how do i address possible memory/cognitive issues with my doctor?

May 20, 2009 5:49 PM

as a twenty-something, how do i address possible memory/cognitive issues with a doctor without both of us thinking i'm crazy? or am i crazy?

I'll try to explain my situation as best I can; pardon me if I make any glaring omissions. Also, please direct any inquiries to [e-mail].

Back in January, I was happily chugging along in my coursework, when I suddenly started having the worst headaches of my life, along with trouble sleeping and remembering and concentrating on things. I didn't think much of it at the time, but I asked my GP anyway and he thought I was probably suffering from depression and anxiety and gave me an Rx for Lexapro. I was a bit reluctant to start taking this, however, since I don't have any history of depression, nor did I feel in any way down or depressed or what have you. At any rate, as days turned into weeks and weeks into months, it seemed that my headaches were getting worse, I felt constantly groggy, and that I had much greater difficulty remembering and concentrating, so I asked to be referred to a neurologist. Before my appointment with the neurologist, I had an MRI of my brain done which was "negative." At my appointment, the neurologist conducted his examination in which he asked me to tell him the current date and remember a few objects to recite back to him a few minutes later. I could not recall the exact date (it even takes me a while sometimes to realize what month it is), and I could only recall one out of the three objects he told me. After he finished his examination, I asked him what he thought and he proceeded to tell me that I was probably just suffering from depression-related concentration issues, so he sent me home with a referral to a psychiatrist. I have yet to see the psychiatrist, since apparently he's booked solid for about two months. Given that this isn't resolving itself, I don't really want to wait that long.

Am I wrong to be skeptical of taking an anti-depressant in this circumstance? I honestly have no idea what depression feels like, but I know I don't feel in any way sad. Should I try to find another neurologist and/or psychiatrist who can see me sooner? This whole situation got markedly more weird when I recently visited a close friend I've seen often in the past, and although I knew how to get to the friend's house, my surroundings on the way there seemed oddly very foreign and I felt like I was lost. I wasn't anxious up until that point, but I certainly am now.

For what it's worth, I've never done drugs, I rarely drink, all blood work was within normal limits, I currently live in Minneapolis, MN, and I have no health insurance. If anyone knows any good options for health insurance and/or good neurologists and psychiatrists in the area, please let me know. I don't really have the time or the money or the energy to guess and test doctors much anymore. I'm about at my wit's end with this and want to be able to return to my classes in the fall as someone who can actually think straight again, if that's even possible.

Also for what it's worth, what I'm going through seems somewhat similar to what this person went through, except for the fact that I haven't had a PET scan.

I hate to ask AskMeFi to be my doctor or to help me find one, but I don't really know what to do anymore. Any help would be so very appreciated. Thank you.

posted by anonymous to health & fitness (19 comments total)

I would find a different psychiatrist. But I would also think about any other changes that have gone on. Different living space, different food, different water, drinking more often, what have you.

I second the theory (from the linked thread) that it might be sleep related. I can only say for myself that feeling stupid, forgetful and sluggish go hand in hand with poor sleep. I haven't yet figured how they are connected up (for me). Try going to bed when it's dark and waking up when the sun comes up. See if there is an improvement.

Depression doesn't necessarily have to feel like "sad". It can manifest in many ways- many people suffer from a sort of over-sensitivity to everything, and eventually train themselves to shut down. They probably don't feel sad- just constantly on edge, annoyed and seeking some kind of emotional silence. An SSRI softens the blows of the world and they can again learn to trust that the world isn't trying to beat them up. For example. Also, for people who have always been depressed, sad is normal so it's hard to recognize as sad.
posted by gjc at 6:16 PM on May 20 [2 favorites has favorites]

There's a societal stigma to taking depression medication. As if, by taking pills, you become a confirmed crazy person. Set that aside and let your doctors guide you; after all, depression meds aren't only for depression... think of them as adjusting the settings of your brain. Run experiments on yourself until you find something that works.

The psychiatrist will probably have you take one of the standard IQ tests. These are like much more detailed versions of "what is today's date?". The purpose is to determine which areas of cognitive function are affected, and this in turn may rule out certain diagnoses. Get a referral to a different psychiatrist, since this one's so busy.
posted by qxntpqbbbqxl at 6:29 PM on May 20

I know you said you've had blood work, but have you had your thyroid tested? Having hypothyroidism can definitely cause headaches and memory lapses.

Also, you say you're not depressed, but what about having an anxiety disorder? I know that if I'm on the edge of a panic attack, I can have moments of depersonalization, where everything feels weird and foreign and I forget basic stuff. It's totally freaky, but I can recognize it now and know that I need some medication that makes it go away pretty quickly.

my surroundings on the way there seemed oddly very foreign and I felt like I was lost

That definitely sounds like when I have one of those moments.
posted by sugarfish at 6:33 PM on May 20

Here is the wiki article about depersonalization.
posted by sugarfish at 6:35 PM on May 20

I should warn you that depending on your symptoms (sleeping/grogginess/etc), your doctor may be legally required to contact the government and have them revoke your driver's license... This happened to a friend of mine right before we left on a major road trip, leaving me to do thousands of km of driving solo.

But you should talk to your doctor.
posted by glider at 6:43 PM on May 20

Not your doctor, etc. Just a jr medical student doing her psych rotation at the mo.

What your physician probably tested you with was a standard test that evaluates people for delirium/dementia (the Mental Status Exam, the St. Louis University Mental Status Exam, or some other version...), not an IQ test. I'm assuming that your cognition was normal prior to the headaches; your performance on the exam was not typical for someone your age and in a normal state of health. From this point on, what will particularly matter is your performance on the test over time.

Anyway - I certainly wouldn't durst evaluate you for depression, but physicians typically diagnose depression based on a constellation of symptoms, of which loss of concentration and cognitive difficulty is a part. Do you have sleeplessness or excess sleep, feelings of low energy, hopelessness, guilt, weight gain/weight loss over the last six months? Have you ever had a history of depression in your family? Answers like these matter in an initial diagnosis.

I would think there are other possibilities other than depression that would explain these symptoms; I would suspect that other possibilities would be maybe some sort of encephalopathy (swelling of the brain), or a tumor (would have been ruled out by imaging). I wonder if a sudden onset of symptoms - wonder if that would support a more organic cause? Any physicians in the house care to comment?

As for finding a doctor - do you live near a large academic center, a place where they have a neurology service that sees a high volume of cases? My county hospital sets up appts with people to "rate" them on a sliding scale - the lower your income, the less you pay for your doctor's visits. Perhaps you could do the same.

Let us know what happens... I hope things turn out all right!
posted by archofatlas at 7:00 PM on May 20

Doctors don't take young people seriously: I had gallstones in my early 20s and the first FIVE doctors I saw diagnosed them as panic attacks after a cursory chat. Despite me not being at all panicky or having any of the actual symptoms of panic attacks beside shortness of breath. At. all. I thought it was a load of BS and eventually found a decent doctor and got cured. Similarly I'm pretty sure that if you are protesting "but i don't feel sad! I feel fine!" you are not depressed enough to be experiencing depersonalization.

If you really think it's physical (and you have a good argument with the sudden onset headaches) then go find another doctor. Don't skip the psychiatrist appointment because they might actually help you by pointing out that you're not depressed. But find another neurologist and tell your GP you found the first one useless- otherwise they will keep referring people there.

Of course it is worth sleeping well, eating well and overhauling your general lifestyle etc if you're feeling run down.
posted by fshgrl at 7:07 PM on May 20 [1 favorite has favorites]

Btw, I've had extended periods of migraine/ cluster headache that left me extremely spacey and unable to focus for weeks at a time (though oddly at peace with the world). You might try taking Excedrin Migraine at the onset of a headache or even a sub-headache and see if it helps. imho, it's as good as any prescription drug.
posted by fshgrl at 7:10 PM on May 20

Other possibilities that crossed my mind and may not be the first that get tested for: lyme and epstein-barr viruses. I do wonder if the neurologist's eval wasn't tainted a bit from the referring doc--s/he saw that you had been diagnosed "depressed," and s/he stopped looking right there.

You really have to fight for yourself in the medical system. Keep asking questions, keep doing your own research, keep advocating for yourself. YOU know yourself better than any doctor ever could.

I'm going to email you a few questions here in a sec.
posted by thebrokedown at 7:12 PM on May 20

I would be concerned that, since you were already taking medication for depression when you went to see the neurologist, the neurologist may have been too quick to attribute your symptoms to that previously (and apparently somewhat offhandedly?) diagnosed depression. This sounds like the sort of thing where you would want to draw on whatever resources you have -- family help, perhaps -- to see another neurologist as quickly as possible.
posted by Dolukhanova at 7:12 PM on May 20

B12 deficiency can cause cognitive problems. Today's poor diets leave a lot of us with B12 deficiency and it is a real problem--energy sapping, memory problems, etc. It's a simple blood test (as is the thyroid). This blood work is at least worth a shot.
posted by FergieBelle at 7:14 PM on May 20

This is exactly what happens if you are exposed to certain types of mold.
You may be able to find obvious signs of mold in your environment; damp basement, leaky pipes in the walls, forest environment. But you also may never find it.

My advice to you is move, right now. Someplace dry and sterile. It can take a year to recover fully from mold exposure.
posted by Osmanthus at 7:59 PM on May 20

I'm not a doctor. If I was in your situation, I would definitely seek a second and third opinion in this case - to me, the sudden strong headaches are the key factor here. That's not depression. Maybe it's migraine related, but I wouldn't make that call. You should keep the psychiatrist appointment, but make him/her really focus on the possibility that it is not depression, and if he/she insists (to a man with a hammer everything is a nail), make them prove their case. Regardless, I would keep talking to neurologists. Doctors, like lawyers, like every human professional, are distributed along a bell curve. The really good ones are rare. There are tons of mediocrities. You owe it to yourself to keep looking for the ones who actually help, rather than prescription machines who dispense an aspirin (or lexapro!) and send you on your way.
posted by VikingSword at 8:10 PM on May 20

Someone pointed me to this post -- a few years back, I wrote the question you referenced. Our symptoms do sound very similar: "worst headaches of my life, along with trouble sleeping and remembering and concentrating on things." I was sleeping excessively, though, and at the drop of a hat.

I was completely sure that depression didn't play an element in my issues. The neuropsychologist I saw agreed. There were times in my life when I had been depressed, so I know what it's like, but this wasn't one of them. I was in an environment I totally loved, and desperate for the energy to do much more. I had no feelings of anhedonia. I'm not saying this is the case for you; I'm just explaining what my situation was.

I went to several different doctors (serially) and was treated for several different things, some of which struck me as big scams. I was diagnosed with narcolepsy, and that medication (Provigil) did a lot to eliminate my excessive sleep -- I'm still perfectly capable of sleeping 15+ hours a day, but Provigil makes it possible for me to keep my eyes open much longer. They also discovered I was Factor V Leiden positive, which is linked to narcolepsy and to Ehlers-Danlos, which they believe I also have. My current doctor believes Factor V Leiden is linked to mental sluggishness. After going through a few scammy doctors, I'm taking that with a huge grain of salt -- these genetic quirks really aren't very rare, and most people who have them don't complain about mental issues. He hasn't suggested any treatment.

The good news is that now my function is almost completely back to normal. I still usually have a low-level headache, but I think I'm up to about the same mental speed and clarity I used to have before all this began. My memory, especially long-term, is still questionable, but short-term has definitely improved from its worst. I can't tell you whether any of this was due to anything but time (or maybe just the brain's coping mechanisms). During all of this, I lived in a bunch of different environments, which didn't seem to contribute at all. I also lost just shy of 100 pounds (no surgery, can go into detail if you want but I'm far from sure it's relevant).

In short, I'm not sure I'm offering you anything helpful at all -- but if you're interested in my experiences anyway, feel free to e-mail me. Best of luck, and please let me know if I can help.
posted by booksandlibretti at 8:35 PM on May 20 [1 favorite has favorites]

A friend of mine had weird symptoms for years. In her 20s she had weird neurological symptoms and got pigeon holed as being stressed/depressed and was put on lexapro. A couple years later, she woke up with the "worst headache of her life" and drove herself to the ER. They did a CT(I think) which was read as "negative" and was sent home with pain meds for migraine

The next day she drove herself back and said "you really need to take this seriously" and they did a spinal tap and found blood in her spinal fluid from a leaking aneurysm. The problems she was having for the last few years was due to it growing. They had read the CT scan wrong the night before also, and it showed the problem when read by someone else. Get a 2nd opinion on the scan you got already.

Since she was young and got pigeon holed I think the drs never really did a good trouble tree on her.

If something is weird keep pressing. She ended up with many new doctors since she moved a lot and I think they all saw "lexapro" on the sheet and stopped there.
posted by bottlebrushtree at 10:03 PM on May 20

I'm no sawbones, but I do work in a memory lab, and young people having that sort of trouble on the MMSE is a major red flag. If someone in his or her twenties couldn't tell me the month or remember three items after a short distraction task, our IRB stipulates that we have to stop our experiments and refer them to a health care professional. Maybe instead of a neurologist or psychiatrist you should see a neuropsychologist. These sorts of memory deficits are not normal at your age.
posted by solipsophistocracy at 10:49 PM on May 20

You mention coursework, so it sounds like you're a student. Can you not get insurance through your school? If you're low-income, you may be eligible for low-cost health care through your state's programs.
posted by Mavri at 5:43 AM on May 21

Someone above mentioned sleep: do you have the headaches in the morning? Are you a bad snorer? You might want to push for a sleep study as well, if you're feeling physically tired too. Non-restorative sleep is murder on memory and executive functioning.
posted by availablelight at 6:49 AM on May 21

My sister had a sudden-onset bad headache year before last (in her 30s) which lasted for months, and was accompanied by excess sleepiness, difficulty focusing, etc. When they took her seriously about it, they discovered she had a brain tumor, which they removed successfully but did not stop the pain. She pushed them to seek another cause, and they discovered (finally!) a small tear in her cervical spinal column allowing spinal fluid to leak. They patched it with a small amount of her own blood and the headache ceased within a couple of days.

Whatever is going on with you, it definitely sounds like you need at least a second opinion.
posted by notashroom at 9:39 AM on May 21