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bipolar and pseudodementia?

Guest saintmartha

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Guest saintmartha

I entered pseudodementia in the google search for crazymeds and couldn't find the term, so I'm posting it here.  I'm bipolar, and currently taking 100mgs seroquel at night for sleeping, and working up to 150 mgs lamictal im the am.  Feeling more stable than I have in years, but still unable to focus, concentrate, stay on task, do anything in a linear way, and I'm forgetful and spacey.  My meds haven't helped with that so far.  My pdoc told me when I saw her last that when a bipolar person has trouble focusing, staying on task, etc. in the manic stage and in the depressive stage, it's called pseudodementia.  And I thought I had ADD all these years.  So of course my reply was "God, I'm demented too, now.  Well this sucks."  But she said it's not really dementia and she gave me a script for ritalin.  I'm not happy with what I've read about ritalin, but if it helps me focus, I'll be thrilled.  I am so tired of feeling stupid and nonproductive.  But I'd never heard the term and wonder if it really applies.  She is having me up the lamictal 50 mgs over the next two weeks before starting the ritalin.  Does this make sense to you all?  Have you ever heard the term pseudodementia?  Maybe my bipolar meds are making me worse.  It seems like this last year, when I went over the edge again, my IQ has dropped to below average and my ability to accomplish anything has gotten worse.  I know I've been able to stay focused in the past at times.  I remember things I've done and realize I must have the ability to focus somewhere in my head.  I appreciate any input.  I hope the ritalin helps. 

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Wow.  I hadn't heard the term before, but did a bunch of Googling on whole Internet, and found some interesting things.  It looks like it's very common in depression, and usually improves as the depression improves.  From your post, it doesn't sound like you've been stable long enough to know if this will be that case ... but patience is hard!  I have suffered from something very similar for a long time, and have been pestering (LOL) my pdoc on and off for an ADD med for about a year now.  So in that sense I would say you're "lucky" to get a trial with it.  Here's one article on the idea of treating depression with a psychostimulant:

Assessment of clinical response to psychostimulants may be secondarily helpful in the differentation of depressive pseudodementia from true cognitive impairment. When given a trial of a psychostimulant, patients with pseudodementia often show significant improvement in their cognitive state, while patients with true dementia generally respond to such medication with heightened cognitive impairment.

More of my experience, for what it's worth:  my moods have been stable for a couple of years now, and I haven't had any trouble with depression for ages.  But the brain fog persisted.  Coincidentally, I've been working with a naturopath for some physical issues (chronic fatigue) and have recently gotten a lot "smarter" again (LOL!!!) What's finally working for me are vitamin B12 shots.  While Googling this topic, I did find a Pubmed abstract on that, interestingly enough.

Pseudodementia in a twenty-one-year-old with bipolar disorder and vitamin B12 and folate deficiency.

Reid SD.

Department of Clinical Medical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago. reid@carib-link.net

A twenty-one-year-old female known to suffer from bipolar type I disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurrence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.

West Indian Med J. 2000 Dec;49(4):347-8.


I suppose it's possible the Seroquel is making you foggier, but I think your pdoc is giving you good advice about waiting a little while for the Lamictal.  Also, I think it takes a long time for the brain to normalize after years of instability.  And that last time you went over the edge might just have pushed it past some threshold.  Patience!  And good luck  ;)

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Wow, you really sound like me. I've never heard the term "pseudodementia" until now. I've been on all sorts of meds. None at the moment. My lack of concentration, brain fog, etc hasnt eased up since I stopped the meds, and never eased up while I was on them, even when I was put on Ritalin (Concerta). I noticed the same thing too, with the IQ drop. I talked to my doctor about not being able to concentrate, things of that sort, and she said I have ADD (after like 3 years of treating me) but didnt mention anything about pseudodementia. The only thing that talked me into taking Ritalin was she said I would be able to concentrate better and such, but it didnt work for me. The only thing I noticed were beginning side effects that SUCKED. I was on Lamictal too. I hope the ritalin helps for you, as it didnt for me.

Its a horrible feeling knowing you used to be able to think, and now you cant for the life of you hold a thought.

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My pdoc didn't give it a name, I assumed it was ADD.  The symptoms that you describe, for me, responded to 6 grams a day of good quality fish oil.  I didn't know when I started that the fish oil that it would do that.  It helped irritability for me too, I don't know if that is an issue for you though.

Sandra P

J Nutr Biochem. 2004 Aug;15(8):467-72. Related Articles, Links 

Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan.

Chen JR, Hsu SF, Hsu CD, Hwang LH, Yang SC.

Department of Nutrition and Health Sciences, Taipei Medical University, Taiwan.

Nutritional factors may be relative to attention-deficit hyperactive disorder (ADHD), although the pathogenic mechanism is still unknown. Based on the work of others, we hypothesized that children with ADHD have altered dietary patterns and fatty acid metabolism. Therefore, the aim of this study was to evaluate dietary patterns and the blood fatty acid composition in children with ADHD in the Taipei area of Taiwan. The present study found that 58 subjects with ADHD (average age 8.5 years) had significantly higher intakes of iron and vitamin C compared to those of 52 control subjects (average age 7.9 years) (P < 0.05). The blood total protein content in subjects with ADHD was significantly lower than that in control subjects (P < 0.05). On the other hand, children with ADHD had significantly higher blood iron levels compared to the control children (P < 0.05). Additionally, plasma gamma-linolenic acid (18:3 n-6) in children with ADHD was higher than that in control children (P < 0.05). Concerning the composition of other fatty acids in the phospholipid isolated from red blood cell (RBC) membranes, oleic acid (18:1n-9) was significantly higher, whereas nervonic acid (24:1n-9), linoleic acid (18:2n-6), arachidonic acid (20:4n-6), and docosahexaenoic acid (22:6n-3) were significantly lower in subjects with ADHD (P < 0.05). Our results suggest that there were no differences in dietary patterns of these children with ADHD except for the intake of iron and vitamin C; however, the fatty acid composition of phospholipid from RBC membranes in the ADHD children differed from that of the normal children.

PMID: 15302081 [PubMed - indexed for MEDLINE]

Nutr J. 2005 Feb 9;4(1):6. Related Articles, Links 


Omega-3 fatty acids decreased irritability of patients with bipolar disorder in an add-on, open label study.

Sagduyu K, Dokucu ME, Eddy BA, Craigen G, Baldassano CF, Yildiz A.

University of Missouri-Kansas City, 8801 West 148th Terrace, Overland Park, KS 66221, USA. feelbetter@gmail.com

This is a report on a 37-patient continuation study of the open ended, Omega-3 Fatty Acid (O-3FA) add-on study. Subjects consisted of the original 19 patients, along with 18 new patients recruited and followed in the same fashion as the first nineteen. Subjects carried a DSM-IV-TR diagnosis of Bipolar Disorder and were visiting a Mood Disorder Clinic regularly through the length of the study. At each visit, patients' clinical status was monitored using the Clinical Monitoring Form. Subjects reported on the frequency and severity of irritability experienced during the preceding ten days; frequency was measured by way of percentage of days in which subjects experienced irritability, while severity of that irritability was rated on a Likert scale of 1-4 (if present). The irritability component of Young Mania Rating Scale (YMRS) was also recorded quarterly on 13 of the 39 patients consistently. Patients had persistent irritability despite their ongoing pharmacologic and psychotherapy. Omega-3 Fatty Acid intake helped with the irritability component of patients suffering from bipolar disorder with a significant presenting sign of irritability. Low dose (1 to 2 grams per day), add-on O-3FA may also help with the irritability component of different clinical conditions, such as schizophrenia, borderline personality disorder and other psychiatric conditions with a common presenting sign of irritability.

PMID: 15703073 [PubMed - in process]

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I haven't heard the term, but I've certainly experienced that. I'll suddenly forget where I live, how to get home, my phone number, etc.  It does get better.

In general, I've heard Ritalin is not good for BP. I took it and it had a paradoxical effect--put me to sleep! I take Provigil (kind of a stimulant but not), and it helps.

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