Return to job after bipolar flare-up, cognitive impairment

January 2, 2020 12:12 PM

I'm wondering if anyone here has returned to work after a period of acute mental illness (bipolar II) and felt dumb as a brick in their high-functioning job? I was hospitalized in April and have had Seroquel added to my drug regime. I'm a software developer. It doesn't help that I was already on mat leave when this happened, so I've been away from my job for a year and a half.

If you have been in this position, can you tell me what helped? Did it get better over time on it's own? Did you need to stop taking the medication that was (presumably) causing the cognitive impairment? Any help or advice is appreciated. I'm feeling pretty worried and down about this.

posted by kitcat to Health & Fitness (12 answers total)

Well, when I was on Seroquel it helped with my symptoms but I had serious brain fog. You could try Seroquel XR, which stands for "extended release," i.e., you don't get the effects of the medication all at once and feel weird all morning. I ended up switching to new meds because the fog was too much for me, even with XR.
posted by zeusianfog at 12:28 PM on January 2, 2020 [1 favorite]

Please don't stop taking your medication without talking to your doctor.

I have had bad reactions to going on and off anti-depressants and ADHD medications as we tried to figure out the best one, some of which induced a real brain fog. Your first stop should be your doctor to talk about the medication effects and what else you can do. We can't say if you will get better or not and anecdotes aren't what I'd rely on here.

For me, anxiety over coming back and performing when rusty did NOT help. I felt dumb and out of place. Mismatched mediation didn't help. But again, doctor.
posted by OnTheLastCastle at 12:29 PM on January 2, 2020 [2 favorites]

Bipolar meds are hard. For most people, antipsychotics and mood stabilizers have more challenging side effects than antidepressants. You shouldn't just put up with shitty side effects — you should definitely talk to your doctor. But expect to try at least a few different ones before you settle on one that works.

I've ended up on a combination of meds — which includes a low dose of Seroquel, mostly to help me sleep, but lithium and Lamictal are doing the heavy lifting now. It did indeed help.

I know switching off a med that's working otherwise is scary, but if this is the first antipsychotic or mood stabilizer you've tried, odds are pretty good that it's not the only one that will work.
posted by nebulawindphone at 12:34 PM on January 2, 2020 [1 favorite]

Response by poster: I wouldn't dream of discontinuing meds without my psychiatrist prescribing exactly that. This is not my first rodeo. I'll be discussing this with her within the next week or so. This is my third week back to work - returning gradually. Just for more info I've pretty much always been on a combination of lamictal, one or two antidepressants and a benzo. It's always worked, until this episode in the spring.
posted by kitcat at 12:36 PM on January 2, 2020 [2 favorites]

Yes, after a parictularly rough migraine episode that left me brainfogged for months. though meds were no longer in the mix for a previous co-morbid mental isdue. I explained the situation to my boss and we lightened my workload to match, and added the equivalent of a code reviewer to my processes and took naps at lunch.
posted by tilde at 1:21 PM on January 2, 2020 [2 favorites]

Yeah, anti-psych meds are indeed awful; sorry you have to deal with them. In my experience they do make the mind less agile, inducing what you aptly describe as a brick-like stupidity.

When you talk to your psychiatrist about other meds options you might ask them about clozapine. It's somewhat a hassle, because while taking it you have to have frequent blood labs to track your white blood cell count, which clozapine sometimes adversely affects. But I've been on several anti-psych meds and for me the clozapine has by far the least of the mind-numbing side effects. I worked at a software company while on it -- though not as a coder.

Also, you might push your psychiatrist to move towards carefully lowering your dosage. My experience is that they prescribe more than is necessary, preferring 'safety' to livability for the patient. And often they go by dogmas about what constitutes a minimum therapeutic dose which are simply false. (I take half of what is officially considered the minimum dose of clozapine and am doing fine.)
posted by bertran at 2:25 PM on January 2, 2020

One thing that helped me a LOT with Seroquel (I've taken it for... 5 or so years now?) was dividing the dose. I take 25 mg in the morning and 400 mg at night. I could not function when I was taking more than ~100 mg in the morning. (I recently for the first time ever accidentally took the 400mg dose in the morning and holy SHIT I was OUT COLD for like 5 hours. So soporific.)

Even so, I have had to learn coping skills to compromise: write EVERYTHING down, put EVERYTHING in the calendar, and I talk to myself while I do things that I need short-term memory for.

Seroquel has a lot of drawbacks but it's also stabilized me like nothing else ever has. It's worth it to me. I'm happy to answer anything else about it you like.
posted by fiercecupcake at 3:20 PM on January 2, 2020

(Oh, and I do very detailed, medium-to-high-stakes work. It IS possible. But you will have to work harder AND smarter, and it takes some adjustment.)
posted by fiercecupcake at 3:22 PM on January 2, 2020

Are you taking it at night? I was on Seroquel and after taking it I felt so drunk. I would take it at night and still felt foggy / drunk in the morning, but it got better by about 10am. I was fortunate in that I was working a part-time job and only started at about 10. But I was doing pretty complex stuff at the job (archiving).
posted by jb at 5:50 PM on January 2, 2020 [1 favorite]

Outside of your medication what are your parenting responsibilities like? If you are doing the heavy lifting on packing diaper bags, shuttling to and from daycare, waking at night, etc on top of your meds and the self-care required by many people to keep BP II in check that could also explain the brain fog.

My youngest is seven and I am just starting to feel on my game at work again and I am only dealing with the parenting part of your equation.
posted by a22lamia at 6:19 PM on January 2, 2020 [1 favorite]

I am a software developer and have issues with working memory when dealing with trauma. It’s super upsetting and second guessing your ability to do the work is really confidence blowing.

Things that really help: writing out natural language pseudo code on paper and checking off the steps as I build them into my code. Pair programming, because verbalizing things externally seems to really help my working memory a ton. Code reviews and transparency - I ask for help and I’m up front about why I need it, but I’ve definitely worked in environments where that’s not a good idea.

It absolutely gets better, for me, and putting things in place to basically exercise my working memory means I feel like I’m taking steps to make improvements happen, which helps my confidence when I mess up something that may have been super simple just a few months ago. You are not alone.
posted by annathea at 9:26 PM on January 2, 2020 [1 favorite]

I have/had cognitive side effects from lithium (but also ECT, trauma-stuff, brain fog in general). My doctor and I agreed it was worth staying on it because it worked so much better than anything else. What helped: I have the luxury of 1) a flexible workplace, and one that I realized expects me to be high-functioning, but not more high-functioning than others 2) a doctor who supports short-term leave if work is exacerbating things.

Also I live by the principle 'write it down Now or you'll forget it forever'.
posted by ahundredjarsofsky at 3:56 AM on January 5, 2020 [2 favorites]