Is post-mood episode cognitive impairment permanent?
April 9, 2012 3:05 PM   Subscribe

Significant cognitive impairment following first major bipolar manic/mixed episode -- is it permanent?

I'm a 30ish woman recovering from my first six months of full-on bipolar 1. After a lifetime of short, severe depressive cycles, I entered my first manic episode about six months ago. It was bad. I ended up in inpatient treatment for a weekend. Once I got out, I careened straight into a classic mixed episode -- angry, irritable, but full of energy and ready to destroy the fuck out of everything I knew and loved. I then spent a week in the hospital and came out much better. New meds, more mindful approach to life in general.

I've always been an extremely high-functioning person. Excellent memory, quick thinker, organized and logical to a fault. I've been very successful in life. I'm a well-known expert in my field and I have a great job with a ton of responsibility (and pay to match).

However, since I left the hospital the second time, I haven't been able to think straight. I have no short-term memory. I can't recall basic facts. I don't remember what I wrote at the top of this post, for christ's sake. I make dumb spelling mistakes. I get lost at Target. I spend impulsively. I can't organize and prioritize tasks to save my life. I haven't been able to return to work -- my entire job is thinking fast, prioritizing and delegating tasks under extreme pressure, and not losing track of anything -- and I know I can't do it anymore. It's humiliating. Instead, I go to art classes and cry when I can't follow the directions, even though I was paying attention. Cognitively, I'm half the person I was six months ago. (I know it looks like I can write fine, but I rely on spellcheck and heavy editing to remove the statements I repeated because I couldn't remember I already stated them. That might be normal for some people, but it is NOT normal for me.)

My doctor says this kind of "executive dysfunction" is normal during recovery. It's not the lithium or the Seroquel, it's just me, and I'll get better. Then I see articles like this, suggesting that cognitive impairment is just part of the disease:

I mean, jesus, the tests they list there are tests I know I would fail right now. It's terrifying.

I feel like an athlete who's been in an accident and may never walk again.

I'm looking for personal anecdotes and more journal articles discussing my situation in particular -- late-life diagnoses of otherwise normal and successful people. Is the cognitive impairment that's apparently a normal part of bipolar 1, will it affect people who never had it before? Or is my doctor right, that it's just part of recovery and I'll get better?
posted by anonymous to Health & Fitness (12 answers total) 8 users marked this as a favorite
Seroquel can cause this. That's not to say that you should get off of it, but you should know that it might not be the bipolar.
posted by the young rope-rider at 3:06 PM on April 9, 2012 [2 favorites]

Seroquel is NOT known to cause these symptoms -- UNLESS the cognitive impairment is actually due to extreme fatigue, which Seroquel CAN cause.
posted by imagineerit at 3:10 PM on April 9, 2012 [3 favorites]

You'll get better. Part of it is adjusting your medication regime, part of it is you adjusting to your medication, but one of my best friends had major, major manic episodes following by year-long depressive swings and now, more than five years later he's managed to put his career back together and is doing great work at a "fortune 10" company.
posted by Oktober at 3:14 PM on April 9, 2012 [2 favorites]

Maybe it's not in the official side effects but pretty much everything I've read by people who have taken seroquel say that it makes them foggy, sleepy, unable to focus, etc.

Of course not being a psychiatrist it's hard for me to say that this is the same thing that the asker is talking about and I surely have been wrong before.

There are, of course, medications that help with executive dysfunction but they can also trigger mania and I don't know if a psychiatrist would be willing to prescribe them to you in this situation.
posted by the young rope-rider at 3:20 PM on April 9, 2012 [1 favorite]

You know you've also been through a life changing event which will take some time to focus. Being diagnosed with a serious illness and hospitalized is HARD.

Don't discount how much of what you're going through is from sheer mental exhaustion which would follow any major life change.
posted by SpaceWarp13 at 3:57 PM on April 9, 2012 [1 favorite]

It's either drug or both. Do you find you are less physically coordinated as well?
A lot of people cannot tolerate lithium. Since it's your first episode, they are purposely overmedicating you right now to some degree, to theorically quash your mania long enough so it doesn't "reignite."
Depending on how long it's been since you were fully manic, you are going to be kind of scrambled, from the new drugs and your brain readjusting.
Cognitive impairment is not an inevitable part of the disorder and cases are extremely heterogeneous.
I did in fact develop some degree of impairment because of long term mismedication. I would stare at the books on my shelf I could no longer read. It turns out I have a kind of acquired ADD.
With medication, focusing in significantly easier, but everything involves more conscious effort in a way, more motivation.
If your symptoms are not better in a month, change your medications.
If you can tolerate lithium, you still want to be on the lowest functional dose.

Besides the biochemical changes, you've been in and out of the hospital, which is fairly traumatic for most people, and you are adjusting to a new diagnosis and recovering from being disconnected from reality. Give yourself a break. If you need to keep busy, do it by tending to your health, because you have to give everything some time to settle down, fer chrissake.

If you have the tendency to worry or ruminate, do not indulge it scaring yourself about having bipolar disorder. There are lots of highly functional people with bipolar disorder. It is all about how you manage it. Educate yourself if you need something to do, but you are on medical leave from work and everyone including you is going to have to accept it.

It is not the end of the world, it's adjusting to a new world. Email if you like. I study bipolar disorder. I have bipolar disorder. And there is approximately 70% misdiagnosis.
posted by provoliminal at 5:30 PM on April 9, 2012 [5 favorites]

Agreeing that it should go away. Hospitalization, or even just severe disruptions to the routine, is very difficult. Even more so when it psychiatric in nature- you are taking different drugs, you are going through therapy, and so on.

I'll offer something I learned after getting treatment for ADHD as an adult. I'm not saying they are alike, but maybe the reaction to the new reality is similar. What I realized after getting started in treatment was that I had been sort of leveraging my ADHD to be productive. I would set impossible goals, stress myself out and generally whip myself into a lather as a way to get the adrenalin going to be able to focus and meet some deadline. What that ended up doing was sort of like squeezing a balloon. I'd be so exhausted from the stress that anything that wasn't an EMERGENCY never got done. I had to re-learn how to be productive in different ways. Learn how to get things done without turning them into emergencies. It felt (and still feels to some extent) like I'm missing things, because I'd been so used to the stress. My mind was still stuck on productivity=stress=productivity, and the converse of no stress = shirking my responsibilities.

So what I'm suggesting is that you are still just adjusting to your new reality of "missing" the bipolarity. That's something that high-functioning bipolar people do, I think, is to leverage the manic times in order to sort of ride out the lower times. Now that the disorder is more under control, there is a bit of a trade-off. You lose the ride up, which can feel weird to not have. But you've also shed the angry ride down and the pit of despair, which will improve your life greatly. You just have to rearrange things a little bit and perhaps over-manage yourself, executive function-wise. To do lists and calendars to keep up with everything. I'm almost certain that in a couple of months of sticking to a routine like that, you'll find that you'll again be functioning at a comfortable level, and probably a lot more productive after not too long.
posted by gjc at 5:48 PM on April 9, 2012 [2 favorites]

What Spacewarp13 says is right. You've been through a great deal.

My brother developed this condition six years ago. His first recovery from a manic episode sounds a lot like yours. He also took Seroquel.

He's loads better now. He said the other day that he can feel it coming back again, but that he feels forewarned is forearmed and that he thinks he can have a crack at handling the next episode a lot better.

Good luck.
posted by devious truculent and unreliable at 6:35 AM on April 10, 2012

If you've had an IQ test before, I recommend taking one again, so you can see exactly what your current cognitive deficits are and how they compare to your previous functioning. You might find things aren't as bad as you think, or you might be able to pinpoint what's failing: short-term memory, vocabulary recall, abstract reasoning, etc. It might help you focus on what you could do to improve your functioning in those areas or plan for how to anticipate and accommodate deficits.
posted by jann at 8:16 AM on April 10, 2012

i have had the exact same experience as you. it will get better, and in the meantime, you can develop cheats/coping techniques to help deal with the cognitive effects (most people won't even notice what you are doing). i started compulsively taking notes and making very detailed lists, for instance.

you might also ask your doctor about the speedy thinking, distractability, etc. that you are experiencing - that's how i am when i am hypomanic, so if you are in an extended episode, you are going to want treatment before it flips into full blown mania.

(((you))) it is such a confusing and disorienting time. feel free to message me, if you want.
posted by unlucky.lisp at 8:40 AM on April 10, 2012 [1 favorite]

Are your doctors really sure it's not the medication? Have you had the blood draw to check lithium levels? If that came back ok, are you feeling dehydrated at all? Are you drinking lots of water? Is your body processing that water properly?

Yes, cognitive impairment can be par for the course with bipolar and hospitalization and new medication, but a lot of what you describe is me on lithium. Even when the blood tests came back that I was not toxic, I was definitely toxic.

Talk to your doctor (I assume you found a regular psychiatrist after hospitalization). Also, make sure you find a good therapist.
posted by MuChao at 8:43 AM on April 10, 2012

Hi. I'm the OP. It turned out you were right -- I was back at work and functioning as well as ever within a few months. Thank you.

Of course, my meds weren't really dialed in yet, and I stopped taking them because I'm an idiot, and you can probably fill in the rest. Now I'm recovering from a nasty mixed episode and titrating the meds back up again. And I feel just as slow and thick as I did when I started this thread. At least this time, I can be reasonably sure I'll feel better soon.

I wanted to post an update, even though the thread is old, because I wanted to give hope to future readers. Also, take your fucking meds.
posted by sock puppet du jour at 6:21 PM on October 4, 2012 [2 favorites]

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