I seem to be losing my mind, and then my job, in that order. Help?
March 23, 2017 1:00 PM   Subscribe

I'm looking for advice on dealing with what feels like cognitive decline, though it's all tangled up with anxiety and depression and it's hard to tell where one stops and the other begins.

Background: I've been struggling with anxiety and depression for 20+ years now, but since 2011 I've been experiencing increasingly severe cognitive issues: forgetting things, difficulty understanding things, difficulty picking up new skills and retaining information. Ten years ago I could pick up a new skill / language / technology pretty quickly, in fact it was one of my strongest professional skills, but that's no longer the case. I've worked around it for as long as I could but I'm now at a crisis at work; there are things I'm expected to know and to do that I just can't seem to get my head around.

This crisis came to a head several weeks ago, at which point I took a medical leave from work because I could see my performance deteriorating and I felt like I had to either take some time off or quit. During that time off I worked with my GP on adjusting my meds and started seeing a new therapist.

I'm back at work now and unfortunately I'm right back in crisis mode. The adjusted meds have helped improve depression and reduced overall anxiety a bit, but I'm still struggling here, and nothing we've discussed in therapy so far is helping.

The only thing I've had limited success with so far has been a combination of beta blockers and high doses of caffeine - I think maybe the caffeine is helping me think better/faster and the beta blocker is helping to get the anxiety out of the way and counteract the physical effects (twitchy/anxiousness) of the caffeine. I've also seen some limited success with various kinds of music through headphones as I work, though not so much lately. (I mostly stopped doing the caffeine/beta blocker thing because it was affecting my sleep.)

I've been taking Wellbutrin XL (bupropion) for several years, with mixed efficacy, and beta blockers (propranolol) as needed for acute anxiety (particularly for work meetings and such). Doctor started me on Paxil as well about 6 weeks ago, which seems to be helping improve my overall mood but which is doing very little for anxiety or cognitive stuff. I also got a couple of weeks of Klonopin, which was intended to help while the Paxil was ramping up, and I find that the Klonopin is much more effective at addressing the anxiety, though I haven't been able to see how well it might help address the cognitive issues yet. (Both the Paxil and the Klonopin have been making me very sleepy also, though I'm told most people get used to it.) Finally, late last year I started using a CPAP machine since a sleep test showed that I wasn't breathing well at all during sleep. This is helping me sleep better and wake up more refreshed, but it doesn't seem (yet at least) to be helping much to address anxiety or cognitive stuff.

I understand that you are not my doctor or therapist or neuropsychologist. That said, I'm looking for any advice anyone can offer, particularly first-hand advice, in any of three directions here:
  1. Has anyone been through these kinds of symptoms and have any anecdotal advice on correcting or dealing with them?
  2. Among other points, I'm struggling to figure out whether the cognitive symptoms are related to anxiety/depression, or completely independent. From experience my impression is that there's a negative feedback loop here, in that cognitive difficulties lead to anxiety which in turn exacerbate the cognitive symptoms. But beyond that I really can't tell whether or how these symptoms are related. Maybe someone has experienced something similar?
  3. Entirely apart from the medical / psychological issues, I'd appreciate any advice anyone can share about how to best handle the situation at work. Obviously this will vary a lot across workplaces and companies; in this case it's a large company with pretty robust options for medical/FMLA leave and both short- and long-term disability. They also seem open to ongoing accommodations for medical issues, though I really don't know what kinds of accommodations might help. Parts of my job I can still do just fine, but the parts that involve tasks I haven't mastered yet seem nearly impossible at the moment.
Anyone here who's dealt with these kinds of issues and can share their experiences? I get that these might be sensitive topics so if you'd rather comment privately, please use thisisthebestemailaddress2017@gmail.com. Thanks in advance.
posted by anonymous to Health & Fitness (14 answers total) 16 users marked this as a favorite
I can't say definitively what's going on with you, but I can say that depression and anxiety cause focus and retention problems for me too. When I'm having a rough time someone can look me in the eye and repeat what they want from me three or four times. As soon as I'm not looking at them anymore, whatever they said just leaves my head. It's immensely frustrating because I've always been one of the "smart" ones. I find Wunderlist helps as long as you can be really proactive about it. Don't trust your brain to retain anything, write it all down.

That said, you sound burnt out. Honestly, this post seems a little frenetic. The boring stuff is sometimes the hardest and the best at making you feel better. It's also not a quick fix, which makes it tough. At first it feels like work and you're already stretched thin, but over days or weeks good habits build. Make sure you're eating well (and also occasionally treating yourself). Make sure you're sleeping long enough. At work, make sure you're taking breaks and try some grounding exercises. It's way easier to keep yourself from getting amped up than to bring you back down once you're there. Do you have a support network? Vent to them. Make sure you're getting a chance to laugh and focus on trying to enjoy little things. Taking a walk outside always helps me level out. I know that's all boring and obvious, but it really will help. All of these things give your brain a chance to rest so it can focus on your work. You've got this!
posted by Bistyfrass at 1:24 PM on March 23, 2017 [1 favorite]

You're are on a lot of psychoactive meds, and Klonopin in particular can lay waste to your cognitive abilities.

Have you considered getting a new therapist who isn't so focused on treatment with drugs?
posted by empath at 1:30 PM on March 23, 2017 [8 favorites]

Have you tried exercise?
posted by amtho at 1:33 PM on March 23, 2017 [2 favorites]

(just to clarify-- i don't think taking anti-depressants per-se is a problem, just that you seem to be experiencing a lot of side effects, and maybe attacking some of those problems from another angle might help)
posted by empath at 1:37 PM on March 23, 2017 [1 favorite]

I have an often-times similar condition as you describe. I've had eras when I've felt as you do now. The fact that drugs alleviate the symptoms of your mental problems, doesn't mean that they take away all of them. What I'm saying is that in moments of severe emotional duress I get the stupids. My memory goes to shit and I feel 90 years old, I can't even type on a smartphone right, or drive a car. Or I can, but badly, and I feel like I've lost my marbles.
I'm not saying that you shouldn't take your experience of a mental decline seriously, but throw them at your doctor and move on. If this is a real thing, they can test for it, but if it's anxiety, it'll go away once you manage to get out of the bad feedback loop.
My shrink is making me do breathing and posture things, and doesn't let me indulge so much in the overthinking department. I've got meds and things, but the only control *I* have is through modifying my thinking and behaviour. I accept that I'm partially ill, and I try to scale down my expectations accordingly. My anxiety interacts with control, trust and expectations. I'm not in the place yet where I've got routine in order, where I can enjoy the benifit of excercise and a good diet, but I try to exert myself whenever posible, and I try to make good choices when I can. I'm meeting my shrink weekly, spending all my disposable income on it, to try to wind down my interaction problems, my emotional reaction problems, relationship problems and emotional baggage. I'm giving it time to work, with low expectations and a decision to have a dogged approach, to appreciate what I do do, rather than focus on my failings, chipping away at the problems bit by bit.
I have ADHD, and certain aspects of my personality create interactions that keep happening, with new people. I tend to become the black sheep in any situation, I'm perceived as lazy and uncaring, no matter how well I deliver. This is one of the issues I'm working on. It's both emotional baggage of mine, and a set of bad "defense mechanisms" that I have to learn to undo. The ADHD is unchangeable, and I think it's fine. I mention this because I do believe that my symptoms don't come from nothing, the sadness and the stress that ends up in panic attacks come from something I can't fix, but I'm learning to work around.
Also, and this may be projection, but maybe your situation just sucks, something (or someone) in your job is unnerving, and the whole situation ending and you going off to find a new place of occupation is maybe not the worst thing in the world? If not, disregard this suggestion :D
So I don't have any advice, as such. But I do believe that you will find your way, because I've felt like you do, and I don't anymore.
posted by svenni at 1:46 PM on March 23, 2017 [3 favorites]

How are your thyroid levels? Undiagnosed hypothyroidism can cause anxiety, depression, and cognitive issues.
posted by artistic verisimilitude at 1:59 PM on March 23, 2017 [1 favorite]

Confusion, memory problems, trouble with word recall etc. are all potential known side effects of Wellbutrin.
posted by flourpot at 3:14 PM on March 23, 2017 [6 favorites]

I had similar symptoms and it turns I was very anemic. I had an iron transfusion and two weeks later I felt like a new person.
posted by Jubey at 3:19 PM on March 23, 2017 [2 favorites]

That's... quite the cocktail of medication. X-R drugs do not always play nice with other drugs, and that's not even mentioning regular side effects. I'd get another opinion from a different doctor,and ask for blood work on things like thyroid levels and iron.

I am weary of any doctor that will say that new or unexpected symptoms are "just anxiety" when you are on a lot of drugs who's side effects and interactions could explain them.
posted by InkDrinker at 4:49 PM on March 23, 2017 [3 favorites]

Have you addressed this medically?
Because a number of issues can be causing this. Off the top of my head, thyroid issues, adult ADHD, vitamin deficiencies (vitamin B12 and D are biggies), chronic sleep deprivation, gluten issues, and simple long-term stress. And what about medication? It sounds like the Wellbutrin isn't working for you as well as you like. In addition, absolutely yes to the negative feedback cycle where anxiety and depression causing cognitive issues in turn causes more anxiety and depression about the cognition problems you are having. For this CBT focused therapy can mediate some of those negative thoughts and rumination.

As far as the untangling between anxiety, depression, and a medical issue goes, that's definitely something a doctor, psychiatrist, or clinical neuropsychologist should work with you on.

I will say though, diet, sleep, and stress play a moderate to large size role in this. A regular sleep schedule (yes, even on the weekends) can help with concentration and memory, especially when getting ENOUGH sleep. Also, do you have time to focus on yourself and get some me-time in? Yoga, long drives listening to your favorite albums, walks in a forest with perhaps some podcasts are decent ways to relax.

And lastly, are you happy at work? Do you want to be learning the things you are and are you excited by the role you play? Because the motivation does matter in getting the work done. Personally, when I see no value in what I'm doing, my motivation tanks and I retain almost nothing of what has been taught to me. In the meantime have you thought about possibly stepping down in your company to a less demanding position while you get this figured out?
posted by wilywabbit at 5:10 PM on March 23, 2017 [4 favorites]

This was me when my B12 was low, down to the doctors trying to diagnose anxiety. I refused to listen to that as you don't suddenly develop crippling anxiety in your 40s after a lifetime of devil may care worryfree existence. Anyway, had dozens of shots, take sublinguil pills now and am back to my normal self. But I had to FIGHT to get treated properly. I'd suggest you go in and make a fuss of the "this is unacceptable, I am losing my livelihood" kind and get a top to toe medical workup instead of letting them experiment on you with pills. You may still have an underlying anxiety issue but at least you can address the rest.

btw, I also have adult onset celiac and that makes me an idiot if I accidentally eat gluten-y stuff.
posted by fshgrl at 8:12 PM on March 23, 2017 [2 favorites]

I think you need a rest. I also have recurrent depression and anxiety, and I become remarkably less compos mentis the more depressed I become. It's a known thing that depression can mimic dementia (even in the elderly! maybe especially in the elderly!). It may be that there's something else going on too, but you won't know until you've got the other issues sorted out. Since your work is Good With Leave, I suggest you get yourself signed off for as long as you can manage, and spend that time actually recuperating and trying to live **without** all the pressure you're putting on yourself. Do some art projects, go on holiday somewhere nice, go to your therapy appointments, just try to get back a sense that you're more than your work performance.

I agree that it's a good idea to get a few blood tests to rule out some of the simple physical things that could be causing this. They may well not show anything. That doesn't mean that you can't get yourself into more of a mens-sana-in-corpore-sano situation. Working on your sleep seems like an obvious point to start with. Remember you're trying to heal your brain from a combo of mental health stress and what may have been years of interrupted sleep. Give yourself lots of hours of good sleep with the CPAP, in a nice comfortable bed and (I don't know why but this always seems to help me) clean, pleasant-textured sheets. There are a few supplements you may want to play around with; it's probably not a good idea to go too crazy here, but I know that I personally have had a lot of success with magnesium supplementation - did you know that most American diets are deficient? (It's important to get an easily-absorbed form, though. Personally, I prefer magnesium malate.)

Another thing that I always find helpful when I'm feeling especially depleted is making sure to have some extra high-protein meals. Because I'm a vegan, for me that means tempeh or seitan, but you can probably find something that fits with your diet.

I'm not sure a blanket rec to 'try exercise' is going to be very helpful, but I do suggest trying to get outside and walk each day, get some sunlight, and do physical things that make you enjoy having a body. For me, the only exercise-like activity I don't hate is yoga, but the woo-woo kind where you're doing it to CDs of people Omming. You may well have different preferences!

It will take time to work out what works for you, which is another reason why I'm suggesting that you take some time off if you can.

I'm going to stand up here and say I don't actually think you're on 'a lot of meds', especially as some of them you seem to have started only in the last few weeks. However, I do think it's worthwhile trying to figure out whether the Wellbutrin is helping or harming you at this point. It might be that it is causing side effects but that you still need to stay on it! Mirtazapine makes me sleepy and hungry (and kinda fat), and venlafaxine gives me migraines and causes hella withdrawal if I am late in taking it by a few hours, and I need to stay on both of them because without them I am crazy and miserable. Sometimes it's a question of adjusting to what a medicated life really means - a lot of people talk like it's not okay to trade off some things in exchange for not being depressed, but personally I think depression is basically torture and I would put up with a LOT to not experience it again. But it's always good to make these decisions with open eyes, either way.

Take care. I really hope you feel better soon. Be kind to yourself.
posted by Acheman at 2:46 AM on March 24, 2017

I second or third or whatever the idea that you're on way too many drugs that are messing with your mind. For example beta blockers aren't great for anxiety as they actually slow down your heartbeat and will make you tired and drowsy. Taking them and counteracting that effect with tons of caffeine seems like madness as caffeine will speed up your heart and cause anxiety. So you have two drugs with nearly the opposite effects battling it out in your poor exhausted body and mind and that's on top of all the other drugs you're taking. No wonder you aren't able to think or function well with all that going on - nobody could!

Can you go back on medical leave, change doctors and get a reset on all these meds to be able to find out what you actually need? I have an anxiety disorder and at one point was taking beta blockers for high blood pressure. They made me absolutely exhausted and I couldn't keep going with them. We're all different but what has helped me the most with my anxiety is cutting waaaay down on caffeine(although withdrawal headaches were hell the difference in my anxiety levels was amazing). Exercise also really helps me. And I take the very occasional Xanax or Valium if absolutely necessary. I'm not saying that would work for you but just to offer an example of being on the opposite end of the medication spectrum with a lifelong psychiatrist-diagnosed anxiety disorder that is pretty well under control now.
posted by hazyjane at 6:32 AM on March 24, 2017

Note: to all those commenting who are upset that the asker is taking too many medications.

The asker is only on two daily medications listed here, Wellbutrin for depression and Paxil for anxiety.

Propranolol is a drug that's meant to be used as needed for performance anxiety. It is usually used once every couple of weeks or months as needed. It is not a drug used for generalized anxiety, usually, and it sounds like the asker was started on Paxil because they were having symptoms of more generalized anxiety.

Paxil is a good first line anti anxiety drug, but it has a long half life and it takes weeks for it to start working. It is not uncommon for doctors to give a very short prescription for a benzodiazepine like Klonopin to use only briefly until the Paxil kicks in, especially when patients are really struggling with anxiety issues in the short term and feel like they can't manage for a few weeks until the other drug is effective. (To the asker, a side note - I would not expect for Klonopin to help at all with your mental clarity. Your doctor only intended for you to use it during the Paxil ramp-up, it's not great for long term use if you can avoid it because it's habit forming).

I can't comment directly on the asker's medication management based on a web post, but as a physician, in general the use of Wellbutrin for depression and Paxil for anxiety are very common and considered reasonable first choices for management of these conditions. I see no cause for alarm or red flags for 'pill pushing'.
posted by treehorn+bunny at 2:14 AM on March 25, 2017 [1 favorite]

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