandios ideas or what we call inflated self.

esteem, the sort of sense of having extra powers or even believing that you're a famous person. Hypersexuality is often goes along with it as excessive sex drive or impulsive behavior like spending, speaking very fast. It's a very sped-up state. Now, those episodes alternate with depressions, which most of us are more familiar with, but it's more than just sadness. It's depressed mood, depressive clinical states involving slowed down, fatigued, excessive sleeping, or having insomnia, perhaps, depression, loss of interest in things, nothing is fun, loss of concentration, and often suicidal thinking or behavior. And people with bipolar disorder alternate between those.

two extremes. There are people who have both at the same time, we call them mixed, if they've had both mania and depression at the same time. We also have a, some people would say it's a milder form, although that's some question of debate, bipolar two disorder, which is a variation between severe depression in hypomania, hypomania being less severe version of mania, less likely to cause impairment, even though the same symptoms may be there. So we have, we think it's about two to three percent of the population that has this disorder in some form. Does that sound right to you, Ms. Cheney? And what does it feel like to cycle between these mood states?

I think that covered most of the territory. I would add that in mania, it's not the fun, euphoric, exciting state. Most people think it is. There's a lot of agitation and irritability that goes along with it. and certainly with mixed states as well, I think that mostly people understand depression better than mania. So that's the big mystery is what is mania really like. What do we know about the causes of bipolar disorder? Is it, as I mentioned in the intro, I was asking whether it's genetic or can it be precipitated by some kind of a traumatic life experience or childhood experience or is it something that runs in families?

I would say this. It is a combination of genetic, biological, and social. It certainly runs in families. People inherit a predisposition to bipolar disorder. They don't necessarily have bipolar people in their family that they can identify. But often there's somebody in the family tree who's had this disorder. Sometimes it's a grandparent. Sometimes it's a parent. And certainly depression. also runs in those families. So we have good reason to believe it's genetic. And some genetic markers have been found, DNA markers. There is also evidence for environmental stress triggering those vulnerabilities. So people who have the vulnerability may have a childhood experience. It may trigger the psychophysiological dysfunctions that are characteristic of the disorder. So we're sort of thinking about it as you come into this world with a vulnerability.

vulnerability, certain life events can make it worse or trigger it in the first place or keep it, make it more recurrent. So both are important. Does that ring true for you, Terry? Are there people in your family who have been diagnosed with bipolar disorder in addition to you? No one in my family that I'm aware of was diagnosed with bipolar disorder, which doesn't mean they didn't have it. They just weren't diagnosed because it wasn't paid much attention to previously. But I certainly felt that I had it, even as a very young child, I had a suicide attempt at age seven. So for me, it went way back.

So at what age do people tend to first experience symptoms of bipolar disorder? David, maybe you could answer that one. Yeah, so that's been a topic of some debate in the last couple of decades. We used to think bipolar disorder didn't have onset till the early 20s, but now more and more university sites and clinics are seeing this disorder in adolescence. And even sometimes in kids, that's where there's the biggest debate is, is this, you know, does this occur in young children? And some people say it's right.

It happens regularly. Some people say it's very rare. My own experience is it's pretty rare, but it does occur. where we see more of it is an adolescence, where people have their first manic episode or their first depressive episode. Sometimes it's that they had a mild depressive episode in adolescence and then a more severe mania when they become young adults, or they have one of these hypomanic episodes in childhood and then a major depression during adolescence. So the average age of onset is, nationally is about 18, but there's quite a bit of variability anywhere from, you know, at the low end

12, at the high end, 25. And how do you treat children with something like bipolar disorder? I mean, one of the class of treatments, and we'll get into this a little bit more, is about, is, is, drugs, but, you know, it's very controversial as to whether you give drugs to very young children. Well, if it's a very young child, we don't come in with all guns blazing, so to speak. You don't necessarily give the strongest medications. If it's unquestionably bipolar disorder, you know, you're really seeing a kid that needs to be in the hospital or he or she is suicidal or they're unable to function in the home or at school, you might try a medicine, which might be an antipsychotic or it might be a miscotic or it might be a miscotic. mood stabilizer, but generally we like to not jump in with the heaviest medications at first. By adolescence, when the disorder has kind of declared itself and we're already seeing

cycling patterns, that's when we're usually introducing a mood stabilizer or an antipsychotic. And it's a hard emotional question to address for the kid and the family about taking medicines and how long do you take them for and what happens if you don't take them. Some people prefer the kind of wait and see, let's see what happens over time. But if the kid is being very self-destructive, then you may not have that option. It's very tough on parents when they have to make that decision. So let me ask you, Terry, how old were you when you first experienced symptoms? I mean, you mentioned a suicide attempt at seven.

Was that really the onset? and then how long did it take for you to actually get diagnosed and get help? Well, I had classic symptoms of cycling throughout my childhood, where I would, particularly with depression, where I would fall into these states where I couldn't get out of bed, couldn't go to school. Those would last a few weeks, and then I'd come roaring back to life

and do all these extra credit reports and all to make up what I'd missed. So it took, unfortunately, until I was 34 years old, before I got a diagnosis, and it was the wrong diagnosis, as so often happens, it was major depression because that's how I presented to the doctor. You don't go in when you're manic because you're feeling so high. So all the doctor saw was my depression and treated me for that. Was that at least helpful? At the time, it did help somewhat, yes, but it also, I think, triggered, I was on an antidepressant, and I think it triggered cycling, which, can happen if you're not treated properly with a mood stabilizer.

So, David, what are the effective treatments? Can we talk about that a little bit? Sure. Well, there's the medicines and then there's the psychotherapies. And the medicines that we found are most effective are mood stabilizers in that category are drugs like lithium, valproic acid or valproate, which is also called depicote. Lomotrogen, which is also called lomyctyl. Those are mood stabilizers. And interestingly, they also have a role in the treatment of epilepsy, at least limitol and depicotone do.

Then we have the antipsychotics, which are drugs like rospadone, areapypipersol, latuda, various drugs that are used. really usually in the acute manic phase to kind of bring someone down from mania, the person may continue on them for longer to be able to stabilize their symptoms, but we don't like to have people on those forever because they have side effects like weight gain, fatigue, agitation, sometimes. All these drugs have some side effects. We do bring in antidepressants once in a while if a person has a very treatment-resistant

depression. But the problem with antidepressants, as Terry was alluding to, is they can increase cycling. They can cause more rapid cycling, more switches from high to low. Then there's psychotherapy. Our particular brand that we've tested in our lab is a family-focused therapy, oriented towards functioning within the family, getting the family to understand what bipolar disorder is, how to communicate about it, how to be supportive without taking over for the person, how to encourage medication compliance without being controlling, how to recognize an early warning sign when it's developing. All that can, the family can be of considerable help in that process. Other people prefer to go the individual route and have an individual therapist who's helping

them kind of with their identity formation despite having this disorder or a cognitive behavioral therapists who might work with them on their self-talk or their attributions. Groups, I think, are very useful for people with bipolar disorder, especially if they involve other people who have the disorder and it can give them advice on how to cope. So most effective treatments are a combination of medications and psychotherapy. And is that what you're doing, Terry? is are you doing a combination of both? And I know you've also written about sort of taking a cocktail of a lot of different drugs over a long period of time, and how do you deal with that?

It can be very difficult to deal with the medication requirement, but I think it is necessary to be on medication if you're bipolar. It also, for me, felt less stigmatic to know that there was a medication that could help me. It felt like, okay, there was something definitively wrong in my brain that could be fixed. And certainly I've been helped tremendously by medication, although I'd like to add about antipsychotics that that's a terrifying word for a lay person to hear because I was never psychotic. But in fact, it turned out to be an antipsychotic ericip resolved. It helped me the most. So you just have to be open to your doctor's advice. Therapy has been essential for me.

I've been in therapy for 30 years, group therapy, regular therapy, everything that Dr. Miklowitz mentioned. I've done it all. And I think what I'm discovering now and I'm doing very well now is mindfulness is a huge part of my recovery. Just learning to try to stay in the moment without too much judgment, without anxiety about the future. It really has been helpful. Is that a treatment that's becoming more common, Dr. McCluret? Yes, it is. We've done some studies on it, and others have as well. It's mindfulness, mindfulness-based cognitive therapy has been found to be effective for major depression and

preventing recurrences of major depression. There's some beginning evidence that it might be effective for bipolar disorder as well. It's not clear that it prevents mania as well as it prevents depression. That's actually what I was going to ask you, Terry, is whether or not you feel like the mindfulness helps during the manic phase as well, whether it helps bring you down from a high well. I have an interesting response to that. I think actually that mindfulness makes me so much happier. Sometimes I think I'm hypomanic, which is the state just below mania, where you're feeling terrific and life is going really well and you feel on top of your game. So I'm very curious, Dr. McLewitz, if you ever heard of mindfulness causing hypomania,

or is that just a great side effect I'm experiencing? I haven't seen any data on it, but I've heard people say it. I've heard people who've been in the groups say that it gives them special insights, and they get very sort of excited about those insights. So I think like any antidepressant, maybe it's like antidepressant medication. When you improve mood, you also have the risk of setting someone into mania. But there's no date on it. What about other lifestyle factors such as getting regular sleep or avoiding alcohol?

Terry, you've talked about how important it is for you to avoid alcohol. Are there other triggers that you feel you really need to avoid? Yes, I've been sober for 23 years, and it wasn't until I stopped drinking that my medications actually began to work. And that was a total shock to me because I thought it was just a suggestion that you not drink alcohol and take this drug at the same time. It turned out to be that my brain chemistry just really needed to not have the alcohol interfering with the medication. But as far as other lifestyle factors, sleep is critical. Sleep has always been a difficult thing for me with bipolar disorder. but interestingly enough, I found when I went through menopause that when I got on hormonal

medications, my sleep improved and my bipolar disorder improved as well. So it's a thing to check out. Also, thyroid has, checking on my thyroid has been important that can impact my bipolar disorder. So there are all these interrelated factors. You need to live a healthy lifestyle. If you want to want to be healthy mentally, I think. Can I add to that as well? Yeah, if you would, yeah. Yeah. I agree with everything Terry said, and I think everything she said about alcohol could also

apply to marijuana. There are people who smoke weed consistently, and they're thinking it's a mood stabilizer, but actually it can, in its own way, contribute to your mood cycling. If nothing else, by interfering with sleep, some people get high and then they can't fall asleep or it makes them sort of fatigue during the day so they take naps. There are various reasons why any substance of abuse is not a good thing to do when you're also taking psychiatric medications. One of the first things we recommend to people with bipolar disorders to try to stay on a regular sleep wake cycle, which sounds easy when you say it, but it actually is very, very difficult

because first the disorder interferes with sleep and it's hard to get to sleep when you have the disorder and also you may be hypomanic, your mind may be going fast or you may be depressed and find it hard to get through the day without having a nap. So one of the first strategies is to try to get people to have their bedtime within a certain range and their wake-up time within a certain range so they don't oversleep or, you know, sleep binge, as we call it. Now, there's an idea that bipolar disorder, particularly the manic phase of bipolar disorder, is linked to creativity and even creative genius. Is there any truth to that, or is that just a myth?

Do you want to answer that, Terry? I'd like to jump in and say, I think there's an absolute connection. I have known many, many bipolar people. over the course of my publishing career. And certainly there is a connection in my mind to artistry and just bipolar disorder in general, not necessarily mania. But there are things that happen when you're bipolar. They give you an extra edge when you're an artist.

You develop a great deal of empathy because you've suffered so much. And so you can bring that to your art. I think you also are somewhat of an outsider when you're bipolar. And that allows you to watch people and, you know, trying to find out what's a normal behavior. That also helps with creativity. So I think there's a lot of that being bipolar that is connected to creativity. Yes. And I would agree with that.

Certainly there is many. historical figures who've had bipolar disorder. At least when we look back, it certainly looks like they had bipolar disorder. Various painters, Chikowsky, the classic musician, the Beethoven, we think, probably had bipolar disorder. Kurt Cobain, more recently, had probably had bipolar disorder. And the linkage, though we think it may be that people create more during hypomania than mania,

because it certainly helps you to speed up a little bit, and your thoughts go faster, and you kind of think outside the box a little bit more when you're hypomanic. But when you get manic, I don't know if Terry would agree with this, but I think people produce a lot of work, but it's not their best work. Absolutely, I'd agree with that. When I'm hypomanic, I see connections between things. It's astonishing.

It's like the fabric of the universe just seems to be connected and it makes sense to me. And I'm able to write about that. But when I'm manic, I think I have all these fabulous, grandiose ideas, and I put them down on paper. And it's usually in the tiniest imaginable little script that I can't decipher later when I'm not manic. So most of my manic writing has gone out the window. So is it a goal then to basically titrate the medicine so that you can sort of keep at that hypo level because it's effective? That's something that Kay Jameson has written a lot about. She was a psychologist and also a writer.

She talked about finding the sort of optimal level of lithium that allowed her some hypomania but still protected against recurrences. And that is a balancing act. It's different for different people. You have to get your doctor on board with having, you know, can I take a lower lithium level? But for some people who are artists, that's very critical to be able to make that balance. Terry, I saw that you wrote about how you believe your bipolar disorder has led you to being very circumscribed in your movements, especially when you're feeling depressed. Can you talk about that? Like, what is that like?

And how did you discover that you were sort of different in that respect? Oh, Kim, I'm so glad you brought that up because that's something that I have written about frequently, and I've gotten the most responses to that subject because I think many people are suffering from what is called psychomotor retardation, a slowing down of the mental and physical processes of the body in depression. And it is terrifying. It's like a paralysis. If I were to, I'm sitting at my desk right now and I want to reach out and grab my pen, I couldn't do that.

I'd have to think about it and think about it and ponder it. And my hands still would not obey my mind. That's psychomotor retardation. And I think it really does not get the amount of attention that it should because I have been helped by psychostimulants with that and I think other people could be as well and Dr. Micklowitz could address that but it really is for me the worst part of being bipolar. Yeah and I wonder actually I was going to ask you this earlier Terry does that extend to the to getting out of bed in the morning do you find that when you're depressed it's very difficult to even move out of bed?

I live in my bed when I'm depressed. I don't go much. further than the kitchen or the bathroom, but the bed becomes my universe, unfortunately, because you simply can't get the, you can't get the comforter off. It's too heavy. Have you found any effective treatments for that particular problem? When it's really severe depression, nothing helps but time. But when it's not quite as bad, again, I found that psychostimulants have been helpful, like modafinil helps me.

Sometimes Ritalin can be helpful or a combination of all of those and along with my mood stabilizers and my antidepressants. So I have found some help with the medication, but I wish someone could help with the terror of it returning because, again, it is the worst part of being bipolar. Yeah, and I think one of the things families struggle with most is they say, well, if you would just get out of bed, you'd be fine. And if you would just, you know, kind of make yourself do things, you know, you'll be a lot happier. Yet what they don't get is that when you wake up with bipolar disorder, it's like having a hundred pound weight on your chest.

You can't move. Even if you want to, even if you feel like you should, it's a physical state that's very difficult. to overcome. And it's hard for family members to understand that. They said, well, I got up this morning. How come you can't? But it's, it is a serious physiological limitation that's brought on by depression. And that brings me back to family focused therapy. I mean, what are some of the techniques that you use when you do this? Because that's got to be something that is very hard for the the patient to hear when, you know, mom and dad are saying, just get out of bed, kiddo. And it's like the kid can't get out of bed. So, I mean, how do you walk the family through

that and get the parents to be helpful and understanding? I think anytime you hear criticism like that, you have to think about it in a couple of different ways. You can't just wag your finger at the parents and say, don't criticize. You have to say, first, their intention is a good one. Their intention is that they want the kid to be happier. They want them to be healthier. They want them to get or her to get out of bed and be able to finish school. But the way they're communicating it is in a way that's just going to feel invalidating to the child. And then we'll work with them on, you know, let's first let's understand why she has this problem getting up in the morning.

That's the nature of the illness. other people who have this disorder have that same problem. Let's set some smaller goals. Like, can she get up within this interval, within this hour of time? If she's a little late to school, can we work it out with the school to accept that or to not dock her every time she shows up late to school? Are there adjustments to medications that could be made, taking them earlier, for example, in the previous day so that she doesn't have the sleep?

inertia in the morning, that's problem solving with the family, really. And also getting them to understand what it's like from the child's or the young adults' perspective and how to communicate about it. Yeah, I would love to, I'd love to jump in there, Dr. Mikulwitz, because I know from my own experience that any type of advice is going to come off as criticism when you're you're depressed because anyone who says you should do this, my God, if I could, wouldn't I be doing it? No one wants to be lying there trapped by their comforter. Right.

But I have a suggestion for how to communicate that I've written about and I feel very strongly about, which you were just referencing. It's understanding what the person is going through by just five little words, tell me where it hurts. Tell me where it hurts. If you say that to a person and you let them open up and explain about how they're feeling in the darkness and the paralysis, it shifts something in the relationship and also in the depressed person's sense of being all alone with their disease. I've seen it work countless times and it certainly does work for me. Just tell me where it hurts. And then you've got to listen. That's the hard part and not try to make it all better. Right. I guess the flip side of that is

the person with the disorder has to also be willing to understand the confusion their parents are going through. You know, they last, last year this time, you were doing great. How come now this year you can't get out of bed? Some parents reject the idea of an illness. You know, this can't be an illness. This is just laziness. You're not trying hard enough. And although, that's certainly not helpful to the person with a disorder. Parents are kind of going through their own journey and trying to understand what's wrong with their kid. Well, my parents didn't believe I had bipolar disorder. And unfortunately, they died before.

Really, there was a kind of awareness there is today about it. But I think this is where education comes in. There is no excuse for everybody not knowing the symptoms. the signs and think simple things like you're going to have trouble getting out of bed. There are so many books now about bipolar disorder and so many great, well, there's this podcast and there's so many great examples of education out there. You just have to go to the internet and start learning the symptoms and the signs and the triggers. And yet it's so it's hard to diagnose. I mean, Dr. Miklois, can you talk?

about why it's so hard to diagnose because, I mean, it sounds like a pretty clear-cut syndrome. So if the person has a clear-cut manic episode alternating with clear-cut depressive episodes, it's not that hard to diagnose. It's, you can get the history, you can hear, you know, go through a checklist of symptoms. Do they have five of those symptoms? Have they lasted this amount of time? And you have your diagnosis. Unfortunately, most people, present in a much more ambiguous way than that. They have manic and depressive symptoms at the same time. They have short episodes alternating with longer episodes.

They have hypomanias, sometimes and manias at other times. They have depressions that have some psychotic features. They also have ADHD and therefore I can't tell what part of this is hyperactive behavior due to the ADHD and what part of it is mania, where they have severe anxiety, which can look an awful lot like manic, over-stimulated thinking. So there's so many things that look like it. You have to take your time to do a diagnostic interview, a full diagnostic assessment. And unfortunately, the mental health system doesn't always allow for that.

And also, I think it's essential to have family input, and I'm sure Dr. Mikulwitz agrees, because you need to see a pattern. emerging over time and the best person for that or the best people for that are friends and family to really talk to the doctor and say, well, three months ago, she was talking so fast I couldn't understand her. You know, little clues like that are really what doctors need, I think. How did you finally get an accurate diagnosis, Terry? What would it take for that to happen? I had such bad depression that I had electroshock therapy. the depression was so severe. And in the middle of electroshock therapy, I escalated into the highest bout of mania I'd ever had. I spent every last cent I owned. I went up the coast to a

five-star resort and just stayed there until my savings account was dry. I had a terrific time, but I had to come back and face the consequences, which was not so great. So it took my doctors seeing that and seeing, oh, yeah, I guess she gets manic. So maybe she's bipolar. That's what made the difference. So, Dr. Mikkelowitz, I want to ask you, what are the areas of research that you're most excited about right now in terms of improving treatment for people with bipolar disorder? What are the big questions that you would like to see answered? First, we're getting more and more interested in early intervention and prevention. If we can catch kids early enough who are just showing the early warning signs, particularly those who have a family history of the

disorder, we may be able to, if not prevent it, minimize the severity. And so we're going in with family psychoeducation for kids who are showing some manic symptoms, some depressive symptoms, and where bipolar disorder runs in the family. We've been able to show we can prevent depressive episodes or at least elongate the periods of wellness between mood episodes. Others have shown the same thing that early intervention may be one way to at least mollify the course of the disorder over time. We're also interested in the whole question of who gets better over time. We have a subgroup of kids. It's about 25 or 30 percent of the kids that we see in our clinic who start off and they look bipolar at the beginning. And by the time they're in

their early 20s or late teens, they're pretty stable, even when they're not taking medications. I don't know why that is. That's something I'd like to know, but other shops are finding that as well, that there's a subgroup that have a good outcome. Maybe it's protective factors. Maybe maybe we had the diagnosis wrong in the first place, or maybe they had a good relationship that protected them against mood variability. Those are things that we need to know. The other thing we're doing that I'm excited about is we've developed a child bipolar network, which is five or six different university sites. We're trying to put together common diagnostic and treatment guidelines for these kids. Like, what do you do when you have a kid who looks

bipolar, but the manic episode is due to antidepressants. How do you treat those kids versus somebody who has a longstanding bipolar disorder or has these mixed episodes? If we could all diagnose kids and treat them the same way, I think we'd be much further along or have a series of guidelines that everyone agrees upon. Last word, Terry, I'm going to ask from your vantage point, what would you like to see science and research illuminate, figure out, understand, and essentially resolve for people who are living with bipolar disorder? Well, I have a whole basket full of dreams about that. I would love to know more about psychedelics for bipolar disorder.

That really hasn't been explored much yet. I think there's great promise in the field of psychedelics. I think mindfulness also in its application to bipolar disorder could really help people. I'd like more addressing of the cost of medication. It's killing me. I'm sure it's killing other people out there. I am just on the edge of being not able to afford my medications, and it's very frightening. So I would like to see that researched.

and addressed. And I'd like to see the stigma of having bipolar disorder reduced simply because it's not that bad a thing. You know, it's not like you're a terrible person. You're normal, quote, normal in between episodes. You're not always manic or always depressed. You know, you're just a human being with a brain that is hypersensitive to certain things and needs to be addressed by medication. So it really is not the shouldn't be getting the stigma that it does. I agree with that 100%. And also the issue about psychedelics, that is something we're interested in as well. Right now, psychedelics are only being used with major depression. They're not being used for bipolar disorder for what I think are obvious reasons. You don't want to kick off in manic episode. But I

I think there is a future for that kind of research, both with ketamine, psilocybin has been proposed, and it may be that a single or two sessions of that kind of drug can break through some barriers that people have in terms of their thinking, the ruminations and so on. I don't think it's a miracle, but I think we haven't studied it enough by any means. Well, it sounds like we've come a long way, but I would certainly have a very long way yet to go. I want to thank you both for joining me today. This has been really interesting. I appreciate particularly, Terry, you're putting yourself out there with your story because it's very, very compelling. Thank you, also, Dr. Micklewitts.

You're quite welcome. Thank you, Kim. I really appreciate your having it here. You can find previous episodes of Speaking of Psychology on our website at W. www. speakingof psychology.org or on Apple, Stitcher, or wherever you get your podcasts. And if you aren't a regular subscriber, please sign up. Feel free to leave us a review as well. If you have comments or ideas for future podcasts, you can email us at speaking of psychology

at APA.org. Speaking of psychology is produced by Lee Weinerman. Our sound editor is Chris Condyenne. Thank you for listening. For the American Psychological Association, I'm Kim Mills.