Side effects,mental lapses, cognitive difficulties

Hi all, This is a difficult subject for me to talk about. I have been asked at work why my speech is slurred or I mix up words. My boss is very understanding as he knows whats going on. My hands shake some time and my writing has changed, He told me I was his best worker. My wife is worried because I cannot remember thingsI just told her recently (cowrkers too) I;m having trouble find the correct keys on keyboard. I"ve been depressed for 13
years I know of. I gradually slid down that slippery slope to many meds,and side effects which i dicuss concerns, Some times I see things outof the corner of my eye that are not there. I am not writing this as a (poor me) letter.I have many gifts. These changes in meds work for the first time in three years.
I just feel sometimes like I'll lose my self;We now have the point of the story
Thank you all very much Johnd

Hi John,

I envy you for your understanding boss - I have not opened up about my mood disorders to mine as there's just too much tension within management right now, but I certainly also struggle with remembering things and mixing up words (or forgetting them altogether). I get tremor attacks sometimes when I push myself too hard and the mood swings make it all the more hard to maintain a stable influence for and on my employees (I'm management too).

A couple things I've noticed have helped me:
1. Keeping routines, including meal/snack/smoke/whatever-excuse-necessary breaks
2. I write EVERYTHING down in a daily journal file on my computer. I write down everything I've done, with whom I've talked and what subject, what decisions I've made. I notate EVERYTHING and then if there's ever a question about something that happened in the past, I actually have a record, instead of being frustrated with myself.
3. I love sticky notes. My significant other and I use notes, text messages, email to keep track of important details because I'm constantly forgetting everything. I have routines that include "idiot checks" to make sure I have everything when I'm leaving the house for whatever occasion.
4. I don't write as fast as I used to, and I have to focus more on making it legible due to occasional tremor (it was far worse when I was on lithium back in the day). I rely a lot on computers to avoid having to send my chicken scrawl anywhere. Just take your time. Don't try to force things. :)
5. Always keep in mind that if the good effects outweigh the side effects, and you feel healthier and more stable, then you're moving in the right direction!!

Keep on keeping on, and thanks for sharing :)

Hi John

I've experienced all the side effects you mention. When I was down they seemed insufferable but now I'm feeling a lot better they are manageable with routines and I feel they are a small price to pay.

I'm very lucky to have very understanding boss and co-workers and some of the problems - e.g. my dreadful memory - have become a standing joke - not in an unpleasant way - a very good natured and understanding way. Friends too, for example, find my inability to eat popadums (because of tremor) without causing shrapnel wounds to all and sundry - or the utter impossibility of drinking soup with a spoon a particular delight! I enjoy laughing with them - and of course I always get my own back!

Stick with it - it is worth it.

John,

As hard as this may sound, it might be time for a 2nd opinion... or at least a re-assessment. It wouldn't hurt to have another Pdoc to look at your med regimen to see if there might be another way to help you get some relief from your depression while keeping your gifts intact. You're on an awful lot of stuff there, another physician might be able to step back and take another look and be able to simplify things a bit. And then again... they may step back, take a look and say, "That looks right to me."

Some Pdocs have their own philosophies and their own favorite meds that they use with patients. They tend to go back to the same tools in the toolbox over and over because that's what they like or that's what their comfortable with. However, their favorites aren't always the best choice, and sometimes patients require treatment with newer tools. I'm not saying that your doctor is in this category at all... I'm just saying that I know this happens.

I wish you the best. Finding a balance between disease, life, and meds is not an easy journey.

Be well,
Jules

John

Jules is absolutely right about getting a second opinion.

I went onto a medication regime in 2005 which stabilised me but had side effects and rooted me in a depressed state with little drive for anything in life. Suicide ideation was a constant companion. I eventually persuaded my team to seek a second opinion and I was lucky enough to be seen by an expert in bipolar disorder. he took a full history from me - including my responses to the many medications I have taken since 1997 - rediagnosed me as bipolar IV and prescribed my current regime. It has changed my life - completely.

If you had asked me 4 months ago if there was any hope in my life the answer would have been no - and what's the point? Ask me now and the answer is yes, life is to be lived and I'm going to live it.

I think I have written elsewhere on this forum that the side effects from and poor responses to different medication types are important stages in the journey to a better life. If I hadn't had problems with all those medications, if some of them hadn't worked and if some of them hadn't made me worse my doctor would not have been able to diagnose me and formulate my current treatment because he would have had insufficient clinical evidence.

Stick with it and try and get a second opinion - ideally someone who won't recycle the opinions of other people you have seen but will come to a conclusion based on their own judgement.

Good luck.

DavidP,

I currently do not have a pdoc because from everything I've been reading ,I have neither BP1 or 2 but am somewhere else on the spectrum. All 6 of the pdocs I've seen so far only seem to be familiar with BP1 and have very limited knowledge of even BP2.

Could you tell me the name and address of the pdoc that gave you the BP4 diagnosis? Even if he isn't in my area he may be able to refer me to a competent colleague.

David - I have BP IV as well. It was a very astute Pdoc who was able to determine that. He has been my doc now for nearly two years, and we have been able to work together, as a team, to figure out what works and what doesn't.

Just for an example... just this week, I have been mightily struggling with sleep. I called my Pdoc to talk it over with him and he looked through my meds. He asked me how I was taking everything and what else might be going on in my life. And then, out loud, he kind of thought through several options.... keeping in mind that I am a recovering addict of 17 years. He did not want to give me anything that would be a "gateway" drug back to my addiction. We discussed this AND agreed as he listed his options that certain medications would be more of an addiction "Trigger" than others. Together, we came up with a solution. Last night, with addition of a very small dose of Ativan, I slept through the night. I am supposed to take them 5 nights in a row to sort of re-set my body clock. (so I only got 5 tablets)

We'll see how it works. But, I appreciate his thoughtfulness and his forthrightness as we worked through this together. I was not at all offended that he had to remember than I am an addict. I don't care if I have been in recovery for 17 years.... I still have the same brain... an addicted brain.

I am pretty depressed right now. So, having him be so clear with me was a gift.

When you look for a Pdoc, you should look for a doc that YOU can work with. People may not like the kind of relationship I describe. But, whatever works for you, is what you need to look for. Pdocs are going to be giving you meds that change your brain... that requires the utmost trust. Kef.... I totally get that you are looking for someone special. You DESERVE someone special. We all do. I happen to know that my doc is a gift from God. He came at the right time with the right diagnosis and the right approach toward me. That doesn't mean that we haven't had to negotiate some bumpy places... but the fact is, we did negotiate and it worked.

Be well,
Jules

Actually pdoc #3 in 1999 for me was pretty good and I found him when I was at absolute rock bottom but he no longer treats outpatients. That is another part of the system that I just don't get. Even though I now live over 100 miles from him, I wouldn't hesitate to go back to him. Why can't pdocs treat outpatients too? My 2nd favorite pdoc is also for inpatients only as well so I don't even count him among the 6 I've seen as an outpatient.

K

Hi Kef

I suspect you are in the USA ..... and since I'm in the North of England it's not ideal for swapping docs!

Bipolar IV is a fairly new classification I think and not all the docs agree about it. Here's the description I was given: basically it's major depression with mania or hypomania triggered by certain antidepressants and some other drugs (for example opiates). The experts can't agree whether the drug induced mania / hypomania is due to the meds or whether the meds unmask an underlying bipolar condition. Usually patients with antidepressant-associated manic states get milder and shorter manic episodes than patients with mania that arises without an apparent external chemical trigger - that's how it's been for me. My doc believes BPIV exists as a distinct condition for precisely these reasons but he says a lot of doctors don't recognise or categorise different parts of the spectrum in this way. He says that examining a patients medication history and responses to medication as well as looking at "mood history" and life events allows a diagnosis to be made.

The guy I was referred to is Prof. Heinz Grunze. He's originally from Hamburg but is now a professor at Newcastle University where they have a special mood disorder centre. He is contracted as a special consultant by our National Health Service. I did some checking up on him when I was referred and he's a pretty eminent guy. I consider myself extremely lucky to have seen him. It's a bitter sweet feeling because I would like evryone to have a doctor like this and of course it's not possible.

I agree that having a doctor be clear with you is a great gift. We all deserve the best care available. In my past the docs, faced with another poor response to their prescriptions just tried something else in what seemed to me a very vague (and therefore quite unsettling) way. I believe that when doctors prescribe like that it contributes, perhaps in quite a big way in some cases, to lack of patient compliance with medication programmes. They don't give the impression of having any confidence in their approach and that must affect our confidence in them and the prescriptions.

Prof. Grunze impressed me greatly on account of the time he spent with me, his respect for my opinion and his respect for the unique knowledge I have about my condition. Also his desire to form an opinion based on what I told him and not what his colleagues had written about me. He made sure to explain to me what he thought and why and how he proposed to treat me. He said he could help me (no doctor has ever said that to me before!) and that what he would prescribe was as near to weight neutral as he could make it (because I was quite depressed about my massive weight gain on valproate). After a few hiccups during the switch over (I had a severe manic episode during the wash-out period when I was on no mood stabilizer in preparation for the new prescription and did a few stupid things) I’m now pretty stable and generally enjoying life.

Jules' point about negotiating with the doc is very relevant. Effective treatment involves both parties. If you break a leg the doctor treats you but you also undertake to do the physiotherapy to get yourself back on your feet. I feel mental illness is the same. A good result is due to a team effort by doctor and patient, although sometimes when we are ill it is incredibly difficult to contribute to the process and a good doctor recognises that.

Sorry - I've gone on a bit ...... that's what happens when you come back from the pub and hit the forum .....

Take care

I was introduced to Bipolar IV by my Pdoc as he was describing the "soft bipolars" to me. (I was horrified by the idea of being given a bipolar diagnosis!!) My doc knows that I am a researcher/geek so he went right on his computer in his office, as we talked, and printed off a few studies by a man by the name of Agpop Akiskal.

My hypomanic episode during an attempt to use an antidepressants to help me sleep was my Pdoc's major clue for my bipolar diagnosis. I am grateful that I knew enough to know that my behavior was out of whack (although LOTS of fun) when I was on the Trazadone.

I also meet the criteria for Bipolar III.... a hyperthymic termperament that overlays major depressives episodes.

So, I'm Bipolar all the way around. The DSM IV doesn't recognize it yet. That's why my official diagnosis is Bipolar II. But, the entire continuum is very important and David is right... not all docs agree about that.

be well,
Jules

When I was prescribed my current meds I had quite an extended period of hypomania - it was darn good fun and as a partially self-employed consultant that month I clocked up 70 hours of private consulting as well as my 96 hours or so of employed work - so it was profitable too! The docs said that provided I didn't get any worse they would let me enjoy it! And I did. It's all settled down now - which is a bit of a let down - but if I think back to when I was really depressed .... wow ... I know where I would rather be.

I was "pleased" to get a diagnosis of BP - I'm analytical and like putting things in boxes with labels on them (not literally I hasten to add). It helped me rationalise the way I felt and why I am like I am.Also, in the UK at least BP is generally better recognised by the public at large than other mental illnesses because a no. of high profile people have "come out" about their BP, so it's easier for people to understand, though it has propagated the myth that BP "only affects clever and creative people" so there is still dreadful stigma attached to mental illness in the UK. here's shocking statistic for you ... in a survey more than 60% of respondents said they didn't want to live next door to someone with a mental illness!

What is it like in other countries ....?

Take care

I really loved the Stephen Fry documentary. I watched it on YouTube but it is no longer available. I think it depends where you live in the U.S. I have lived in 2 places in the same state. In one town I was considered a plagued freak. Where I am now people try to be more informed and understanding. I think the media still tries to lump all mental illness in the same crazy basket and mislead people that there is a pill to fix all our problems if we crazy stubborn people would just take it.

K

Yeesh, a pill to fix all our problems---I wish. Really, all there are are things, including meds, that sometimes make it possible for us to work things out ourselves. We work just as hard at containing our illness as diabetics or heart failure patients do, and get a whole lot more negative feedback if we fail or relapse.
John, I agree with Jules, its probably time to get someone to take another look at your meds. Its always a questions of the benefits of being on something vs. risk of being off of it, vs side-effects and risk of the med itself. I think something in your balancing act is tipping too far in the side effects end.

DavidP
where did u find a specialist in bipolar disorder? I live in the DC metro area the the diagnosis in kind of new to me. I have been treating with the same docto for 6 yars amd now she diagnosed me as having ciclothymia. This past weekend I was winning off effexor and coming up on lexapro and I also use tompamax same dose I was before. and I was haing so much depression and OCD, i was having OCD thoughts when I was driving to drive off the road or against a truck, I didnt want to do it but the thoughts keep coming and coming and they were making me crazy, I was crying and fightin g with everyone around me and I coulnt sleep. My doctor is a doctor at Georgetown Medical Hospital and I cannot cominute with her on wekends or nights so I called the emergency line in the hospital, few minutes later a resident in pyquiatry called me, he told me to take 2 pills of lorazapan, I did and I slept well but coulnt get out of bed and work. My doc called this morning and I aksed her about a cel phone or e--mail she said she doesnt work that well and thats why they have that line. I'm thinking about swtching doc, I need sobody that knows my hisotry. how are your doctors? This whole thing is new with me? I thinking about geting a therapist also? Does anyone knows good doctros around DC area??? Thansk again

Hi Cristty25

I'm in the North East of England so I can't point you to a doc local to you I'm afraid!

This is my story of diagnosis and treatment.

I was diagnised with a depressive illness in 1997 after years of problems and was treated for depression. My GP thought I was bipolar but was unable to get me treated by a consultant psychiatrist despite several hospital admissions. I was eventaully placed under a consultant psychiatrist in 2003 and was treated for depression - again despite my GPs advice that I was bipolar. I was told repeatedly by my consultant that I wasn't bipolar. Due to reorganisation of the local health service my consultant was changed. I was pretty ill (depression) and was admitted to hospital where my new consultant took the opportunity to "experiment" with some treatments (including ECT). He diagnosed me as bipolar in 2005 and prescribed a mixture of antidepressants (moclobemide), a mood stabiliser (lithium) and an antisychotic with antidepressant properties (quetiapine). This stabilised me, but in a state of moderate to severe depression. I moved house to another district and another consultant. They have a policy here to use sodium valproate instead of lithium - and in my case it was necessarey because I had some thyroid toxicity - so I was prescribed ever increasing doses of that which robbed me of the last vestiges of drive that I had. Eventually - after 3 years of this - my consultant threw in the towel and called on the services of a specialist in bipolar, which is where I am now - through a combination of circumstance and plain good luck!

I've had to fight my corner - which is hard when you are ill. Someone mentioned about cardiac or diabetic patients in this thread; would they have to fight to get a diagnosis or appropriatye treatment? Usually, no! It's a disgrace that we have to and it seems to be a common failing in health services around the world.

This is probably no help to you other than to say there IS hope and while you can still fight a bit you CAN influence things. Can your family or friends add some weight to the arguments? And, more importantly do they support you? I've found the support of understanding friends a real help over the years.

Good luck.

Hi Cristty25

I'm in the North East of England so I can't point you to a doc local to you I'm afraid!

This is my story of diagnosis and treatment.

I was diagnised with a depressive illness in 1997 after years of problems and was treated for depression. My GP thought I was bipolar but was unable to get me treated by a consultant psychiatrist despite several hospital admissions. I was eventaully placed under a consultant psychiatrist in 2003 and was treated for depression - again despite my GPs advice that I was bipolar. I was told repeatedly by my consultant that I wasn't bipolar. Due to reorganisation of the local health service my consultant was changed. I was pretty ill (depression) and was admitted to hospital where my new consultant took the opportunity to "experiment" with some treatments (including ECT). He diagnosed me as bipolar in 2005 and prescribed a mixture of antidepressants (moclobemide), a mood stabiliser (lithium) and an antisychotic with antidepressant properties (quetiapine). This stabilised me, but in a state of moderate to severe depression. I moved house to another district and another consultant. They have a policy here to use sodium valproate instead of lithium - and in my case it was necessarey because I had some thyroid toxicity - so I was prescribed ever increasing doses of that which robbed me of the last vestiges of drive that I had. Eventually - after 3 years of this - my consultant threw in the towel and called on the services of a specialist in bipolar, which is where I am now - through a combination of circumstance and plain good luck!

I've had to fight my corner - which is hard when you are ill. Someone mentioned about cardiac or diabetic patients in this thread; would they have to fight to get a diagnosis or appropriatye treatment? Usually, no! It's a disgrace that we have to and it seems to be a common failing in health services around the world.

This is probably no help to you other than to say there IS hope and while you can still fight a bit you CAN influence things. Can your family or friends add some weight to the arguments? And, more importantly do they support you? I've found the support of understanding friends a real help over the years.

Good luck.

Hi Cristty25

I'm in the North East of England so I can't point you to a doc local to you I'm afraid!

This is my story of diagnosis and treatment.

I was diagnised with a depressive illness in 1997 after years of problems and was treated for depression. My GP thought I was bipolar but was unable to get me treated by a consultant psychiatrist despite several hospital admissions. I was eventaully placed under a consultant psychiatrist in 2003 and was treated for depression - again despite my GPs advice that I was bipolar. I was told repeatedly by my consultant that I wasn't bipolar. Due to reorganisation of the local health service my consultant was changed. I was pretty ill (depression) and was admitted to hospital where my new consultant took the opportunity to "experiment" with some treatments (including ECT). He diagnosed me as bipolar in 2005 and prescribed a mixture of antidepressants (moclobemide), a mood stabiliser (lithium) and an antisychotic with antidepressant properties (quetiapine). This stabilised me, but in a state of moderate to severe depression. I moved house to another district and another consultant. They have a policy here to use sodium valproate instead of lithium - and in my case it was necessarey because I had some thyroid toxicity - so I was prescribed ever increasing doses of that which robbed me of the last vestiges of drive that I had. Eventually - after 3 years of this - my consultant threw in the towel and called on the services of a specialist in bipolar, which is where I am now - through a combination of circumstance and plain good luck!

I've had to fight my corner - which is hard when you are ill. Someone mentioned about cardiac or diabetic patients in this thread; would they have to fight to get a diagnosis or appropriatye treatment? Usually, no! It's a disgrace that we have to and it seems to be a common failing in health services around the world.

This is probably no help to you other than to say there IS hope and while you can still fight a bit you CAN influence things. Can your family or friends add some weight to the arguments? And, more importantly do they support you? I've found the support of understanding friends a real help over the years.

Good luck.

Oh Gosh, u mus have suffer a lot! I took every single anti depressent before she though I ave ciclothymia, I guess they think we would be so abnormal or something, I cask jer severasl times if she think I maybe be bi;olar she said no way you are to normal t be bipolar, and here I'm and I thin I'm more than ciclothimia I dont feel that confeltable with he rthat I told her about my vare free behavior and my sexual adventures and how I use to collect me as a conquest just for fun but anyway just to talk about it makes me blush. I dont have family of friends here. I had a few friends which a alienate myself since I becaume the anguer bipolar ( i use the be the happy one) that happen ed agyet I had a baby, I feel like I get no pleasure aout of anything and to complete hy history my baby;s father is a alcaholic trying to recover and his doctor things his is bipolar to thats why he drinks, wow, it is very heavy here these days, I feel like I raise a child, a man and I can barealy take care of myself. Thanks for the kind works I wish I could be stabilized to I can deal with all this crap aroud me

David,

You are a courageous man who can be an example to each of us about not giving up!! The state of mental health treatment IS improving, yet it has FAR, FAR to go. People who have some vestige of resiliency will eventually thrive. People who do not, must either have a rabid advocate, an incredibly astute provider, or dumb luck to get excellent treatment.

I am in the midst of an on-going struggle to be heard and appropriately treated in relation to my hormonal mood shifts. My menstural cycle absolutely RULES my life for one week per month. That's 25% of my life. That's far too much of my life to depressed, anxious, suicidal, jumpy, unfocused, irritable and sleep deprived.

I currently have providers who have finally agreed that my symptoms are "real" during that week of the month. However, no one has agreed on how to treat it. So.... the symptoms continue. I will NOT let them off the hook. I keep coming back. I keep calling. I keep telling them that this thing is going to kill me before I reach menopause if they don't take me seriously and treat me. The wheels of medicine turn oh so slowly.

Keep up the good fight, those of you who do not feel that your condition is being adequately treated. Your quality of life.... or maybe even your life... depends upon it.

Be well,
Jules

Hi Jules

Hopefully this post won't appear three times and result in floods of forum notifications into everyone's inboxes.

Thanks for your comment. We are all special and within our special group I don't think I'm anything extra special - I got fed up with feeling c**p and I've been incredibly lucky to have friends who kept me going and helped to motivate me to fight my corner and also a great Community Psychiatric Nurse who advocated for me. Without them - I don't know - I think it would have been a lot tougher - and possibly even fatal.

Certainly from an experience point of view - i.e. as a mentally ill man in the UK - my struggle is not out of the ordinary and is a great deal less distressing than many.

I have always been open about my condition with family, friends and colleagues and that has helped (mostly - though some have run a mile!) If they find it hard to understand I sometimes send them a copy of Lewis Wolperts book "Malignant Sadness" (which I think should be compulsory reading for all in the medical profession) and I know it's been enlightening for some people. Also, I'm lucky not to have come up against situations where I might have to conceal it - for example in seeking a new job. I'm partially self-employed and my employer is very understanding (!) - but I know many aren't and admitting to a mental illness on a job application form is like playing Russian Roulette with your livelihood and career.

Sometimes I'm incredibly moved by peoples understanding; I "came out" to two clients recently when it got to the point that the work I was supposed to be doing had been stalled for months and during a bad phase I destroyed all the files (don't ask!!). I could no longer avoid phone calls and emails so I had to tell them - and also tell the two National regulatory authorities to whom I was supposed to be making licence applications on my clients behalf. They were all very sympathetic (though they had every right not to be) and they all said they wanted to continue working with me and deadlines were extended - with the proviso that we set up a 'safety valve'. Basically, if I stop producing work or communicating they can call up my psych team direct.

I think the thing that really exercises me now is the ignorance, discrimination, injustice and poor care that psychiatric patients often have to endure from all directions. It's not as if we are a tiny minority either!

I'm sorry to hear of your travails - at least you now have two providers who are starting to listen to you. If they don't know how to treat you they must be able to identify a route to someone who can - or someone who can educate them.

Good luck with that and to everyone fighting the system.

Take care

David you are an example for me to keep fighting!!! Although today I feel like as ostrich and I want to put my head on a whole and stay there ahahahaha