Inside Bipolar Podcast: Combatting Sexual Side Effects With Your Doctor

Inside Bipolar 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 also hosts Healthline Media’s Inside Mental Health podcast available on your favorite podcast player.

To learn more about Gabe, 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 to the show, 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: And today we’re going to rip the Band-Aid off and talk directly about sex. Sexual side effects are very common with bipolar treatments and medications, yet for some reason, everybody’s always talking about it in like whispers. Nobody wants to be direct about it, probably because of the shame and stigma that comes along with it. Dr. Nicole, you are a doctor. You see patients. Do any of your patients ever look you straight in the eyes and just say, hey, I can’t have sex right now and I need you to fix it?

Dr. Nicole Washington: Some do. Usually, those are the ones I have really great relationships with and we’ve built rapport. Without that rapport, it can be really difficult because for some reason people see us as not people. They see us as these doctor-people who are boring and never had sex today before in our lives and don’t know anything about enjoying life. So they don’t think we’d get it.

Gabe Howard: And today we’re going to talk about why it is so difficult to bring up any sort of sexual side effects, dysfunctions, issues that we may have when we are battling bipolar disorder. Like how I said, battling Dr. Nicole. I like to, this is war. I’m prepared for war.

Dr. Nicole Washington: It sounds intense.

Gabe Howard: It feels intense. I want everybody to know I’m not manic. I’ve got a psychiatrist with me that can vouch for that fact.

Dr. Nicole Washington: [Laughter]

Gabe Howard: I just I really feel like it’s a battle. Us against bipolar disorder. Sometimes the way that bipolar disorder is talked about, it just seems so serene. It’s like you will have mood swings that you can’t control. What? This is like calling a hurricane, I don’t know, like a thunderstorm or a light rain. It’s it’s not that. I can’t control it. It blew my house away and then it attacks sex. And sex is a very important part of the human experience.

Dr. Nicole Washington: So I could see how it sounds like a battle because even when your mood feels stable, then you still have to do all the things to try to prevent the mood episodes. Right? And then you also have to then deal with the side effects from the medication, which the sexual side effects are huge, huge, huge.

Gabe Howard: The sexual side effects are huge. In fact, in my non-scientific study, the number one reason that people tell me, Gabe Howard bipolar speaker and advocate, that they stopped taking their meds is because it prevented them from having sex. They walk up like, yeah, yeah, yeah. My beep didn’t work. So I just stopped taking it and I get it. Right? I get it. Especially, you know, young people, right? I mean, we’re young when we get this thing. I know I’m preaching to the choir here with our audience, but man, I remember 22-year-old Gabe and everything stopped working. That was uncool. And my knee-jerk reaction, Dr. Nicole, was just to stop taking the meds.

Dr. Nicole Washington: Yeah.

Gabe Howard: It messed with my sex, so I’m out,

Dr. Nicole Washington: Your knee-jerk reaction and a whole lot of other people.

Gabe Howard: Dr. Nicole, why is this bad? Why is it bad just to say that med messed with my sex? I ain’t taking it anymore.

Dr. Nicole Washington: Well, it’s bad because then if you stop taking it, what do you think is going to happen?

Gabe Howard: Well, I’m going to get my sex life back. That’s what I think is going to happen.

Dr. Nicole Washington: But what else? What else is going to happen?

Gabe Howard: I’m going to get my sex life back.

Dr. Nicole Washington: Uh-huh. And you’re also putting yourself at a whole lot of risk of having a mood episode, which is also not what you want.

Gabe Howard: It’s not what you want and it’s not what people think about. Right? We become so laser focused on getting our sex lives back. You know, for me, Dr. Nicole there, you know, in those early days of battling bipolar disorder, there wasn’t a lot of good there

Dr. Nicole Washington: Yeah.

Gabe Howard: Just wasn’t, you know, suicidal depression mania blowing through all of my money. I was losing friends by the day, but sex still felt good,

Dr. Nicole Washington: Yeah.

Gabe Howard: You know, masturbation still felt good. So the minute the medical establishment took that away from me, I was ready to fight back in in in whatever way I could. And I know that our listeners feel that way. But you brought up a good point. Is it out of the frying pan and into the fire? Am I getting my sex life back? But having a mood episode, the suicidal thoughts coming back, the depression coming back, maybe having mania and blowing all of my money.

Dr. Nicole Washington: You have to say something about it. I mean, you got to help me help you. I can’t help you with the side effects or any problems you’re having if you never tell me about them. So if you sit in a visit and I ask you, how are you tolerating the medicine? How’s it going? And you just go, I’m fine. Yeah, everything’s good. Knowing good and well that you aren’t even taking the medicine. Then I can’t help you.

Gabe Howard: Not only can you not help me, you’re going to make me worse. I think that’s the thing that we don’t often think about. See, in our mind, we stopped taking the medicine and we didn’t tell you. So that loop is closed, right? That’s, that’s how we think about it. But it’s more insidious than that, right? Because while you’re looking at possible solutions to get rid of the depression, suicidality, mania, all of the horrible symptoms that come from living with bipolar disorder, you think were stable on that medicine, don’t you?

Dr. Nicole Washington: Well, yeah, because that’s what you said. You said I’m doing okay. Or, even worse, you tell me. Well, yeah, I am having some symptoms, but you don’t tell me that you’re not taking the medicine. So then what do I do? I increase the dose.

Gabe Howard: The of the medicine that I’m not taking.

Dr. Nicole Washington: Yes. Yes. And so then you have a higher dose on hand and then there’s going to be the day like it’s going to come when you feel like, Hmm, I think I should probably take that medicine for a few days because I’m feeling a little out of sorts. And then you start taking a high dose right out of the gate, which is not recommended by anybody.

Gabe Howard: You did not ramp up. You did not prepare.

Dr. Nicole Washington: No, you just jumped in. You just jumped in and thought, I’m just going to take this dose. And what if it’s a high-end dose and then you have more side effects? And what do you say to yourself? See, I knew that medicine was terrible. I knew Dr. Washington didn’t know what she was talking about when she gave me that medicine. But you did it to yourself.

Gabe Howard: I really, really, really feel the need to say, Dr. Washington, it is such a worthwhile goal to want to get your sex life back. That is a good mission in this war. But we go about it in all of the wrong ways. And you brought up a really good point, you may raise the dose of a medicine that we’re not taking, and then all of a sudden we take that medicine. And in the example of antidepressants that can push somebody into mania, especially a high dose that you’ve taken suddenly without monitoring, that can be the difference between you spending your entire rent check, quitting your job, and declaring that you are king of the world and stability. And we see this happen all the time. I do like that you touched on and then we blame you. That’s my favorite part. I love blaming anybody but myself. But let’s stay focused on the part where we’re just not getting good care because we’re giving misinformation to you.

Dr. Nicole Washington: And then you blame me. And that’s not fair to me or any of the other doctors out there trying to help you in this battle. But I don’t know that patients always see us as on the same team. I don’t know that they think like, oh, she’s in this with me. Like, she wants me to have a great sex life and have a good quality of life. And there are a great number of people who feel like we’re just out here passing out pills, like we don’t care. We’re just passing out pills, which could not be further from the truth. But we get very, very frustrated when we find out down the road like, Oh, well, I really haven’t taken that medicine for like three months because, you know, I was trying to get my sex drive back.

Gabe Howard: Dr. Nicole, let me ask you this. Do you understand and respect the desire of somebody to care more about their sex life than they do about managing bipolar disorder? Is that a thought that relates to you?

Dr. Nicole Washington: Uhm, I get how, I get how important sex is, right? Like, I think those of us who don’t take medication, who don’t have, you know, a mood disorder that messes with our sex life and has to take medication that mess with our sex life, I think sometimes we take for granted the ease of how easy it is for us to just find a partner and date and you meet somebody and you have sex. I mean, there’s so many things even before we get to the actual act of sex that sometimes bipolar illness takes away from people. And I don’t think we always get that part. But I personally find it very important. I think sex lives keep us going. They are good for our mental health, our physical health. They’re good for relationship health. But I don’t know that I can always say that I think it trumps taking your meds and being stable because from my end I have a front-row seat to all the horrible things that happen to you when you’re super manic or super depressed. I’m watching that part, and then you come to me and you say, Well, you got to fix it. Like, I feel terrible. And I genuinely want to say, Well, why didn’t you just do what I asked you to do? Which was take the dadgum medicine. I mean, you can come to me and talk about the side effects and we can get creative together and figure out how to help you with your sex drive. But if you never bring it up, I won’t know. Right? You know, I’m not going to ask you, are you having?

Gabe Howard: But should doctors? Should all doctors look at their patients and say, hey, are you having sex? How’s your sex? Can you orgasm? Are these questions that should just be part of a routine medication exam?

Dr. Nicole Washington: So yes, doctors should absolutely ask about it. But I will tell you this, the reality of a session, right? So how long do you get to spend with your doctor? 20 minutes? Maybe 30, if you’re lucky.

Gabe Howard: Twenty minutes? You must, you have doctor insurance.

Dr. Nicole Washington: Right,

Gabe Howard: Some of us get 12.

Dr. Nicole Washington: Right. So

Gabe Howard: Some of us get eight.

Dr. Nicole Washington: Right. So in that short time, I have to ask you about depression symptoms, suicidal thoughts, homicidal thoughts, agitation. I have to ask you, have you been feeling manic? How’s your sleep? I’m asking you about medications from other doctors. Like are you seeing your primary care? That’s a lot to cover in a very short period of time. And I will not even sit here and lie and say I ask it every time. There are times that I just forget. I mean, it is important, but if I have to prioritize in my head the things that I need to make sure I hit, sometimes I miss it. So I need you to do me a solid and say, Oh, by the way, I need you to hit me with the oh, by the way, and not when you’re walking out the door. But I need you to hit me with the. Oh, by the way, can we talk about my sex functioning?

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Dr. Nicole Washington: And we’re back with how you talk to your doctor about sexual side effects.

Gabe Howard: I talked to so many people about why they’re not talking to their doctors about this. The first thing is, I want to remind everybody listening, the average onset of bipolar symptom is 16 to 24. So a lot of young people, a lot of unmarried people, a lot of people who don’t want their parents to know what they’re doing, who may still be on their parents’ insurance or at least a close enough relationship that they’re afraid their parents are going to find out that they’re sexually active or that they’re having multiple partners or. Listen, I want to be like super frank. When I was 16 years old, I was embarrassed that I was masturbating. Right? So to tell a doctor that I couldn’t do this anymore, that was not something that was in my vocabulary because of all the shame. It is a big, big lift to ask young people, unmarried young people in America’s culture surrounding sexual shame, to say I can’t orgasm or I can’t get an erection or I’m not enjoying sex or my libido is gone. That’s a huge ask for young people.

Dr. Nicole Washington: It is a huge ask, and I wish I could sit here and tell you that there aren’t psychiatrists out there who would say, well, you don’t need to be worried about having sex anyway. You don’t have a partner and you’re 19. And I’m more concerned about your stability. And while I get part of that, I think we just have to meet people where they are and realize it’s not my care, it’s theirs.

Gabe Howard: I want to address two things real quick, Dr. Nicole. First, let’s talk about what happens if a doctor does freak out? Because it does happen from time to time. So now the doctor has shamed you, lectured you, whatever words we want to put on it. They made you feel bad because you wanted to be sexually active. What’s a recourse? Who do you complain to?

Dr. Nicole Washington: Well,

Gabe Howard: Can we speak to your manager?

Dr. Nicole Washington: Yeah. Ask for the manager. Ask for the manager. It depends on what kind of setting it is. If it’s a setting where there are multiple psychiatrist options, if it’s a group, if it’s a community mental health center, or maybe there’s more than one person, you may just ask the office manager, you know, I had a meeting with Doctor So-and-so. I shared with them some issues I was having. They really made me feel some kind of way. I don’t know that I can continue to work with that person. Do I have an option to switch? Sometimes that’s an option. Sometimes they’ll tell you, no, you can’t switch, or there is nobody to switch to. And then you become your best advocate and have a conversation and maybe not in that particular visit because let’s face it, at this point, you’re ticked off. Having a conversation with your doctor right now is pointless. But at the next visit, if you can gather the words and have your words ready and say to them, Doctor So-and-so, last visit I talked to you about my sex life and you seem to feel like I shouldn’t be worried about having sex. It may not be the way that you would like to see, but sex is very important to me. And this is something I want us to work through and see if that helps.

Dr. Nicole Washington: I can’t tell you that some doctor wouldn’t say, well, should you really be thinking about having sex anyway? So you’re right. I mean, we all say things that aren’t always in the best interest of our patients. But ultimately, I do feel like we do have their best interests at heart, like we want them to be stable. We want them to not fluctuate between mania and depression. Like we want you all to have a very stable mood. And we just have to also think that part of that stability, once you get it, then it’s about improving quality of life. And that’s where the sex comes in. And we have to think like beyond the keeping you out of the hospital and out of jail and keeping you employed, like what else is there to enjoying life and quality of life? And sex is really high on that list for a lot of people.

Gabe Howard: Dr. Nicole, I’m glad that you brought up that it depends on where you get your care. If you’re in a big setting, you could ask to speak to the office manager, maybe a patient liaison, and have these discussions. If you have insurance or you’re in a big city, you can just decide, you know what, I’m moving along. You can call your insurance company, ask for another referral and go straight there. The point is, is do something. I want to circle back to something that I said at the very, very beginning, which is many young people there, they’re still sort of codependent with their parents, especially if they’re minors. You know, even younger folks, you know, 19, 20, 21, 22, maybe you’re still on your parent’s insurance. Are you allowed to just get up and tell my mom that I want to go to the club and meet a whole bunch of women? I’m on my parents’ insurance. My mom’s sitting in the lobby. What rights does she have to know what you and I talked about.

Dr. Nicole Washington: So I have a 20-year-old, and when he turned 18, we had a big conversation about him being in charge of his care legally and me not having access to his information without releases of information. So I need releases to be able to get information from his doctors. In theory, I can’t even call the office and schedule an appointment for him without a release of information like I’m so removed. But I definitely get those EOB’s and I get the copay bills and I get all that stuff. And I could see how as a parent, you would feel very, very frustrated that I’m paying for this and I have no control. And let me just sidebar and tell you, parents of young adults are struggling because we all of a sudden are in this role where we don’t have as much control as we think we do and we don’t have as much control as you think we do. In theory, I can’t just walk out to the lobby and say, hey, you know, he wants to go out and have sex. You need to do something about that. I can’t do that without your permission, without a signed release of information.

Dr. Nicole Washington: I can’t just go out there and say whatever I want to say to your parents. Even with a release of information, you can be very specific about what you want me to talk about. You can sign a release that says, I only want her to be able to schedule appointments for me. I only want her to be able to talk about medication refills and things like that. You don’t have to sign a release that opens up and gives your mom or dad the keys to the kingdom. Right. They don’t need to know everything you’re talking about with your psychiatrist. And I will tell you, there are some parents who will try to call you after sessions and get what do they say? Or what’s the, what’s going on with the medicine or how are they doing? And then it’s on us to honor your privacy and to be very specific about what we say or don’t say to your parents. And I am empathetic, especially now that I’m in this space of having a young adult and understanding that as a parent, we are just really struggling with that loss of control. But that’s our issue, not yours. Ultimately, we’re not going to go run and tell your parents what you said about sex. I mean, we’re doctors. If I can just impress that upon you. Enough. Just don’t look at me as a middle-aged woman. Look at me as a doctor first who knows a lot about how to help you with this particular issue. And then we can just talk about it.

Gabe Howard: Like you said, don’t look at you as a middle-aged woman. Look at you as a doctor. So I’m going to go a step further and say, don’t look at her as a person. Look at her as the tool for your health, for your happiness. Right? And a tool is only as effective as your ability to use it. Right. I’ve always been, when I use tools at my house, the end product always does not come out looking like it did on the home improvement show. I use the same saw. All right. I don’t understand why my wood cracked in half and my roof fell in? I use the same tools? Because I don’t know how to use them. I bring this up because if you’re sitting across from your doctor and you are not using the tool correctly, giving them all the information, giving push back when they get it wrong, saying no, I understand that you’re saying that this is not the top priority, but I’m telling you that it is. I am telling you that it is my top priority. And if you don’t make it your top priority, I am going to leave here and stop taking the medication.

Dr. Nicole Washington: Right. You’re absolutely right. I will tell you, when people yell at me and say things like, well, I’m just going to quit my meds, my gut reaction is fine, go ahead and quit them. Let’s see what happens. Like let’s just see if you want to play that game. It’s just hard to not have that initial knee-jerk reaction of matching that same energy. Right. But when a person says to me, this is really important to me, and there are times I think about quitting my medicine because it’s so important to me, I don’t have the same reaction like I see them different. Which I will tell you this, making a threat to your doctor. Well, fine. I’m just going to quit my medicine is the most pointless threat because it doesn’t hurt your doctor. It hurts you. So at the end of the day, I’m going to go home whether you take your meds or not, and I’m going to live my life, whether you take your meds or not, you’re not hurting me or your doctor by threatening me with stopping your meds, you’re going to hurt you.

Gabe Howard: We have to be empowered, right? We have to empower ourselves. Taking our medicine is for us. Going to therapy is for us. Learning coping skills is for us. Getting better is for us.

Dr. Nicole Washington: And it’s not an either-or thing, right? It’s not either I can have sex or I take my medicine. It is possible if you have a discussion with your doctor. That you can take your medicine and that you can get control of your symptoms. And it’s not like, Oh, well, I have to choose between my mood being stable or being able to have sex or my mood being stable and being able to masturbate like I have to make that decision. And sometimes, you know, you kind of make that up in your head like you don’t have any choice. You don’t have any control. I can’t tell you that there aren’t times where you’ve been on everything. Right. And it seems like the one medicine that really gives you the most stability is the one that causes you the most sexual dysfunction. I can’t tell you that I haven’t seen that for some people, and especially when we get into some of those long acting injections and things like that. And that’s where we get really creative about what we can do to try to help you. Because I understand that there is very little that is more important to a late teens, early twenties, male and female. But my guys, they are like, Ah, we’re not doing this. Like we’re, we’re not doing this. So I know how important that is. But it’s not either or. It’s just not.

Gabe Howard: I really want to point out to everybody listening, you know, play this for your doctor if you want it. Play this for your parents. Sometimes it’s not about having sex. It’s about having the ability to have sex.

Dr. Nicole Washington: Right.

Gabe Howard: Right. The ability to have sex creates opportunity. It creates hope. It’s very, very difficult to lie in bed at night and think, man, I hope I meet the right person when you know that you’re having sexual dysfunction. Because you’re thinking, well, I don’t want to go out and try to date. What if? What if things go well? Well, what if I get to the third date or the sixth date or marriage and I’m still having this problem? It would be wrong to date right now. We’ve always been tabling this as, hey, I want to get the act done right. I want to orgasm. But listen, the inability to do so, it has this backwards effect that I think that sometimes doctors, parents, therapists and even us don’t understand, which is if you’re incapable of being fully in the relationship, the thing that’s really occupying your time is that what if Prince or Princess Charming does show up on the horse? I’m not going to be there. I’m going to be at home broken. And that’s super important because this just often gets tabled in you just want to have an orgasm. You have more important things. No, I want to live my life fully. I want to have every single opportunity available to me. And I want to compromise on nothing. I think that’s really like a powerful goal that everybody can get behind it. It’s also a powerful goal to get behind that you just want to have an orgasm, right? I mean, let’s. It’s okay. Right, Dr. Nicole.

Dr. Nicole Washington: It’s perfectly fine if that is your, if your goal is just not quite as evolved as the one Gabe just described, it’s okay. It is just fine. But we forget, though, right? I mean, think about okay, here you are now, you just said you’re 26 years later. Here you are. It is hard to remember being that young and hormonal and just wanting to feel that feeling. And as parents, we sometimes are like, but really your priority should be your stability. We have to think back to when we were 19 was our priority of stability? You know, doctors, you know, we had we’re like, well, but I just really want you to be stable and out of the hospital. But there has to be more than that, right? Like we got to get buy-in from people. And I think the best way to do that is to just really, really focus in on what their goals are. And so if the person’s goal is eventually, I want to get married and I want to have a sex life with my spouse and this is what I want. I want to be in a long-term relationship is a goal and I want to be able to have sex with that person. I think we all can kind of understand that sentiment and then that will hopefully give us what we need to kind of back back a little bit and help the person. But yeah, I can’t tell you that there aren’t times that it’s hard to see that as a priority when the person is so unstable.

Gabe Howard: It is certainly understandable from your perspective and I know you can understand it from ours. I hear so often in the bipolar community that this is such a huge issue and people just lack the words to understand it and they think that nobody else is talking about it. So I hope that this episode and the presence of Dr. Nicole has shown you that everybody’s thinking about it, everybody’s talking about it, and we have to self-advocate because having a great sex life is part of human experience. And if that’s what you want, bipolar or not, you should absolutely advocate for that. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” You can find that book on my website or Amazon, but if you get it on my website, I’ll sign it. That website is gabehoward.com.

Dr. Nicole Washington: And my name is Dr. Nicole Washington, and 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 I both travel nationally as speakers. You can find out more information on our respective websites. And, hey, we need you to do us a favor. Wherever you downloaded this episode, please follow or subscribe. It’s absolutely free and also tell a friend whether it’s social media, email, text messaging, word of mouth. I don’t invite everybody over for like a listening party. Sharing the show is how we grow and we will see everybody next time on Inside Bipolar.

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