Inside Bipolar Podcast: Treatment-Resistant Bipolar: Myth, Misunderstanding, or Medical Fact?

Is treatment-resistant bipolar disorder a real diagnosis, just a concept, or entirely made up? It may surprise you, but depending on your perspective, an argument can be made for all three. Join Gabe Howard, who lives with bipolar disorder, and Dr. Nicole Washington, a board certified psychiatrist, as they demystify what “treatment-resistant” bipolar disorder means.

This candid conversation unpacks whether this label is in the DSM, what qualifies as an adequate trial of medication, and why the term can feel so daunting. Dr. Nicole reveals how the concept is rooted in treatment response — not symptom severity — and why patience and persistence are critical to finding stability.

Gabe shares his personal journey of recovery, proving that treatment resistance doesn’t mean hopelessness. If you’ve ever felt frustrated with your treatment progress or questioned why recovery takes so long, this episode will give you clarity, hope, and a fresh perspective. Don’t let this label confuse you — tune in to understand the truth behind the term.

“As we talk about treatment-resistant bipolar disorder, I want people to know that it doesn’t mean meds won’t work for you. And in fact, I want to give you a little challenge. There are over 250 available psychiatric medications to treat bipolar disorder. The average person with bipolar disorder is taking three medications. Some people more, 4 or 5. But using the 250 available medications, the average cocktail of three, that’s over 2.5 million combinations before you can say that it’s not going to work for you.” ~Gabe Howard

Our host, 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.

To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com. You can also follow him on Instagram and TikTok at @askabipolar.

Our host, 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.

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 everybody, welcome to the podcast. My name is Gabe Howard and I live with bipolar disorder.

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

Gabe: Before we jump into the episode, we want to remind everybody that we love hearing from you. Hit us up at [email protected] with all of your topic ideas, and if you want to see clips from the show, you can follow Dr. Nicole and I on social media. She’s over there @DrNicolePsych and I’m @AskA Bipolar on TikTok and Instagram. Just just find us. It is really cool, right?

Dr. Nicole: Yeah, and we’re cool.

Gabe: Yeah. And people need more of us.

Dr. Nicole: Yeah. Yeah. They do.

Gabe: In smaller doses with pictures. Dr. Nicole, today we’re going to be talking about treatment resistant bipolar disorder. And in preparation for this episode, it was interesting because again, you think about it like a doctor. I think about it like a patient, but that’s not really the interesting part. What’s interesting is that I kind of don’t believe it’s a thing. And you’re like, well, it’s not, but it is. And then we started having a semantics discussion that eventually led to you saying, just turn on the recorder because I don’t even know what you’re doing anymore. And here we are. So I don’t know how this is going to go. I hope everybody is excited for the journey as I am.

Dr. Nicole: I. I don’t know how it’s going to go either. We’ll see if we’re still talking at the end of this. Are we still are we still liking each other at the at the end of this episode?

Gabe: I think we do a good job of modeling that disagreement does not equal disrespect. Even though you’re wrong, the. So let’s rip the Band-Aid off. One of the reasons that I struggle with the whole treatment resistant bipolar disorder is it’s not for scientific reasons. It’s for my email box, it’s for my DMs. It’s for my support groups. It’s for my peer support work. It’s for my private conversations where people tell me, like, I have treatment resistant bipolar disorder medication doesn’t work for me, and that’s why I don’t take it. And I’m like, wait a minute, wait a minute, wait a minute. What do you what do you mean? Like you were diagnosed with treatment resistant bipolar disorder. And like my doctor said, I have treatment resistant bipolar disorder and that’s why they don’t prescribe me meds. You know, you scratch below the surface and just it falls apart immediately for a variety of reasons. But I just want to ask you and I want to ask a very medical. Right. Like, like put on your your Dr. Nicole hat.

Dr. Nicole: Mm-hmm.

Gabe: Is treatment resistant bipolar disorder an actual diagnosis?

Dr. Nicole: It is not a diagnosis. It is not in the DSM. There’s no modifier for treatment resistant bipolar disorder in, in the DSM. It’s not a thing in there. So it’s not a diagnosis. Your diagnosis is still bipolar disorder but it is a thing. It exists. It’s a concept that we can wrap our hands around. The problem is that we don’t have a very firm definition of what treatment resistant bipolar disorder is. Now, if you look up studies about treatment resistant bipolar disorder, a lot of them will use the definition, which I guess has become the definition as failure in two or more interventions. So that’s when we say, okay, somebody has treatment resistant bipolar disorder failure and two or more interventions on the surface. I mean, as you sit back and think about it, you think, well, that doesn’t sound like a lot. I mean, that that doesn’t sound like you gave it a good try. That that sounds like we tried a couple things and we said, oh, well, you’re treatment resistant. It does sound like we gave up a little a little early. I will admit, it does sound like we gave up a little early or we put somebody in.

Gabe: I’m also curious as to what an intervention is,

Dr. Nicole: Well,

Gabe: Right? Not not. I apologize for interrupting,

Dr. Nicole: No.

Gabe: But it’s just when you said intervention. Like, if you put me on one drug and then you add a second drug, there’s two. So if I come back and you need to add a third, isn’t that three interventions? Is one intervention the inpatient psychiatric. And the second intervention is the first medication because there’s the two. So what about if you put me on a drug, and then you you notch it up, right? You put me on the low dose, and then that’s two, right?

Dr. Nicole: Well, that’s not two.

Gabe: I think that’s confusing me as well.

Dr. Nicole: So, we do typically think of it as in practice. I’m thinking of it as we tried. We had a regimen going and then we were trying different things. And if we’ve changed meds a few different times, that’s what we would consider. But this is where the tricky part comes in. It’s an adequate trial. It’s not a trial. It’s not just oh, I took it for two days. So somebody says, oh, I took four different drugs for bipolar disorder and none of them worked. And then you start digging and you realize they didn’t take them every day. They weren’t consistent with taking them. They gave up after a week or two. Like those aren’t adequate trials. So then I don’t count those. You know, when I’m going through a medication history with people and I say, okay, tell me all the things you’ve ever taken for your fill in the blank bipolar disorder, schizophrenia, depression. And they start naming drugs and they’re like, oh, I took lithium. Okay, tell me about when you took lithium. Oh, I took it, and, I don’t know, I felt funny. I didn’t feel much better, so I stopped it after a week. Okay. Did you ever get your lab done? Did you ever follow back? No, I just I just didn’t.

Dr. Nicole: Okay. I took I took valproic acid. Okay. So how did that go? I don’t know, like, I felt like my appetite was increased. I just kind of quit it after a couple of weeks. Okay. Okay. What else did you take? And they go down the list of. Oh, I took these things, but you find out they didn’t take it long enough or they didn’t take it consistently enough. Those don’t count. And we got to get you to a good dose. So we’re talking about you and your doctor got you up to a therapeutic level. You took it long enough. You took it consistently. All of those things have to be in place for us to consider a medication, to have had an adequate trial. And a lot of times, unfortunately, I don’t see adequate trials, especially in the beginning when there’s lots of symptoms, because sometimes your symptoms get in the way of you being consistent and that can interfere with the process of adequate trials. So it is a thing, we think of treatment resistant bipolar disorder. But it I’m looking for very specific things to happen for me to consider someone to have treatment resistant bipolar disorder.

Gabe: I think that some people believe that treatment resistant bipolar disorder means that they have more serious symptoms. But it sounds like you’re saying that treatment resistant bipolar disorder means you’re not responding as favorably or as quickly or as. What word am I looking for here? Dr. Nicole, it’s not about the symptoms, right? It’s specifically about how you’re responding to treatment.

Dr. Nicole: Yeah, it’s the treatment response. So you could seemingly have symptoms that aren’t as severe as someone else standing next to you and not respond. It isn’t really based in how severe your symptoms are. I mean, I think if we think about somebody who’s manic, I think we would all agree that the person who’s manic, who runs naked down the street near an elementary school and gets put on a sex offender list, that would be a more intense kind of severe mania than the person who, you know, spent $500 on bubble gum at the at the Dollar General. Those are those are different intensities of how serious. But when we talk about the response and treatment resistance, it’s not really based in how severe your symptoms are.

Gabe: So you can have mild symptoms. But if those symptoms aren’t clearing up after you’ve tried two, three,

Dr. Nicole: Yeah.

Gabe: Four different types of interventions, then that would be treatment

Dr. Nicole: Yes.

Gabe: Resistant bipolar disorder, where if you have this extraordinarily severe case, but the very first treatment out of the gate works, even though, again, and I hate to compare,

Dr. Nicole: Yes.

Gabe: You know, a person with bipolar disorder to another person, but for the purposes of this example, it’s just all about the response to treatment.

Dr. Nicole: Yes, yes.

Gabe: It’s not judging how severe your bipolar disorder is.

Dr. Nicole: Yes. Yes, but I would argue with you that the person who can’t get control of their symptoms will likely feel that this is severe. Like it won’t go away. This thing is not going away. I think that person would argue. So that’s why it’s good not to compare. Because that person would argue like, yeah, that’s a really bad thing happened to that person. But man, they sure responded quickly to meds and now they’re stable. And here I am still dealing with this. So it is very dangerous to it is very dangerous.

Gabe: And of course, to clarify, it’s it’s it’s kind of luck, right? Nobody really understands why one person with bipolar disorder responds immediately to this treatment and another person doesn’t. It’s it’s why it’s individualized. If this if this were simpler, we wouldn’t need Dr. Nicole to just be over-the-counter bipolar medication. I just just take a quiz online, discover you have bipolar disorder. Go buy “bipol-away.” I’ve decided that’s the name of the drug, bipol-away. And you would just take it, right? The very fact that you need a Dr. Nicole shows you how difficult this is. And it really just boils down to I hate to keep saying luck, but I mean, am I stating that correctly? You don’t know which one of us is going to respond favorably or positively or easily, or have a good time? You’re using an educated guess, a deductive reasoning, and your medical experience to try observe and then adjust. And whatever happens biologically is, well, luck.

Dr. Nicole: I mean, I guess if you think of genetics and biology as luck. I mean, who knows why somebody drew one genetic card and somebody drew another? We don’t know. I mean, why do you even have bipolar disorder in the first place? Because genetically, biologically, there was there was something different about you than somebody else. And we know that there are genetic predispositions when you have family members with bipolar disorder. But then we also know that there are people with no family history of bipolar disorder who then go on to develop the illness. We don’t know. And so if you’re saying, look, in the sense of you were lucky enough to genetically be predisposed to respond, then yeah, I mean, I guess I would consider that. Consider that luck.

Gabe: I just want to base this in a little medical reality and get outside of bipolar disorder for a moment to make sure we’re all playing with the same cards. The reality is, is multiple people are diagnosed with, let’s say, cancer every year. Some people immediately respond to radiation. They immediately respond to chemotherapy, they make full recoveries, they go into remission. And other people who have the same diagnosis, who are the same age and, and everything else, they don’t. And we don’t know why. It’s not a personal failing. It’s my point. And I, I think we understand this in other areas. But whenever people with bipolar disorder are struggling, they tend to internalize it more

Dr. Nicole: Mm-hmm.

Gabe: And society tends to blame them more.

Dr. Nicole: Yes.

Gabe: But this is just how medical science works.

Dr. Nicole: Yes.

Gabe: Some people respond better than others.

Dr. Nicole: No, that that is true. And nobody blames the cancer patient for not responding. They don’t blame that person because your tumor didn’t respond. You must have done something wrong. Nobody does that. But we do have a way of blaming people with whatever the mental illness is when they don’t respond to the medication.

Gabe: I am completely aligned with you saying that somebody is treatment resistant. Just so you know, just just so nobody thinks that Dr. Nicole and I are actual enemies. Like, it does make sense to me. But what I worry about is I think it carries more weight with the patient than it deserves to carry.

Dr. Nicole: Okay.

Gabe: I think what you’re saying is you’re a harder case and we’re going to have to work harder.

Dr. Nicole: Yeah, absolutely.

Gabe: Harder. And I think what the average patient hears is nothing will work for me. I’m in a special class of people who cannot be treated, and I think there is a very large disconnect between what you’re actually meaning and what patients are actually hearing or understanding. What patients are understanding is probably a better word because they really believe that they’re special. They have a worst case than the average. They’re there, they’re suffering more. It spirals into the dark abyss very quickly, which of course is understandable because they’re sick with bipolar disorder. It’s very easy to spiral when you’re not in recovery and when you’re sick and when paranoia, anxiety. So it’s understandable how we get here.

Dr. Nicole: Mm-hmm.

Gabe: But I think anybody listening is like, well, I have treatment resistant bipolar disorder. There’s no hope for me. I don’t think that’s what’s being said. I think they’re just saying we got to put in a little extra elbow grease.

Dr. Nicole: Yeah. I mean you know there are studies out there that will say you know up to a third of people don’t respond to adequate doses of medication. You may be in that third, you know, and I could 100% see how as a person living with any disorder, if someone tells you you have a treatment resistant version of that disorder, that it would make you think all hope is lost. There is no hope. I cannot be treated? So why should I even bother? And I get that. I could see how if someone said those words. But I will tell you, I have never said those words to somebody. I can in my brain conceptualize somebody as treatment resistant. But I don’t know that I’ve ever told a patient, you have treatment resistant bipolar disorder. I don’t think I’ve ever used those words with a patient. I don’t think I’ve ever told someone you have treatment resistant depression. I just don’t think that’s terminology I’ve ever used with a patient.

Gabe: See, I think the average patient doesn’t understand

Dr. Nicole: Yeah,

Gabe: That at all. Right? They’re

Dr. Nicole: Yeah.

Gabe: Like, I went to I went to the doctor. I saw my Dr. Nicole Dr. Nicole gave me a prescription. I filled the prescription. I put the drug in my mouth. It didn’t work. I’m done.

Dr. Nicole: Yes, yes.

Gabe: And there are so many misunderstandings. We don’t even have time to fall down all of the rabbit holes about the misunderstandings of treatment for bipolar disorder. But. But keeping on treatment resistant depression because this comes up a lot. I agree that some people are harder to treat than others, but what people are really hearing, and I’m not trying to belabor this point, but what they’re hearing is that they have a special case or a worst case or a more difficult case, and their odds of reaching recovery are are either lower than expected or zero. And it doesn’t sound like that’s what you’re saying. You might be saying that their journey is longer,

Dr. Nicole: Mm-hmm.

Gabe: But even with people with treatment resistant bipolar disorder, do you see paths to recovery for them?

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Dr. Nicole: And we’re back discussing what it means if you have been told that you have treatment resistant bipolar disorder.

Gabe: Is it less likely that they will reach recovery, or does this mean you have to work harder? You being Dr. Nicole?

Dr. Nicole: Well I do have to work harder because I have to get creative sometimes. And sometimes we have to combine things and sometimes we have to go outside of what we would normally do. I do have to work a little bit harder in those cases. You also have to work a little bit harder because you have to not give up and you have to kind of stay the stay the course and keep the fight and not give up. After you’ve tried a couple things and you haven’t been able to achieve mood stability. But the other thing we always have to talk about in this is there is the reality for some people that they never reach that symptom free for years and years and never have an episode or any kind of symptoms. That’s just not some people’s reality. And so we then have to define what are we, what are we doing here? Why are we doing this? What are we trying to improve. That’s the whole reason you keep going back for appointments monthly. I think a lot of times what I see is my folks with bipolar disorder are very all or nothing like either. I’m completely stable and I don’t have any symptoms or I’m a failure in my treatment. Like that isn’t the case. There has to be. There has to be something in between those two roads, because that’s just not everybody’s path.

Gabe: So let’s jump in a different direction. There’s a couple of things that I that I think about, and I want

Dr. Nicole: Okay.

Gabe: To use my personal story to illustrate this. So the first thing is I, you know, I looked up online, according to the National Institute of Mental Health, 12 to 18 months from time of diagnosis until time of recovery,

Dr. Nicole: Okay.

Gabe: The average amount of time is 12 to 18 months. Now, it took me four years. So four years is a lot longer than 12 to 18 months.

Dr. Nicole: Yeah.

Gabe: Now, a couple of things here I just want to point out, I don’t know what the average time from diagnosis to recovery was 20 years ago when I was diagnosed. But, you know, fill fill it in for the purpose of this podcast and the purpose of this discussion, it took me longer to reach recovery than the norm.

Dr. Nicole: Okay.

Gabe: Is this the kind of thing that when somebody says treatment resistant bipolar disorder that could cover it, you could say, well, Gabe, it sounds like you struggled a lot to find the right treatment. So you may not believe in it, but that type of distance, I bet your psychiatrist I bet your Dr. Nicole was thinking this guy’s got some treatment resistance going on.

Dr. Nicole: Well, I mean, let’s talk about earlier on in that, in that four years, were you consistently taking medication as prescribed?

Gabe: Yep, I was perfect.

Dr. Nicole: You were?

Gabe: Sincerely, sincerely.

Dr. Nicole: You were, you were taking it

Gabe: I was perfect.

Dr. Nicole: Okay. So then that that if you were taking the medications and you were taking it as they were prescribed, and you tried multiple things before you found the right thing. You could have, by definition, been considered to have a treatment resistant bipolar disorder, but they didn’t give up on you and you didn’t give up on you. And so, like we said, it took you a little bit longer to get to get to that point. You had this point off in the distance where you knew you wanted to be, but it took you a little bit longer to get there. Maybe sometimes you crawled instead of walked. Maybe sometimes you walked instead of jogged, but eventually you got to that point that you wanted to be at. It just took you a little bit longer. And then some of it, I think, is based on expectation. Your expectation, I’m sure, was to feel better right away.

Gabe: Oh, there’s no doubt about it. I had a very, very large misunderstanding of how the treatment for bipolar disorder worked, and I think that’s worth discussing as well. There are so many myths and misunderstandings surrounding medication. We’ve covered them on this podcast before, but one of the biggest misconceptions of medication is that it works like it does on television. It basically has been reduced to a headache medication. The person has a symptom of bipolar disorder. They take the medication, the symptom goes away. Right. So again, to compare it to the headache medication, a person has a headache. They take Tylenol, aspirin, ibuprofen, Aleve whatever. And then suddenly the headache goes away. That that that’s this is serious. This isn’t a headache. This isn’t an over-the-counter drug. This is this is I think this contributes to this extra mythos surrounding treatment resistance and what exactly it means. And it is not lost on me. The irony of the fact that I don’t believe that treatment resistant bipolar disorder is an actual thing. I think it’s just sort of a shorthand for a difficult case. And I myself have

Dr. Nicole: Mm-hmm.

Gabe: Treatment resistant bipolar disorder based on everything that we’ve discussed. So I do hear my own hypocrisy, but I also want people to hear that I got through the four years.

Dr. Nicole: Yeah.

Gabe: And I do think, and this is very important and meaningful to me, and I hope it’s meaningful to the listeners as well. I do reflect back and worry that if somebody would have told struggling Gabe at the two-year mark, when I know that I’ve been med compliant, I know that I’ve shown up for all my appointments on time. I know that I’ve gone to all the groups and done all the homework, And I’m doing everything I can, and I would have had an authority figure, a Dr. Nicole say, oh, you have treatment resistant bipolar disorder. What it would have sounded like to me is we’ve done everything we can for your health issue, and you’re just one of these people that can’t be helped.

Dr. Nicole: So two years in, would you say you were better than you were at day zero?

Gabe: You win. Yes, I was absolutely better two years later than I was on day one, but I was not in recovery. I was not able to hold down a job. I was still irritable. I was still getting in toxic issues. I still had a lot of symptoms. Nobody would have called me in recovery, but I was no longer suicidal and I was no longer seeing demons. And those two things are huge.

Dr. Nicole: So, you were improved.

Gabe: I was huge improved, but I was still struggling with some delusions

Dr. Nicole: Okay.

Gabe: And I was still having some very serious symptoms. But oh yeah, yeah, I was way better

Dr. Nicole: Yeah.

Gabe: Off. I was I was so much better off.

Dr. Nicole: So, I think then on my end and I will say the danger of labeling something treatment resistant, there is the danger that you worry that your Dr. Nicole whether you know, consciously or subconsciously, then kind of stops making recommendations or stops trying things because they just decide, well, this is about as good as it’s going to get for you. Gabe, it’s been two years. This is about as good as you’ll be. Like, there is a danger in that because we’re human. And so I think we have to work hard at not giving up on people and continuing to try and having it be a discussion where we’re a team and we’re talking about what our options are and what the benefits of trying this and the risk and kind of doing that with each other. There’s the benefit of that. And then on the patient end, you you really have to not give up. I mean, if Gabe had given up at two years, he would not be sitting here with me today and and wouldn’t and wouldn’t we all be worse off without Gabe sitting

Gabe: Awww. [Laughter]

Dr. Nicole: Here today? So, I mean, you have to put the work in. I mean, it’s hard, though. It’s not easy. It’s not easy for either side.

Gabe: Comparison is the thief of joy. And we’ve talked about this before, and I think sometimes thinking that you’re worse off because you’re comparing yourself to somebody that doesn’t have this label, that doesn’t have the treatment resistant bipolar disorder, etc.. I think you’re doing that comparison thing. I think it’s okay to understand that, that your psychiatrist, who sees lots of people with bipolar disorder, might consider you to be a harder case, who needs longer to reach recovery, who has to put in more work? Who has to try harder, who needs four years instead of the 12 to 18 months? But I still really get back to this. This concept of treatment resistant bipolar disorder is, it seems, just like a note in a chart.

Dr. Nicole: Yeah.

Gabe: It really doesn’t seem to have any other meaning other than maybe a guide to how long or how hard you need to work. And I kind of want everybody to know that it takes as long as it takes, and you need to work really, really hard for ever.

Dr. Nicole: Yeah.

Gabe: So in a way, I just I see it as such a throwaway line anyway.

Dr. Nicole: Yes.

Gabe: And, but, you know, we’re doing this topic because it shows up in our

Dr. Nicole: Yes.

Gabe: Email boxes. It shows up in search engine optimizations. It shows up in questions on Healthline.com over and over and over again. How do I defeat treatment resistant depression? And it really seems like the answer to that question is you try harder, you work harder, and you keep going back to your Dr. Nicole and I think people want a better answer than that. Is

Dr. Nicole: Yeah.

Gabe: There a better answer than that?

Dr. Nicole: I don’t think there is a better answer than that. I mean, you said, you know, it’s kind of a throwaway term, kind of a note in the chart or a note in the margin for us, so to speak, to just signify to us that, okay, this person’s bipolar disorder is a little more stubborn and we need to work a little bit harder to to get it to do what we want it to do. And maybe that’s why, you know, your doctor has said, oh, you’re treatment resistant bipolar disorder. We’ll try this. We’ll try that. They probably weren’t thinking about it in the way that you received it. And that’s where the disconnect comes.

Gabe: I was 26 years old when I was diagnosed with bipolar disorder. Up until that point, every time that I had gotten sick, I had gone to a doctor. A doctor prescribed me a drug. I filled the drug at the pharmacy, took the drug, and I got better within a few weeks. And that’s exactly what I thought was going to happen here. Even though I was admitted to a psychiatric hospital, even though I was diagnosed with bipolar disorder, a severe and persistent mental illness, even though there was every indication that this was not just the flu or a run of antibiotics or a sickness that was even going to cause me to miss a couple of weeks work, even though there was every indication that this was severe and serious and nothing that I had ever gone through before. My only thought process is I’ve been through this. I’m just going to take the medicine as prescribed, follow it until I run out and not stop when I feel better and this will all be over. And you can only imagine my surprise when that didn’t happen.

Dr. Nicole: [Laughter] Yeah, I agree with all that. And I would say if you are somebody who has been told you have treatment resistant bipolar disorder, or let’s say you just saw it in a forum and somebody said, oh, I have treatment resistant bipolar disorder. And then you went and looked it up and you saw that it said, oh, two or more failed trials and you thought, oh crap, I have treatment resistant bipolar disorder. I challenge you to take that information back to your psychiatrist and have a discussion about treatment resistant bipolar disorder and what that means specifically for you, instead of just taking it as all hope is lost and giving up.