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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by CJ Young on March 7, 2002, at 14:26:53
I'm on 50mg Seroquel, 400 Wellbutrin, 300 Effexor, 60mg thyroid
and xanax (.25mg) to help me sleep. I had seizures as a child and
recently had another one which I chalked up to accidental overdose of the above
drugs due to time-zone changes while traveling to asia.My problem is this--I am in a PhD program in literature and faced with
what seems to be my inevitable departure from the profession. I cannot
think properly, my memory is astonishly deficient--the hundreds of books I have
read are no longer accessible to me in my mind. It is heartbreaking to
pick up a book and have no memory of having read any of it. Marginalia
appear foreign.The qualities I valued most were my verbal acuity, creativity, and eloquence.
My emails would leave friends and colleagues on the floor laughing. Distance
never came between myself and my friends on the other side of the country because
I could express myself perhaps better than I could if I were there. I no longer
write emails anymore and have lost touch with my friends.I cannot find words. My boyfriend, a brilliant man who fell in love with me
before I was on medication, is heartbroken that the medication does not
allow people to know me or my intelligence. Sometimes I think he is talking
about himself too.My mind operates at about 10% capacity versus prior to the meds. When your life,
your identity, your passion are circumscribed by your intellect, you are left with
nothing but the consciousness of your loss.In this case, ignorance is not bliss, but agony. I feel I need to make a decision.
Severe, treatment-resistant bipolar II depression with borderline personality disorder
OR mediocre quality of life emptied out of all content and meaning.I cry all day. I have lost everything just so that I can keep living.
Please share your experiences.
Posted by Blue Cheer 1 on March 7, 2002, at 16:37:31
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
> I'm on 50mg Seroquel, 400 Wellbutrin, 300 Effexor, 60mg thyroid
> and xanax (.25mg) to help me sleep. I had seizures as a child and
> recently had another one which I chalked up to accidental overdose of the above
> drugs due to time-zone changes while traveling to asia.
>
> My problem is this--I am in a PhD program in literature and faced with
> what seems to be my inevitable departure from the profession. I cannot
> think properly, my memory is astonishly deficient--the hundreds of books I have
> read are no longer accessible to me in my mind. It is heartbreaking to
> pick up a book and have no memory of having read any of it. Marginalia
> appear foreign.
>
> The qualities I valued most were my verbal acuity, creativity, and eloquence.
> My emails would leave friends and colleagues on the floor laughing. Distance
> never came between myself and my friends on the other side of the country because
> I could express myself perhaps better than I could if I were there. I no longer
> write emails anymore and have lost touch with my friends.
>
> I cannot find words. My boyfriend, a brilliant man who fell in love with me
> before I was on medication, is heartbroken that the medication does not
> allow people to know me or my intelligence. Sometimes I think he is talking
> about himself too.
>
> My mind operates at about 10% capacity versus prior to the meds. When your life,
> your identity, your passion are circumscribed by your intellect, you are left with
> nothing but the consciousness of your loss.
>
> In this case, ignorance is not bliss, but agony. I feel I need to make a decision.
> Severe, treatment-resistant bipolar II depression with borderline personality disorder
> OR mediocre quality of life emptied out of all content and meaning.
>
> I cry all day. I have lost everything just so that I can keep living.
>
> Please share your experiences.The combined effects of the medicines you're taking can cause a lot of cognitive impairment. Are you clearer when you're not taking them, or all of them at those doses?
How long have you been ill? It's good that you recognize you're not well, but adaptation to your illness can be hard to do. It took me at least 7 years. Do you feel as "deficient" when you're not depressed? You have to accept that things won't be as easy as they once were (at least some of the time), and that you should strive to make it back to where you can continue to build on what you've achieved (which is considerable), and not think of yourself as "flawed" or develop an ego-damaging self-concept of being a "mental patient." I remember feeling as you do whenever I went from being high-functioning (e.g., working as a university administrator for several months, then sleeping on a rooftop (or in a refrigerator box in an alley) of the Moonie headquarters. I can assure you that with proper psychiatric care and support from friends and family, that your reading, memory and other intellectual abilities will return. The thing to do is to recognize you have to get on top of your illness fast and while you're young, stay on top of it, and make the necessary adjustments in your life. The worst thing you can do is to try to pretend that it'll go away. Also, psychotherapy and developing a relationship with a therapist who can get to know you is important. Maintaining friendships and family relationships, too.Keep your spirits up,
Blue
Posted by Zo on March 8, 2002, at 1:58:49
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
You do know, don't you, that your post was incredibly literate, beautifully written? Everything is not gone--and what is lost (I am speaking from my own experience) reforms in unpredictably interesting ways. I understand you're feeling a tremendous sense of loss. I'd also be interested to know if your meds are being overseen really, really well. Wellbutrin, for example, carries some small seizure risk--and it's entirely possibly there's something in that strong combination, high doses of several powerful meds, that isn't working for you.
No, this needs looking at before we write you off!
Best,
Zo
Posted by Geezer on March 8, 2002, at 9:40:00
In reply to Re: Severe decrease in cognitive function » CJ Young, posted by Zo on March 8, 2002, at 1:58:49
>
>
> You do know, don't you, that your post was incredibly literate, beautifully written? Everything is not gone--and what is lost (I am speaking from my own experience) reforms in unpredictably interesting ways. I understand you're feeling a tremendous sense of loss. I'd also be interested to know if your meds are being overseen really, really well. Wellbutrin, for example, carries some small seizure risk--and it's entirely possibly there's something in that strong combination, high doses of several powerful meds, that isn't working for you.
>
> No, this needs looking at before we write you off!
>
> Best,
> ZoProbably won't sound very enticing but let me suggest AN UNQUIET MIND (first), then TOUCHED WITH FIRE - both by Kay Redfield Jamison. Jamison is a Phd. and about as good as they get in Bipolar disorder (she is Bipolar I). I am Bipolar II like you. You have some very important choices to make. Blue & Zo have given excellent comments - all is not lost, honest!
Geezer
Posted by Ponder on March 8, 2002, at 13:38:59
In reply to Re: Severe decrease in cognitive function, posted by Geezer on March 8, 2002, at 9:40:00
CJ,
Your post nearly brought me to tears. I relate strongly, having been quite successful in an intellectually demanding career and having a respectable publication portfolio from freelancing on the side.I often question my own intellectual functioning and wonder if that quick, incisive mind is gone forever -- and what is causing the decline? Is it meds or is it the illness?
I am Bipolar II. I used to doubt the diagnosis, but now have become convinced (another story). My "smart self" does, indeed, return when the depressive part of my illness lifts, but, alas, this competitive world demands consistent, not episodic performance.
I agree that early and effective intervention and treatment is crucial. It IS possible to get stabilized on meds and be functional enough to maintain your career, but I know how difficult that is while the job pressure is still heavily, and impatiently upon you.
I agree with a previous post that the meds you're on are probably contributing to your cognitive difficulties. I also question the selection of meds (I'm not a doctor, just an experienced patient). And I wonder what else you may have tried. Mood stabilizers are important, but some are more "dulling" than others and somtimes those effects can be ameliorated by another drug used in combination. Lamictal has been good for me.
I haven't read the books recommended above, but think I will now. I will be thinking of you and hope you will continue to post. BTW, I found this board during one of my depressive episodes, but did not have the cognitive functioning to figure out how to register for a year. Geesh! Clearly, you're doing better than that!
Posted by Chris A. on March 8, 2002, at 20:42:50
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
When your life,
> your identity, your passion are circumscribed by your intellect, you are left with
> nothing but the consciousness of your loss.I identify strongly with your pain and sense of loss, because I am there. Depression, meds and seizures all can have effect on cognition. For me it was the ECT that most likely did the worst damage. Thorough neuropsych testing revealed "mild cognitive impairment comparable to that typically seen in epilepsy patients." When I am very depressed my thought processes come to a complete halt. Intellect and education are valued highly in my family, so I've staked my self worth on them, which isn't good.
Med changes might help. I am diagnosed bipolar, mixed, 99.9999% depressed. Lamictal is the best mood stabilizer for me, not dulling like the others. ADs make me more depressed. Bottom line: They threaten homeostasis and my brain over-corrects. The closest analogy I can think of is driving off the shoulder of a road in a vehicle at a high rate of speed, turning the steering wheel and ending up in a ditch. When trying to pull me out of bipolar depression my doc has me use a light box, small doses of selegiline (Eldepryl, Deprenyl) very judicously. Excercise helps if i can force myself to move. I am trying to get off of the Ambien I've been taking for several years, as it may also be impairing my cognition.
From reading this you would never know that I used to write. I've also lost touch with friends and family because it is difficult to communicate, which adds to the depression.You sound quite articulate, so don't give up on yourself.
Blessings,
Chris A.
Posted by trouble on March 9, 2002, at 1:52:11
In reply to Re: Severe decrease in cognitive function, posted by Chris A. on March 8, 2002, at 20:42:50
Hey CJ,
Over on PSB there are some threads that might lift your spirits or at least make you feel less alone. One's called BI-POLAR ARTISTS or something like that, it's fairly recent.
Didja ever heat that the leading vocation of bi-polar sufferers is creative writing? I made a list of them in my journal and it's two pages long! I can recmd a few books on creativity and madness if your're interested, an evening w/ one of them can leave me almost proud to be a headcase.You take care,
trouble
Posted by fachad on March 10, 2002, at 9:19:44
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
How bad were the problems that led you to take 50mg Seroquel, 400mg Wellbutrin, 300mg Effexor, 60mg thyroid, and .25mg of Xanax?
Sometimes I think people jump into, or get into a "slippery slide" into taking high doses of multiple meds, for problems that are real, but not severe enough to merit the meds they are on.
It's a choice you have to make yourself. Think about this example.
Someone who is suicidal depressed responds to Elavil, but gains 100lbs. That person may say "being fat stinks, but I was in hell before, so it was worth it.
Contrast that with someone who is dysthymic, mildly depressed and responds to Elavil, but gains 100lbs. That person will say, "I was feeling a little sad before, but now, being so fat, I am totally miserable."
The question is "was it worth it?"
Two things come to mind when I read your story.
First, ask yourself how bad off would you be without meds? I'm NOT suggesting that you just quit all meds cold turkey, just that you stop and ponder if the price you are paying in cognitive impairment is worth the benefit you are gaining from meds.
Second, ask your pdoc if your meds could be optimized to minimize cognitive impairment. Ask if there are ways to treat your symptoms without fogging your brain.
For example, if you wanted to minimize weight gain, Elavil would be a bad choice. But if you wanted to minimize insomnia, Elavil might be a good choice.
Each med has a unique profile, none are perfect, but you can carefully select meds to minimize side effects that are particularly bothersome to you.
A supermodel may embrace a significant amount of cognitive impairment (not losing much really - grin) but be adamantly against weight gain. An aerospace engineer may accept some weight gain (not necessary like it, but accept it) if her symptoms are relieved without cognitive impairment.
Optimize on tolerability. Decide which symptoms and which side effects are not tolerable, and what you will tolerate, and make some rational choices.
Finally, if they are not contraindicated by some other condition you have, pstims like Ritalin, Dexedrine, or Adderall may be of substantial benefit to you.
This is not like some college student abusing stims to cram for exams. This is about your core functionality as an academic professional being deteriorated by both psych problems and by psych meds. It is at least worth asking you pdoc about.
Your innate intelligence is your greatest asset. Use it as a way to take an active part in your recovery, and do research to optimize your medication regimen.
I don't usually get this preachy, but I really feel for your predicament.
> I'm on 50mg Seroquel, 400 Wellbutrin, 300 Effexor, 60mg thyroid
> and xanax (.25mg) to help me sleep. I had seizures as a child and
> recently had another one which I chalked up to accidental overdose of the above
> drugs due to time-zone changes while traveling to asia.
>
> My problem is this--I am in a PhD program in literature and faced with
> what seems to be my inevitable departure from the profession. I cannot
> think properly, my memory is astonishly deficient--the hundreds of books I have
> read are no longer accessible to me in my mind. It is heartbreaking to
> pick up a book and have no memory of having read any of it. Marginalia
> appear foreign.
>
> The qualities I valued most were my verbal acuity, creativity, and eloquence.
> My emails would leave friends and colleagues on the floor laughing. Distance
> never came between myself and my friends on the other side of the country because
> I could express myself perhaps better than I could if I were there. I no longer
> write emails anymore and have lost touch with my friends.
>
> I cannot find words. My boyfriend, a brilliant man who fell in love with me
> before I was on medication, is heartbroken that the medication does not
> allow people to know me or my intelligence. Sometimes I think he is talking
> about himself too.
>
> My mind operates at about 10% capacity versus prior to the meds. When your life,
> your identity, your passion are circumscribed by your intellect, you are left with
> nothing but the consciousness of your loss.
>
> In this case, ignorance is not bliss, but agony. I feel I need to make a decision.
> Severe, treatment-resistant bipolar II depression with borderline personality disorder
> OR mediocre quality of life emptied out of all content and meaning.
>
> I cry all day. I have lost everything just so that I can keep living.
>
> Please share your experiences.
Posted by bookgurl99 on March 10, 2002, at 10:46:30
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
CJ,
I've just recently begun experiencing something similar; my doctor says that it is due to reduced levels of neurotransmitters, possibly caused by a reaction to Luvox.
Luckily, in animal studies, those with depleted levels of neurotransmitters were eventually able to replenish them to almost-normal levels. I'm hoping that I have the same response.
Is it possible that your experience could be due to the same thing? I have been pushing for further medical examination of this, despite my doctor's initial attempt to minimize the problem (they tend to feel that we 'head cases' are overreacting hypochondriacs), and hope that you do the same.
Good luck, CJ! Here's to hope.
Elisa (bookgurl99)
p.s. I don't know where you live, but the evergreen has been a symbol of hope for me right now. I see it, green among snow, and am reminded that spring will come.
Posted by Chris A. on March 10, 2002, at 20:28:00
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
CJ,
What I --forgot-- to mention in my post was the most important thing I was going to say. Aricept or one of the other anticholinesterase inhibitors such as Excelon may help. The most respected psychopharm/mood disorders expert in my region of the country told me that they could improve cognitive functioning regardless of the cause. Excelon works best for me. Currently I'm not taking it because of some side effects, but that is too long a story to go into here.
I have jury duty tomorrow and am hoping to get disqualified because I worry about not being able to follow the arguments and remember who said what, etc. It is too embarrassing to tell them I am cognitively impaired or have bipolar disorder. On the otherhand, I think I have as much common sense and concern for justice as anyone.
Posted by CJ Young on March 10, 2002, at 22:14:27
In reply to Re: Severe decrease in cognitive function -P.S. » CJ Young, posted by Chris A. on March 10, 2002, at 20:28:00
Sincere thanks to everyone who responded. You all hit the nail on the head--I just ended a relationship with a
pdoc who was abusing his position as an acute psychological trauma/suicide prevention specialist to milk money out
of me. Looking back, it seems as if his guiding philosophy is to keep his patients
as heavily medicated as possible (when I complained about insomnia he just kept telling me to take more seroquel)
while he recklessly bills them $40 to call in refills, $38 to read emails, and leaves for weeks to attend academic
conferences where he airs his (he thinks) brilliant insights. I made two half-hearted attempts to find a new pdoc,
but I think I am still traumatized by this last experience. It is difficult to reconcile the idea that the person
who saved your life a number of times can also appear to consider your tortured existence to be a cash cow. I do
need to find a new one but don't know where to start looking.I did go out and buy Kay Redfield Jamison's _Unquiet Mind_ which in typical bipolar II style, I have already completed
over half of in the span of about 2 hours. It is a difficult read, mostly because you observe her
debilitating difficulties while at the same time noticing that you don't have the professional situation, the family, friends,
doctors, and string of extremely understanding lovers she had. How much more difficult will it be for you, then? Still, I am
glad to have found it as it forces pleasantly masochistic questions to the fore (another bp II classic) and I am now somewhat
disabused of my mania-envy.I hope I do not have to permanently exchange my bookshelf for my medicine cabinet when it comes to citing the
foundation of my identity. Extremely successful loved ones assure me that your underwear drawer or one's CD collection
are just as satisfying loci of one's sense of self. I have stopped trying to get them to imagine losing something so
integral to who you are that you cannot even conceive of it as something separable much less believe that you could continue
to exist without it. I keep up a private hope that somewhere in Virginia, Dick Cheney is tending to my back-up "shadow self."Recently, something happened which drove me to stop the seroquel altogether. I did, and my
verbal acuity returned to some degree, but so did the dark mood swings and depression. It is only the needs and desires
of others which move me to go off or back on again. Both states leave me too impaired to decide for myself.Thanks so much for your responses--clearly I need first & foremost to find a good, even average pdoc.
p.s. As for green as a sign of hope, I have been described by my allergist (who is also a pdoc--I'll explain that upon request) as
the second most allergic person he's ever met so maybe I'll pass on that (plus I live in N. California). For now, dark satiny brown will suffice
as it is the color of the inside of my lace-trimmed eyeshades;)
Posted by Zo on March 12, 2002, at 2:36:17
In reply to Thanks much . . ., posted by CJ Young on March 10, 2002, at 22:14:27
If that's just a *degree* of your verbal acuity. .. my my.
And, just to second your feelings about Kay Jamieson. . and for that matter, all these people who write books about their trials and tribulations---and have these *magnificent* support systems around them. Ha!
Zo
Posted by Andy123 on March 16, 2002, at 12:01:27
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
> I'm on 50mg Seroquel, 400 Wellbutrin, 300 Effexor, 60mg thyroid
> and xanax (.25mg) to help me sleep. I had seizures as a child and
> recently had another one which I chalked up to accidental overdose of the above
> drugs due to time-zone changes while traveling to asia.Of all the drugs I've taken, Effexor has affected my cognition the most. However, it's important to separate out what is a legitimate assessment of intellectual impairment. I think it is unlikely that anyone of us is permanently disabled because of these drugs. I had convinced myself that I was impaired, and clearly I am at times. But soon after one of those 'episodes,' I find myself comprehending fairly difficult material while studying (I'm a graduate student in physical chemistry.) So take your self assessments with a grain of salt!
-Andy
Posted by PsychoSage on February 19, 2004, at 18:20:44
In reply to Severe decrease in cognitive function, posted by CJ Young on March 7, 2002, at 14:26:53
> I'm on 50mg Seroquel, 400 Wellbutrin, 300 Effexor, 60mg thyroid
> and xanax (.25mg) to help me sleep. I had seizures as a child and
> recently had another one which I chalked up to accidental overdose of the above
> drugs due to time-zone changes while traveling to asia.
>
> My problem is this--I am in a PhD program in literature and faced with
> what seems to be my inevitable departure from the profession. I cannot
> think properly, my memory is astonishly deficient--the hundreds of books I have
> read are no longer accessible to me in my mind. It is heartbreaking to
> pick up a book and have no memory of having read any of it. Marginalia
> appear foreign.
>
> The qualities I valued most were my verbal acuity, creativity, and eloquence.
> My emails would leave friends and colleagues on the floor laughing. Distance
> never came between myself and my friends on the other side of the country because
> I could express myself perhaps better than I could if I were there. I no longer
> write emails anymore and have lost touch with my friends.
>
> I cannot find words. My boyfriend, a brilliant man who fell in love with me
> before I was on medication, is heartbroken that the medication does not
> allow people to know me or my intelligence. Sometimes I think he is talking
> about himself too.
>
> My mind operates at about 10% capacity versus prior to the meds. When your life,
> your identity, your passion are circumscribed by your intellect, you are left with
> nothing but the consciousness of your loss.
>
> In this case, ignorance is not bliss, but agony. I feel I need to make a decision.
> Severe, treatment-resistant bipolar II depression with borderline personality disorder
> OR mediocre quality of life emptied out of all content and meaning.
>
> I cry all day. I have lost everything just so that I can keep living.
>
> Please share your experiences.
I am so sorry you were feeling this way. Do you still read the board? I am bipolar also, and I suffer from concentration and studying troubles. I have been in and out of my undergraduate program at an elite university. Your message reminds me of Kay jamison's _An Unquite Moind_. I studied literature, and I hope to return soon to do so again.
Posted by Dr. Bob on February 21, 2004, at 1:30:53
In reply to Re: Severe decrease in cognitive function, posted by PsychoSage on February 19, 2004, at 18:20:44
> Your message reminds me of Kay jamison's _An Unquite Moind_.
I'd just like to plug the double double quotes feature at this site:
http://www.dr-bob.org/babble/faq.html#amazon
The first time anyone refers to a book without using this option, I post this to try to make sure he or she at least knows about it. It's just an option, though, and doesn't *have* to be used. If people *choose* not to use it, I'd be interested why not, but I'd like that redirected to Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
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