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Can mood disorders permanently affect how the brain processes your thoughts?


"Beardenís review of what could be wrong with the brain reads like a neurologistís laundry list from hell."


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Brain Damage in Depression and Bipolar Disorder


Kay Jamison PhD of Johns Hopkins University in Touched with Fire writes:

"The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or madness, to patterns of unusually clear, fast, and creative associations, to retardation so profound that no meaningful activity can occur."
 
This inability to think clearly is a feature of both depression and mania, as well as psychosis, and its effects are often felt long after an episode has abated, leading experts to question the long-held belief that mood disorders are episodic in favor of the idea that its course may be truly chronic.

A lengthy review article by Carrie Bearden PhD and others of the University of Pennsylvania published in the June 2001 Bipolar Disorders cited "findings of persistent neuropsychological deficits" in long-term bipolar patients, even when tested in symptom-free states. The relationship between these deficits and length of illness led the authors to suggest that "episodes of depression and mania may exact damage to learning and memory systems."

Bearden et alís review of what could be wrong with the brain reads like a neurologistís laundry list from hell: ventricular enlargements, cortical atrophy, cerebellar vermal atrophy, white matter hypertensities (especially in the frontal cortex and basal ganglia structures), greater left temporal lobe volume, increased amygdala volume, enlarged right hippocampal volume, hypoplasmia of the medial temporal lobe, and more. Then thereís the matter of those chemical imbalances, such as glucose metabolism and phospholipid metabolism.

Say all that in rap time and you have the sound of our brains breaking down, no longer capable of processing information the way it is supposed to. An article by FC Murphy PhD and BJ Sahakian PhD of Cambridge University in the June 2001 British Journal of Psychiatry drew a similar conclusion:

 "The balance of evidence ... supports a hypothesis of residual cognitive impairments."

Cognitive Impairments in Bipolar Disorder

These impairments, said Deborah Yurgelun-Todd PhD of McLean Hospital at the 2004 APA annual meeting, include attention, concentration. psychomotor speed; abstract reasoning, executive control, verbal fluency, and verbal memory performance. Some one-third of the bipolar population, she said, are affected by these residual impairments. Accordingly, Dr Yurgelun-Todd argued, cognitive deficits should be regarded as a core feature of bipolar disorder.

One of the best known tests to measure the ability of the brain to process tasks (commonly referred to as executive function) is the Stroop Color Word Test, where various colored words representing colors, but not necessarily matching colors, are displayed with the clock running. Thus the word, ďGreen,Ē may appear in blue text. Rather than calling out ďGreen,Ē which the mind reads instantly and almost automatically, the subject being tested needs to respond with "blue," which requires being on top of one's cognitive game.

In a study published in 2004, Dr Yurgelin-Todd and her colleagues scanned the brains of 11 stable bipolar patients while undergoing the Stroop Test, and found significant delays in their ability to respond with correct answers compared to 10 healthy controls. The study also found decreased activation of the brain region responsible for processing the task compared to the controls.

A 2003 Dalhousie University study of bipolar adolescents with their illness in remission found they took significantly longer than remitted depressed youths and healthy kids in completing a math test. Only nine percent of the bipolar kids scored above average. The bipolar kids also scored significantly lower on spelling and reading.

Other recent studies have found deficits in working memory, visual processing, long delayed free recall, and verbal organization.
Unfortunately, these deficits have severe real world implications. A 2004 Sheppard Pratt-Stanley Research Center study that ran 117 individuals with bipolar disorder through a battery of tests found that "current employment status was significantly associated with cognitive performance."

Keeping the Brain Sharp

The prospect of losing brain function is as frightening as being buried alive Ė just ask any senior citizen who has misplaced his car keys. But never underestimate the brain's unending capability to remap its seemingly limitless neuronal pathways. A cognitive deficit from bipolar disorder is not the same thing as Alzheimer's. You are not a helpless bystander. There are things you can do to keep your brain sharp. The Mayo Clinic recommends:

  • Exercising your mind. This includes crossword puzzles, reading, and interacting with people.
  • Staying physically active, which improves blood flow.
  • Healthy diet.
  • Developing a system of reminders and cues, such as keeping a diary.
  • Learning relaxation techniques. Stress and anxiety interfere with concentration.

In the meantime, a Cambridge (Massachusetts) Hospital chart review of four bipolar I patients with severe cognitive dysfunction (mainly short and long-term memory impairment and word-finding difficulty) found that the two on higher doses (24/mg and 32/mg a day) of the Alzheimerís drug Reminyl (galantamine) "experienced marked cognitive improvement" vs the two on lower doses (8mg/day). The drug was well-tolerated.

An article in Psychology Today reports that antioxidants scavenge and fight off free radicals, those rogue oxygen molecules that damage cell membranes and DNA. The brain, being the most metabolically active organ in the body, is especially susceptible to free radical damage. Free radical damage is implicated in cognitive decline and memory loss, and may be a leading cause of Alzheimerís. Studies suggest that vitamins C and E may work synergistically to prevent Alzheimerís and to slow memory loss. The RDA for vitamin E is 22 international units (IU) and 75 to 90 mg for vitamin C, but supplements may contain up to 1,000 IU of vitamin E and more than 1,000 mg of vitamin C. In the Alzheimerís study, involving 5,000 individuals, the greatest impact occurred among those who took the two vitamins in combination. Taking either of the vitamins alone or taking multivitamins provided no protection.

Racing Thoughts in Bipolar Disorder

Bipolar disorder is one defined by polar opposites, and this applies with equal force to thinking as it does to mood. Imagine a chronic physical illness that has you bedridden one week and running a sub-four-minute mile the next. The DSM in its criteria for mania refers to "flight of ideas or subjective experience that thoughts are racing." Believe me, there is nothing subjective about these racing thoughts. The only reason that the word, subjective, made it into the DSM is that science has no way to objectify the phenomenon.

Researchers only have the capability to get us into a room and put us through tests that make us look stupid. These are the parts of our brains that function like busted laptops. We droop on the Stroop.
What the experts have yet to figure out is how to set up an experiment that can record the birth of a creative thought or take a snapshot of a breakthrough idea. These are the parts of our brains that run like Cray supercomputers. We rule in this school.

Our minds are literally processing data so fast that we make the type of connections and associations that lead to Eureka! moments, often at a rate that astounds people who do not share our illness. If there is anything subjective about our thinking, it is only after our brains have delivered the mental goods, when a solution miraculously reveals itself or a revelation floors us.

Society has benefited enormously from this aspect of our illness, from Newtonian physics to the Sistine Chapel. A good case can be made that we would all still be living in caves were it not for our supercomputers. In Darwinian terms, this would explain why our illness - terrible as it is - is seen as a positive trait worth passing down to the next generation.

Like our cognitive deficits, one need not be in an episode to experience racing thoughts. For this writer, they are a constant in my life. Since these thoughts are often running in the background as I am performing other tasks and at speeds usually quicker than the conscious mind can capture, one might call the process subconscious. Ideas literally pop out of the brain.

Paradoxically, my brain can run like a supercomputer and a clapped out laptop at the same time. I can go to Google to follow up on a brilliant thought only to forget momentarily why I am on the page. Since I am not a math whiz, my supercomputer is not going to outperform Stephen Hawking. It is only as good as what I put into it, from the books I read to the people I meet to the problems I focus on.

Racing thoughts can be a liability. The mouth can find itself articulating an errant thought before the rest of the brain has had a chance to process it. The intoxication of a latest revelation can distract one from current projects, ironically ones initiated by previous moments of inspiration. And many bright ideas turn out to be plain stupid ones. Our rational minds can usually protect us here, but in a state of mania we are not thinking rationally. It is one thing to come up with a brilliant idea for dog mascara, for instance, but it is another to quit your day job and sink your entire 401(k) in pursuit of such a venture.

No doubt, a future Business Week cover will feature the entrepreneurial genius who succeeded in convincing millions of dog owners that they were abusing their pooches by neglecting their mutts' eyelashes. That person could well be you, but only if you possess the skills to marry reason and persistence to inspiration and enthusiasm. Be advised: Our supercomputer is both a rare gift and potentially devastating liability. Act wisely.

For three free online issues of McMan's Depression and Bipolar Weekly, email me and put "Sample" in the heading and your email address in the body.

Updated Jan 21, 2004

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 Discussions

Sheila (Oct 20, 2002): I have a rapidly deteriorating body and come from an underprivileged background.  I am disabled due to Bipolar Disorder I and have PTSD from child abuse and accidents.  I have earned my Associate's degree and am going into my second year at a university.  I can only handle 10 credits at a time, despite having a high to genius level IQ, I cannot remember things and at times cannot even take notes in class because I have no attention span.  My mind is my only "trump card" I have to play in life and I am desperate to overcome and to be a resource in this life, to help others.  I want to work again.  I am 34 and need answers about cognitive impairment linked to IQ and age, and I want to submit as well that there is evidence for active minds being resistant to Alzheimer's symptoms even though the brain plaques have developed.  Can you help me get the most out of my mental capacities which I was born with?  I feel like an idiot at times and despair.  Friends mention things I don't remember, so I say, I forgot.  "Did we have a good time?"  I am easily confused and disoriented and study 80 - 90% of my waking hours during school taking only 10 credits at a time.  My GPA is presently 3.48 but I am contesting a 3.2 which should have been more nearly a 3.9.  This teacher seems determined that my illness is made up.  He is an idiot.  Life goes on.  I used to be the household dictionary, thesaurus, phone directory and address book, with little effort.  Now I have to paste my PIN numbers in code on the backs of my cards and then hope I remember the nature of my codes.  Passwords and user names are the bane of my existence.

I am on high doses of everything and mostly euthymic, but stress out easily and have even demonstrated autistic symptoms when severely overstimulated and depressed.  My major is Psychology.  I hope to get my MSW and then to go on to be a PhD in Psychology and go on to do real scientific work on the problems of the mind and social issues impacting mental health and vice-versa.  Meds: Neurontin 2400mg/day
Trileptal 300mgs/day
Zyprexa 10mgs/day
Clonazapam 2mgs/day
Effexor 375 mgs/day
Wellbutrin 300mgs/day
Vistaril prn - can't use because it destroys all concentration and learning.
Please help me save my mind!!  It is all God gave me!!!  I have attempted suicide 3 times.
I am a rapid cycler and treatment refractory but I take my meds.  I like caffeine.  I drink 1/2 oz of alchohol per day.  (I like a weak White Russian at night before bed.)  I play Mahjongg solitaire and challenge myself to learn and memorize things daily, largely with my internet connection.  I study and love new information.  I write but find word-finding to begin to be a problem for me, affecting the rapidity of my speech and its fluency and accuracy.  Writing is easy.  Speech can be hard.  I used to be a spelling bee champ but now have problems with common words.  I make myself refrain from the spell check so that my mind is disciplined to work out the spellings as I know I can if I just try harder.  I want to live to a happy and productive 120 years. Can anyone help?

Shoe (Feb 13, 2003):  Sheila, I can closely relate to your problem.  I got hit in the 10th grade with a severe manic episode and was diagnosed bipolar.  Despite spending two separate months of high school in the hospital, I was able to graduate with a 3.9 GPA and 14th in my class.  When I decided to start college(1yr after high school), I began doing well, but partying outside of school led to my demise.  Dual diagnosis and mania caused me to lose interest in classes and I dropped out. 

I don't know if the drug usage caused any noticeable impairment (probably), but I do know that some medications do.  I remember trying to think strait in the mornings in class on Zyprexa, or at least to stay awake I was on 20mg).  For the past year, I've been much slower mentally) than I ever was starting high school...less in touch with reality, duller memory and thinking.  I am 22 now. I would have never guessed it, but nutrition plays a huge role in this too (as well as bipolar). Finding nutrition advice is very helpful.  I've been advised to strictly monitor my sugar intake.  I've only started recently, but I notice that I am much more mentally alert while drinking water than soda.  I also suggest reading the article here
http://www.mcmanweb.com/article-110.htm

I think aspartame has a bad affect on me too. After only a few days of cutting the aspertame and reducing the sugar, I feel much more mentally acute. Finding this out really makes a difference. The nutritionist who helped me also strongly suggested some vitamins to help the bipolar. Cod Liver Oil, C and B vitamins and a multivitamin were among the suggested.

I can sense that more pills is "just what you need," Sheila, but you're probably used to taking them by now.  Vitamins may even be useful as a replacement for some psychiatric drugs.

John (April 29):  Sheila, I have the exact same problems!!  I am only a junior in high school, and the symptoms of lack of concentration, inability to pay attention during class, too much sleep, and memory loss has been going on since 9th grade.  I am seriously worried... my gpa is a 3.99 and it is becoming ever so harder to study...  I cannot find the right words when I write up my reports...   I do not know how to do the math problems I've learned in 8-10th grade...  I dun remember a lot of things.  i feel that my brain is dying...  I feel that I'm losing brain cells.. i cannot use my brain like I used to.  I was spelling bee champion in 6th grade. whatever happened.  if possible I would like to hear from you.  how are you doing now?  have u found anything that works?

Bob (June 6, 2003):  Yes I too feel that I have brain damage.
I know for a fact that I do have bipolar even though I was never officially diagnosed.  My grandmother had this and she went through hell for over 30 years of her life. It was having her tubes tied that triggered it and she was on every med in the book.  I didnít help her one bit.  In fact she went toxic on lithium quite a few times, that was very scary because she did not know what year it was or where she was at all.

Iíve mostly had to deal with debilitating depression and "brain fog" I loose complete sense of where I am and of time.  Moths pass by and I might have a couple of hours where the "brain fog" clears up.  I used to take caffeine with ephedrine and DMAE and that would clear it up.  However long term I think it led to my demise.  Now I cant think at all.  I have terrible anxiety and cant work because of it.  Whenever I get a job I just stop sleeping and become very restless.  In the past I would self medicate with benadryll, valerian, kava and melatonin.  But ever after taking a large dose of this when Iím in that anxious state, I can only sleep 2 hours.  Then I wake up nervous and paranoid.  Itís all anxiety. 

I wonder if my brain is indeed damaged or if Iím just low in certain chemicals, or its not working right.  Sometimes it clears up and I feel fine, though thatís usually after something exciting or some stimulants.

Thumper (June 7, 2003):  Sheila, that is quite the combo of meds you are on. I am a nurse practitioner who treats a lot of bipolar clients, and have a minor version of it myself. First you might try fish oil supplements to see if they are at all helpful for you. I have many clients who have gotten quite a bit of benefit from 2 capsules (1000mg each) three times a day of fish oil. The active ingredient seems to be the omega-3 essential fatty acid EPA. It may take 2 or 3 months of supplementation before you see results. If it's helpful, the first med to slowly come off is the Klonopin. It is a benzodiazepam, and they are notorious for causing memory impairment. In the meantime you might see if your Doc will try a different atypical antipsychotic, like Geodon, Abilify, or Risperidal. Zyprexa is strongly anticholinergic, (as are Seroquel and Clozapine). The cholinergic nervous system is largely responsible for learning new material. That's why the Alzheimer's drugs enhance the cholinergic system. Good luck, keep on what you're doing. You sound like a remarkable lady.

Jenna (July 19, 2003):  Shelia, I too can relate. It took me six years to finish my undergraduate degree. After taking a three year break I am back in school working on my masters. Despite my high IQ and my love of learning, I am feeling very frustrated. I have no memory or recall of what I have read, let alone the terms and concepts I need to remember.  In class people spurt out terms and facts that I did not remember, even though I have just read about them a few hours before. Having to deal with this is pain, but if you do not push through then the illness wins. Our victories and success, no matter how small, are sweeter than for others because we have worked so hard for them.

Clairece (Aug 20, 2003):  yes Sheila, I can relate. I haven't been diagnosed with bipolar, but all the symptoms are just so common in my regular everyday life. I just can't concentrate. My spelling and memory gets fuzzy and its hard work even staying awake in the lunch hour, since my sleeping pattern is so irregular. I lie a lot about how I feel and am not comfortable in many situations, especially when people are staring at me. anxiety is at its worst when I'm on the way to school, being in year 10 I should be able to have fun.. but am constantly worrying about every small thing i say and do.. like just today when i explained to a friend that i felt uncomfortable lending her my pencil.. i mean.. that's not me.. i used to be such a great friend, i felt comfortable giving my opinion...

And after lunch its always hard to keep my hyperactivness at bay.. I've already chucked 4 saucers over a balcony in art..i thought they'd look great on the ground..

please help.. i just can't understand.. I'm terrified of killing myself.. buses come and go so often in my street.. its a constant fear..

I feel so alone..

Mo (Sept 13, 2003):  I have tried about 2 yrs worth of Effexor before it was determined that I was bipolar and not just depressed. This has been hard b/c I am trying to obtain a chemical engineering degree and I have memory lapses all the time.  Nobody can figure out why, except to take me off the Effexor and switch to Lithium. That, of course, brings its own concerns, for me, and my memory lapses are still occurring. Are memory lapses just something that all bipolar people experience?

McMan (Sept 13):  Hi, Mo. It seems to be a common enough complaint. One very recent study found the volumes of the hippocampus of women with a history of depression corresponded with less time on antidepressants.  This isn't exactly a smoking gun, but it does suggest depression has an effect on memory.

Mo (Sept 13, 2003):  Clairece, I think everyone (bipolar or not) thinks about killing themselves at one time or another. I know I've definitely thought and planned it out; however, that doesn't necessarily mean the person wants to carry out their plan. I usually am just looking for someone else out there in the world that understands how i feel. sometimes is is difficult to find another human willing to admit that they are having some troubles in their life as well. BE PATIENT. you are not alone. it just takes some people a little bit longer than yourself to  sort out their feelings and finally feel comfortable posting them on the web.

James (Sept 13, 2003):  I would like to respond to the first message listed, Shelia was her name. I was diagnosed with bipolar 1 about eight years ago. About two years ago I was also termed (diagnosed) borderline personality disorder. When I was a child I was raped and some torture occurred, but little, or what could be called a form of torture. I was adopted and traumatized by the family that adopted me. They were all in all good to me. I was bought toys and things like that, but there was no love, or if there was it was alternated with abuse; mental, physical, and sexual.

My response is I was on a slue of drugs mostly lithium and valium, but I have taken anit-this and anti-that. This may sound paranoid, but I think lithium caused damage to my brain. I was at a time a very high functioning college student, then a idiot who couldn't barely read a page out of a text book. I had a very hard time finishing my thesis.

Furthermore, I am a very, very smart person who knows some things about the way the world works and I must say the jig is up. I studied my doctors and their patients to find out how many people felt the same way I did. I am, as they still are bi-polar, but drugs are not the answer. Those patients of my doctor's discovered as well as I did, drug do help, but long term therapy is not the answer. The answer is to look deep within yourself, lock yourself in a room if you have to, and ask yourself what is it that is causing all this stress, get off the meds and feel your true feelings. Your body is trying to tell you something, find out what it is saying. See a good therapist, one you can talk to, I mean really talk to.

The problem is not biological, as "they" would like you to believe (the drug companies), as far as I can tell, it is related to the working mind, conscious and unconscious, and could be brought out of the closet of your mind by the right therapist.

I take my meds now in a very different way than the doctors say I should, not in prevention of mania, but for acute mania. As needed! I do have some disturbing emotional problems due to the trauma that occurred during my childhood, but I am growing by leaps and bounds though the help of DBT therapists and some one good EMDR therapist.

One more thing I would like to point out that I found in my research is that many of our most troubling of mental disorders can be linked to the patterns of learning we encountered as children with our parents. It seems that maladaptive behaviors in parents result in maladaptive behaviors children. I hope what I have written has been helpful.

McMan (Sept 13): Hi, James. I appreciate all you said, but I must take issue on one point: If you were to take your meds to prevent you from a manic episode you probably wouldn't have acute manic episodes to worry about. Waiting till your manic is inviting trouble.

Laura (Jan 1, 2004):  When I read your message, Sheila, I began to cry.  It sounds so much like my life.  I quit college and take care of my three kids (11,10,8).  Several years ago I was a functioning mother and wife.  Loved my life.  I had dealt with depression before and thought that I had beat it. A year ago I was diagnosed with BD.  I've been on different meds and nothing really helps.  At one time I even tried street drugs.  That just compounded the problem.  The last few months I have felt like I don't know who I am and cry constantly.  I would give 50 years of my life just to be the person I was before I fell apart or broke.  My biggest fear is the effects it is having on my children.  I grew up in a very dysfunctional place and all I've ever wanted was to raise children the way they are suppose to be.  I'm at my end of the rope.  I can't seem to find help that helps.

Mark (Jan 13, 2004):  I was on lithium for 8 years and now I take a drug called Epival. I don`t feel as bright as I once was,and I often experience episodes of severe brain fog. It has gotten to be so bad that
some people have referred to me as `retarded`. I am wondering whether anybody has tried a mix of supplements that can wake up my dying
brain. My diagnosis is bipolar disorder.

Muddled Mind (Feb 11, 2004):  Memory, cognition, and learning problems seem to be pervasive.  I was diagnosed depressive in my 20s and then bipolar II at 30, and now bipolar I.  I also have borderline personality disorder and PTSD.  This mishmash has created all kind of memory and learning problems.  I have gaps in memory from periods of my childhood, from depressions, and from manias.  I have also had ECT.  This affected my memory and information acquisition skills on a serious basis.  I forgot how to get home, couldn't read, forgot I saw movies, forgot I went to Boston with my best friend, etc.  Most of those memories are gone forever.  I also had to go from a high-paying director level job to a receptionist job because I knew I could not handle the stress and had forgotten the information in my field so that I couldn't do the work.  It is now two and one-half years later and I have made an uneasy peace with the learning and memory problems.  I lose things in my one bedroom apartment.  I write everything down and send myself emails and voicemeils to remember things. I make jokes about things I repeat to friends.  I set up lists and systems at work to track what I do.  I can't change what has happened, nor what may continue to happen.  Unless I choose to let myself succumb to severe mania or depression and the inevitable death that comes with it, I need to make do with what I have and be thankful that I started out so smart that losing some capacity just leaves me at above average. 

Lyndy (Feb 20, 2004):  I am 34 years old, married 4 times, have 4 children and have just been diagnosed with Bi-Polar disorder.  I also have PTSD from childhood abuse.  I have always thought of myself as intelligent, I have a high IQ but you can't tell from my past!  I am frustrated because I am more than what I have become.  I too can't remember things I should, phone numbers, dates of Birthdays, things I am told at work, etc.  No one understands what it is like to think and feel this way.  I am the rapid-cycling person.  Always need to go 90 MPH.  I keep reading everything I can about the disorder.  Its too early to tell if the medicine I am on is helping or not.  I go to counseling all the time and I try not to make any major decisions.  That is how I get through each day.  I have to work in a factory to make money to pay my last husband child support because when I left to get help he filed for divorce and the court isn't taking my illness seriously.  One day at a time.

Annie (March 30, 2004):  It is almost scary how identical my situation sounds to so many posted here.  I am 46, female, bipolar 1 with PTSD.  I also had a very high IQ and an extremely good job...high paying computer consultant...struggled with the bipolar all my life, tho...but in the past 6 years my cognitive abilities have deteriorated drastically...i had to go on disability...can't work at all anymore...can't remember the simplest things...lose things all the time...repeat myself constantly...have to ask the same questions over and over because i can't remember the answers...become so confused sometimes i can't figure out what i'm even saying...just seem to go into a daze and find myself pouring coffee instead of water into a glass of ice tea mix...

I really feel like I'm watching my brain atrophy...the rapid cycling and often psychotic states I go in and out of are incredibly disorienting...my sense of time is so distorted it literally can feel like years since yesterday...and I simply don't remember large bits of what happens...I can NEVER remember my emotional states, can't get back "into" what i was thinking/feeling...my memories are more like remembering the "fact" that something happened, not really re-experiencing it like what i understand is the normal way of remembering...

I have been on about every med known to man, from tricyclics in the 70's to anti-seizure and atypical anti-psychotics now...it's kind of like living in a nightmare...

I'm so sorry that so many of you are living this way, too...i just pray that one day they will understand what is really happening to us on a cellular level and be able to help us...right now I feel we are in the "leeches and lobotomy" stage of medical knowledge of and ability to treat this illness...

Longtimer (April 17, 2004): I was very surprised in reading all of these responses and finding that other people are feeling the same things as me. I guess that's part of this "illness": feeling alienated and thinking that your the only one in the world that is going through this. Up until today I never really thought about it, but I guess it's actually not normal to think about suicide at least once a week. Funny how one of the few things that give me pleasure is thinking about how to kill myself. I just wish that I had someone to talk to in person that was going through the same thing as me. A couple times I have indirectly shown someone close to me that I feel this way, but they seem to just ignore it as if they never saw it, and everything is normal. I don't know what to make of this. I'll shut up now and stop boring whoever is making themselves read this. Good luck to you all.

Limirt (May 1, 2004): I too understand the frustration in not being able to remember things. This started for me back in 1997. I was employed as a bookkeeper. It was a job I had for years. Then I started having days where I came to work and did not know what to do. I could not believe this was happening to me. Eventually I could no longer perform at my job and had to quit. I now have a dream job, working and teaching in a stained glass shop. But it's happening again. I had to leave work early on Thursday because I could not do my job. I recently was hospitalized for eleven days. I wanted to commit sucide because of struggling with the ups, downs and panic. Two years ago I actually tried to kill myself just to quite my mind and end the madness. I drank vodka and took a bottle of kolonapin. I've struggled with depression as long as I can remember. Then came the panic attacks. Back in '97 the periods of mania started. Now my marriage is ending because of all of these problems. I have put us in financial ruin. I am terrifed at where things will go from here. In the hospital they found me to be bipolar and I have started on several new meds. The meds seem to help quiet my mind. I try to take it one day at a time, but it's a struggle. I am afraid of not being able to hold down a job and supporting myself.

PurpleCutter (May 1, 2004): I too understand the frustration in not being able to remember things. This started for me back in 1997. I was employed as a bookkeeper. It was a job I had for years. Then I started having days where I came to work and did not know what to do. I could not believe this was happening to me. Eventually I could no longer perform at my job and had to quit. I now have a dream job, working and teaching in a stained glass shop. But it's happening again. I had to leave work early on Thursday because I could not do my job. I recently was hospitalized for eleven days. I wanted to commit sucide because of struggling with the ups, downs and panic. Two years ago I actually tried to kill myself just to quite my mind and end the madness. I drank vodka and took a bottle of kolonapin. I've struggled with depression as long as I can remember. Then came the panic attacks. Back in '97 the periods of mania started. Now my marriage is ending because of all of these problems. I have put us in financial ruin. I am terrifed at where things will go from here. In the hospital they found me to be bipolar and I have started on several new meds. The meds seem to help quiet my mind. I try to take it one day at a time, but it's a struggle. I am afraid of not being able to hold down a job and supporting myself.

Nan (May 7, 2004): I am glad to hear that I am not alone, but am sorry any of us has to live this way. I find that my word retrieval is slowed much of the time. It seems worse whenever my meds are changed. It is a bit like it was before I was diagnosed, when I had to see "which head" I was in each day. Sometimes the mindless high- energy super- cleaner, other times slower and focused enough to manage the checkbook.

I am wondering if some of this is what used to be called "state dependant learning"- that if you were jazzed on coffee when you studied the book, you had better get jazzed before taking the exam , as well. If its true for caffeine, why not zyprexa, depakote and the rest ?

I, too, write myself notes. My office is a clutter of post-its. I have a dry erase board on the frig so I can remember to water the garden or pay the bills. I even call my own answering machine, because my work and home minds don't "talk to each other". I am lost without my day-book. Although i sometimes forget to look at it!

Bree (May 14, 2004): I also feel like i'm losing my mind. I feel like I used to be so smart and alert. I was in the top 10 of my high school graduating class in 1995. I've been deteriorating ever since. I was miss-diagnosed for years as having unipolar depression, and was on a couple antidepressants. Then I quit cold turkey because I couldn't pay for the doctor visits or the meds (I had lost my job.) Now I have been diagnosed with bipolar, not even 4 months ago. I am on a barrage of meds, including Gabitril, Lamictal, Lexapro, Trazodone, and Abilify. I feel either way too agitated or way too hyper, sometimes within days. I get a night or two of insomnia every week. I've tried lots of meds for that too, including Ambien, Restoril, Adivan, and Trazodone. Most of those don't work. I love to write, but reading sometimes bores me, and t.v. really bores me. I almost always have racing thoughts when I try to go to sleep, some nights worse than others. It's all very frustrating and I'm starting to worry that I'll never just feel okay.

Lu (June 8, 2004):  I have struggled with severe depression since I was 16, and was diagnosed as bipolar nine years ago, when I was 27.  I really empathise with everyone who has posted, as I have severe memory problems. I find it extremely difficult to remember faces, names and follow conversations, and I have left-right confusion.  (I read somewhere left-right confusion affects a lot of bipolar people, do any other readers experience this?)  However, I have a real gift for remembering numbers and dates, but having read another posting, I wonder for how long.

As the years go by, my problems just keep on getting worse.  I am unemployable and socially I just don't want to bother anymore because although I make friends easily I can't usually keep them due to my ever-worsening memory problems.  When people confide in you (and people are always confiding in me, it must be the glasses and my earnest -ie baffled -expression) and you can't remember what they said, they go cold on you pretty quickly!  Even more so when you can't remember meeting them in the first place.

I have a few good friends, and enjoy dabbling with photography, writing and art, but really I feel my life is pointless.

Marie (July 2, 2004):  I know that this isn't related to current topics, but want to know if other bipolar persons are afflicted with the cognitive dysfunction that i am??? I am a health care professional, a nurse practitioner, and since 1999 have been on one antidepressant or another, hospitalized X3 in a psych facility for depression, then in 2003 ended up being diagnosed as bipolar. since being on antidepressants, i have found that my attention span is limited, and I can't remember much since 1999, in regards to retaining stuff related to my job. I'm in a new job now, with a lot of responsibility, and I'm having difficulty remembering stuff that I need to know for my job. My therapist states that it is a problem of my "working memory" as opposed to my attributing it to "Short term memory" loss. Is there anything out there that any of you can recommend to improve one's working and /or short term memory???? I'm up for anything at this point, My psych NP thinks it may be because I'm anemic, and states that my mood will be better when my anemia is corrected, which may very well be true, but the memory problems are what concerns me right now. Any help is greatly appreciated. Great newsletter by the way. I look forward to it immensely. Thanks, Marie

Jim (July 13, 2004):  I agree with Annie that we are still in the "leeches and lobotomy stage". And I agree with James that the drug companies and the doctors are over prescribing this stuff. I don't have any faith in the science.

I guess Lithium has been my worst experience. I've gone toxic 3 times, vomiting may way to the emergency room late at night, just because I didn't swell myself up with enough water. When I'm on it I feel like my head is packed in cotton. I actually lose the ability to speak at a normal rate. I've never been on it for more than a few months at a time. I'm currently on Trileptal and Bupropion which I imagine are slowly melting away my grey matter. My doctor doesn't know it yet but I'm about to drop this stuff too. I just don't trust any of these meds. In thier place I'll just meditate and practice self-restraint.

As for memory: I've found that I'm too impatient to actually memorize anything. If I'm not interested in the subject my mind will reject the material no matter what I do. I guess it's like selective thinking. I don't even bother remembering peoples names. I just say "hey" until some important occurrence forces me to actually learn it.

Q: In regard to being manic (When un- medicated): Does anyone else talk a lot (rapid speech) when they are in the racing thoughts phase? I'm always building and then burning bridges by saying a lot of crazy impulsive things. Everything on my mind comes out. It's like that movie with Jim Carey; I think it's called "Liar, Liar".

McMan (July 13):  Hi, Jim. Is the Pope Episcopalian? Rapid speech and racing thoughts seem to form a manic tandem. Just ask anyone who has seen me in full manic flight.

Nathaniel (Aug 4, 2004):  Hello, I was diagnosed with Major Depressive Disorder; Recurrent cycles in 2001 after I was discharged from the Navy for another medical illness. I spent about two years trying various SSRI antidepressants with limited efficacy and mood improvement. They have helped to precipitate mood swings that really made me feel that I couldn't control my mind. Hell, I was once in the accelerated academic programs at school , like Academically Gifted English in Tenth Grade ,and in about four of the AP courses, but since taking the medications I have noticed several gaps occurring in my cognition. There was one time that i Could absorb a book and debate its fine points with anybody for hours on end, but now I am reduced to the point where I have a hard time sustaining a basic conversation for longer than a few seconds.

I noticed that this problem became manifest after I took Paxil/CR for Panic and anxiety problems. I have read that this medication is notorious for causing changes in memory and learning ability because of its chemical affect on those associated areas in the brain. Like many in this list, I too feel like I am losing my mental abilities and for a time I thought I developed early-onset Alzheimer's or some other rare form of dementia that strikes young people. I would like to know too if any nutritional program or some other chemical agent has shown success in reversing this problem if at all possible. Until then it will probably be difficult for me to attend university and concentrate on any of the lecture material. Hell, I Feel like i want to doze off if I have to complete a multi-step problem or essay that requires a lot of analysis.

Ian (Oct 30, 2004):  sometimes in a manic episode, we are able to pull things off that we really didn't fully understand. Ie some of the things we remember "doing so well" are the things that we did but perhaps not as well as we would like to remember.

Yes I too got 95% average one high school year and now I cant do the problems. That was because I was on a high at the time and just did whatever to get through, I didn't understand the half of it. Now that you've come down, you're more inclined to really try and figure out what it was that happened.

Your brain may not be damaged, but a manic high can cause some of the most profound disorganization, even though the feeling of control is overwhelming.

Wabajoebaba (Nov 17, 2004):  Sheila, I think all those medications are hurting you. I'm not a doctor but you have a huge list of medications you are on. The list of common side effects could fill a page.

Julie (Jan 13, 2005):  Hi, I came here for info on bipolar disorder after coming home from seeing my psych dr. and being told that the bipolar is a "neurotoxin"...I'm really scared and now I think I realize what's happening to my brain. I have forgotten alot of word spelling and can't seem to remember names and phone numbers and I have ALOT of trouble coming up with some words I want to use and can't remember. And also, as Mark posted, he said he'd been referred to as "retarded"...I was called retarded by my own boyfriend! What I was told my dr. today, along with info I've found online tonight, has been quite disheartening. By the way, I'm taking Depakote ER and have been on it for almost 3 yrs. Anyone else taking that and if so, how's it going for you? Thanks.

Jennybean 4/18/05:  Two of my MIs are Major Depressive Disorder and Dysthymia. I have been psych tested for my memory problems and I test out that I do have short-term memory problems (I had to pay a ton of money just to be told that which I already know?!?!). I also know from my real-life experience that I have long-term memory problems, as well, although those didn't test out as a problem. (Guess them tests aren't so perfect after all! HA!!!)

As for when my memory problems began, it was LONG before I began meds. (I suffered for many years before getting help.) Although I haven't yet taken a med that has given me help, I don't think any of the ones I have taken have caused additional memory problems; I believe it is all due to the MIs themselves.

Anyhow, the same night I found this site (tonight), I also found a very interesting PowerPoint presentation on a "Journal of Psychiatry" (or something) Web site that mentioned long-term depression causing brain damage. (The overall PowerPoint was about the physical symptoms of depression.) It talked about how there are parts of the brain that are powered or fed or something by the serotonin and that other brain chemical (forget the name, sorry) so since depressed ppl don't have enough of the chemicals, those parts of the brain are negatively affected. Pretty scary!!

Stupid drain bamage.... ;-P

Miss Dipsy 5/16:  One interesting thing I noted when reading this article and some of the posts is how strikingly similar many of the symptoms are to Attention Deficit Disorder, which I "suffer" from (I actually ended up on this site by accident, but it's very interesting!). Working memory problems, racing thoughts etc are all part of the fundamental diagnostic criteria of ADD. I'm not saying you all have ADD, necessarily, but its interesting to see the degree of overlap. Personally, I'm of the opinion that these diagnostic categories like "bipolar" and "attention deficit disorder" are pretty arbitrary, everyone's brain is unique, and these "syndromes" are simply a collection of behavioural outcomes that are grouped together for simplicity, because people like to have nice black and white, easy to define categories. The pharmacalogical solutions are so hit and miss precisely because of this complexity. There are so many chemical process going on in our nervous systems, that any one drug is not nessecarily going to get the job done.

The key thing I'm saying is don't let yourself be blinded by the medical labels attatched to you, you are an individual with a unique brain, and its always worth being open to looking at your "problems" and "gifts" in another light.

Post your opinion  here.

John McManamy

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