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lamictal and cognitive functioning


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first of all, if there's another thread that asks this same question, i'd be really happy to just go read there... i just can't find it! (apropos for this discussion i guess).

secondly, i LOVE my lamotrigine. LOVE it. i have never felt so normal in more than ten years. it is not perfect but it's the closest i have ever come and i can't imagine a med getting better than this in the mood department.

however - and i'm sure you can all relate - i am REALLY stupid. like it just gets worse as time goes on kinda stupid.

i thought depression made my memory bad. i thought dissociation made my memory bad. this just doesn't even compare. i feel like i've spent the better part of the last year on a huge bender, and i can only remember a few of the sober bits. (i don't drink often or even enough to get drunk).

i thought smoking weed made my memory bad. i smoke about a quarter of what i used to on effexor, still to control nausea. i don't think the amount i smoke is enough to impair anyone's memory. and even when i smoked a couple of grams a day, i still remembered all my words and how to spell and what i did last anniversary.

this is something else. all my days run in together now. i have to think really hard what day it was when i did something, even if it was just yesterday. everything feels like it was "last week". yesterday was last week, last month was last week. the other day i had a little crying fit because no matter how hard i try, i cannot remember last christmas. i looked at old posts from that time, my partner related ALL the details to me... and it is still a complete blank.

i can't remember a lot of occasions in the last few years, the more i try to pin them down. i can't remember if it was this birthday that my kid got a phone or last birthday or the one before that, i don't know how old her laptop or camera is because i forget what year we bought it. i have to look at a list of the classes she's taking every few days because i forget. she's taking THREE credits this semester. and one will always escape me and i'll have to read the schedule.

i am finding objects in my house and asking my partner "where did this come from?", only to find out that i purchased it months ago and i have no memory of having looked at that object probably a hundred times since then. i found a lovely boxed set of scented candles the other day that apparently i bought on sale this summer - they don't even LOOK familiar.

i know being multiple means this should be normal. it's NEVER been like this - things might be new that shouldn't be, but someone ALWAYS knows who bought what and when (since we are incredibly tight with money). someone always remembers holidays. someone always remembers important schedules.

all of it is just.... gone.

and that doesn't begin to describe the decline in my vocabulary, spelling, grammar, and word-finding in general. if not for the sound of my voice, people would no longer recognise me in a conversation. it's that different. i speak so slowly now because i have to think about finding most of the words. and even then i'll miss one every second or third sentence, no matter how simple the word might be. i get stuck and stutter. even at work.

i blank out on where a button on my work screen is even though i've remembered where it was a hundred times previous in the last three hours. and i will not find it no matter how long i stand there staring - i have to ask someone, again, to tell me where it is (and then make a bad joke about being old or something because nobody knows i am nuts or medicated).

i walk into things without thinking. i ruined my eyeglasses last week walking into the corner of a wall. a month ago i destroyed a CRT by walking into it with such force i knocked it off the corner of the desk. i can't wear a dress to this week's xmas party because my legs are blue and brown from walking into stuff at work.

about a dozen times a day i can't track what someone just said to me. i have to ask four times for a repetition of one simple sentence ("i would like a medium coffee and a cheese croissant with some butter please." "i'm sorry could you repeat that?" "i'm sorry, was that a ...*repeats order back all wrong*" "i'm sorry ma'am what was that again?" *walks away to get food* "was that a croissant you wanted or a scone?" *customer frowns and rolls eyes*).

this from a woman who graduated cum laude. this from a woman who knew nothing about science or medicine and aced neuropsych classes she shouldn't have been allowed to take as an arts student. this from a woman who won awards for the very first psych test she ever developed (and it sucked, but because she could detail each and every way the experiment was flawed, it was apparently stunning). this from a woman who got paid to cheat for other students by writing papers for classes she'd never taken - because her writing was THAT good and she was quick enough to pick up on the subject at hand without much difficulty.

i know i am not the only one. but it's really bothering me because i wonder what my future holds. am i just going to keep getting stupider until i can't remember anything anymore? am i going to forget this christmas too? am i going to remember my child's last years at home (oh wait maybe i don't want to)? am i going to just forget more and more of her life? my life?

how much stupid is okay? when is stupid not okay anymore? what the hell can anyone do about it? i'm not giving up the med. but does this happen to EVERYBODY? how to you handle it? how do you grieve the loss of intelligence? the loss of memories you can't get back again?

this is depressing the hell out of me.

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My Lamictal unacceptable cognitive impairment threshold is 200mg. When I was first titrating and got to that point, my overall memory and intelligence were effected enough for me to back down to 175mg. It helped a lot. The level of impairment was made more obvious when we added Depakote to my cocktail. Depakote roughly doubles the action of Lamictal, so when I started we cut Lamictal in half. Ha. The day after (maybe two or three days, don't remember) I was driving to a tdoc appt and got so thoroughly turned around on roads I know that I pulled over scared and crying. We cut Lamictal back more and my light bulbs came back on.

I am living with noticeable but manageable cognitive impairment. My academic history is not so different than yours only I had non-academic priorities as an undergrad so didn't do the cum laude thing until grad school. I'm used to being one of the sharpest in the room, but now I sometimes struggle to keep up. My grammar sucks which is a blow to my ego. I over-write in expressing thoughts. Word find isn't too bad, but it is there. All of this is a major adjustment and I feel like a part of me has been taken. All of my meds except Mirapex nibble at my cognition. At a higher dose any one would take a big chunk. For me, this is the most difficult side effect. At first I tried saying that I would accept anything but this one. Unfortunately, AAPs have not been kind to me and it seems that all of the ACs and Lithium effect cognition to some degree. I prefer stability enough to accept some of it.

So, that's a long way to say that you are not the only one cognitively effected by Lamictal. It's also a way to say that some level of trade off may be necessary. Idk. I think you have a lot of options before you have to settle, though. Talk to your doc about backing down a little. It may still do the good stuff while restoring some of your smarts. If you become symptomatic, there also is the option to add a low dose of something else to compensate.

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I take 300 mg. Lamictal daily and also suffer from some cognitive impairment, mostly memory-related. I have always attributed the memory lost to all my ECTs, because the problem was proximate in time to the ECTs. I think the Lamictal really helps me to keep on a level keel though, so I find it worth it (If that is what is even causing my memory problems).

Tommy

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I'm not really aware of Lamictal making me stupid on a daily basis, but the couple of times I haven't taken it, I've woken up in the morning feeling fabulously clear & quick. So I'm going to be asking my pdoc about reducing my dosage, and see if that helps.

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My lamictal/lamotrigine is still being titrated, so I'm not at my full dose yet so I can't say what, if any, cognitive impairment I will have with it.

However, lithium had a HUGE impact on my cognition! I felt as though I'd suddenly got stupid overnight. I was having terrible trouble finding words. I'd have to stop in the middle of a sentence and search my head for the word. Nine times out of ten, I didn't find it and would end up feeling like a fool. Like Stacia, I'm used to being the sharpest one in the room (most of the time) so it's been a struggle.

I guess I just wanted to say I sympathise and know how frustrating it can be.

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I sympathise too. What you're going thru sounds scary.

I had severe cognitive impairment on Lamictal when I went up past 350 mg. 400 was as far as I went. I was also on 1500 mg depakote which prob'ly made it worse. But it was really bad. much like what you describe.

So I backed down to 750 Depakote and 250 Lamictal, and those problems seemed to go away. I'm normally very distractable, so I don't count that.

Then I went off Lamictal altogether last spring when Wellbutrin was introduced. (I couldn't pay for Lamictal but don't have to for Wellbutrin) and went thru a mild hypomania for several months where my cognitive functions were really sharp. Now my memory is very good again, but I don't remember how bad it was..lol...and I'm as distractable as ever.

But I sure went stupid when I was taking 350 plus.

I think you should talk to your doc about this. It sounds really distressing.

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I was really stupid. I lasted on it the first time about a year and a half, and it was progressive. I think it initially got bad around 200mg, but it didn't get much better when I went down as far as 100. It's possible that I just didn't give it long enough before I refused to take it anymore; once I did stop it was months before I was even close to myself in terms of cognition. The worst part of the whole thing was that I couldn't get anything done. No, maybe the worst part was that I was that stupid and it wasn't even all that effective for my depression, always the difficult symptom to treat.

I'm trying it again, this time with Lithium, and hoping it will work better. So far I'm up to 75mg, and my brain is still working. I'm not yet stupid, and am hoping it will start working at a lowish dosage so I have a better chance of avoiding at least some of the cognitive problems.

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I don't feel stupid in general, not more than can be expected after a couple of rounds of ECT, but since starting lamotrigine I certainly have been having some language-related difficulties, esp. spelling. I used to be excellent, now I stare at common words and just can't figure out how they are supposed to look. I'm on 300 mg so I suppose I should just be grateful that it's not worse. I prefer a spellchecker before having my stomach pumped.

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thanks everyone who shared what this is like for you. it helps a lot to know it's not "just me"...

it is true that i'll definitely choose this over a stomach pump. i'd have to get a lot stupider than this to change my mind about that!

after thinking on it some more, my pride hurts more than anything. i think i just have to adjust my self-esteem accordingly around something other than teh smarts. it's always been the one and only thing i ever liked about myself, no matter what - i knew i wasn't dumb. well, so much for that... i think i'm scared i won't find anything that means as much to me.

my pride hurts every time it bumps up against someone else's expectations, too, and i just have to learn to deal with it. i suppose i could develop a whole repertoire of jokes about getting old or something. with new people, it doesn't matter. with people who've known me a long time, i feel really really ashamed. i feel like they'll think i'm high on my meds or drunk or god knows what. i can't believe i'm saying this, but maybe i'd have been better off just being normal to start with. then nobody would turn to me to answer the question nobody else in the room remembers the answer to (or can figure out). i just can't be that person now.

time to figure out who else to be....

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i can't believe i'm saying this, but maybe i'd have been better off just being normal to start with. then nobody would turn to me to answer the question nobody else in the room remembers the answer to (or can figure out). i just can't be that person now.

time to figure out who else to be....

Yanno, remember what Silver said to me on the Fat blog? Maybe you didn't read this one, but it was suggested to me that instead of taking inventory of all the stuff I can't physically do anymore, I should inventory what does work and what I do have.

I think the same could be applied to your situation, don't you? Okay, so your memory is fucked. That is distressing, but Lysergia you still run circles around a vast majority of humanoids when it comes to "teh smarts." And I'm not blowing smoke up yo' ass either. You have NOTHING to be ashamed of. Like PR told me, my body has seen me through a lot, and I need to have nicer thoughts toward it, I think the same can be said for our brains.

Anyway, I don't want to sound like it's trivial because it's not. But, maybe, if you can look at your brain for what it does for you and not how it works against you, you might feel more peace about it.

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Lysergia,

I experience some of what you are saying. I used to be able to write awesome papers effortlessly. I used to be great with my vocabulary and ability to talk in detail without stuttering/slurring or saying the wrong thing. Now it takes so much more effort. I constantly say the wrong thing or forget things. I used to write a lot of poetry, now it is impossible. I know these symptoms aren't like yours, but it seems that I'm younger given the age of your daughter. I'm 27 right now, so I'm worried it will get worse as I'm getting older. I'm not on lamictal. I'm on paxil and effexor xr. However I do know that serious mental illnesses are degenerative diseases. It is something that isn't talked about a lot. I've noticed (especially with people with bad schizophrenia, or severe schizoaffective/bipolar) that as they get into their 50s and 60s they almost appear mentally retarded. I had this one guy that was on my case load when I was a case manager that people kept labeling mentally retarded when he wasn't. He graduated from a normal high school and was a perfectly average guy until schizophrenia came. I am not trying to uspet you even more, but I worry about all of this too.

From what I've read about this, the medications are supposed to slow the brain damage that occurs over time with these illnesses. But like you are saying, what is causing the problem, the illness or the meds?? It is scary no matter what. I guess like anything we should just keep trying to work our brains and hope that it helps somewhat. Maybe since you are so upset about this, you could see a neurologist or neuropsychologist??

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My daughter had panic attacks while away at school. She was on lexapro for awhile but still felt depressed. Now she's on lamictal. This stuff scares me. She is having crying jags which she never had before. And this cognitive thing is really disconcerting. I don't want to see this happening to her. I wonder if they jumped the gun going directly to lamictal without trying some of the other SSRI's first.

BTW, how does lamictal work compared to an SSRI?

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droopy, lamictal is an anticonvulsant, completely different to an SSRI .... and i cant explain it because i'm too tired, but.. google it.

As far as stupid... I was at one stage on 400mg Lamictal and 600mg of Tegretol and i felt as stupid as you can get. I could just zone out and not focus on anything. I would forget stuff pretty much the moment you stopped talking. I would start talking and forget what i was talking about, forget what the whole conversation was about. Read a book and forget what happened. Not remember any names of anything. I forgot peoples names and what they looked like. If i tried to recall anything i couldn't bring a picture to mind. Its like it might have been there but it was just impossible to get. My sharp replies like having an argument or a witty conversation just flew out the window.

I'm off it now, and just take the tegretol with effexor. I think its better, but also because i'm not so depressed. Less anticonvulsants seems to help. If it had made me happy, i think i would have just stuck with it, but my problem was that it didnt work for me anyway.

Making lots of lists is a good thing, but i would forget i had them. I colourcoded everything, asked people to remind me of stuff. I guess after a while i got used to it, but for a while it was really hard.

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My daughter had panic attacks while away at school. She was on lexapro for awhile but still felt depressed. Now she's on lamictal. This stuff scares me. She is having crying jags which she never had before. And this cognitive thing is really disconcerting. I don't want to see this happening to her. I wonder if they jumped the gun going directly to lamictal without trying some of the other SSRI's first.

BTW, how does lamictal work compared to an SSRI?

Droopy I have no clue based on what you said, why they would put her on lamictal. It is mostly used for people with bipolar who have a lot of trouble stabilizing their mood. So it helps prevent severe mood swings. If the lexapro induced a manic episode, then I could see them putting her on lamictal. But it won't help panic or anxiety as far as I know.

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I've noticed (especially with people with bad schizophrenia, or severe schizoaffective/bipolar) that as they get into their 50s and 60s they almost appear mentally retarded. I had this one guy that was on my case load when I was a case manager that people kept labeling mentally retarded when he wasn't. He graduated from a normal high school and was a perfectly average guy until schizophrenia came. I am not trying to uspet you even more, but I worry about all of this too.

I wonder if this is the effect of taking old school neuroleptics long term? Mellaril, Orap, etc??

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I've noticed (especially with people with bad schizophrenia, or severe schizoaffective/bipolar) that as they get into their 50s and 60s they almost appear mentally retarded. I had this one guy that was on my case load when I was a case manager that people kept labeling mentally retarded when he wasn't. He graduated from a normal high school and was a perfectly average guy until schizophrenia came. I am not trying to uspet you even more, but I worry about all of this too.

I wonder if this is the effect of taking old school neuroleptics long term? Mellaril, Orap, etc??

It's not the meds. Psychotic episodes during Schitzophrenia have been shown to cause grey matter loss. That's why it's so important to get it under control early.

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i didn't mean to alarm anyone taking lamictal that your brain is going to eventually become oatmeal or anything. there really are lots of people out there taking this drug and feeling fine and not stupid at all. i'm just one of the few who gets all the lovely benefits, plus a big helping of stupid.

whether it's stupid or something else scary, well, we're always going to end up with something we don't like as a byproduct of taking our meds. unless you're really, really lucky!

just about everything else i ever took for craziness did something to me mentally or physically that was intolerable (or felt intolerable, when weighed with their general ineffectiveness). effexor stripped me of eighty pounds and permanently changed my ability to eat normally. risperdal gave me amenorrhea and some bonus lactation. every night on prozac was a three dimensional technicolour hell located within the walls of my bedroom - that only i could see and hear.

i had crying jags from hell for the better part of 2008, too - so bad i couldn't function normally outside my home from bursting into tears every single place i went (how humiliating). but it wasn't my new lovely crazy meds (lamotrigine) - it was my thyroid meds. i needed more of them and it took awhile to make that happen. if i had been scared of the ACs, i might have blamed it on that and stopped. so there's an anecdote in support of "it might not be the new med making the new problem". it's always worth looking into - but with an open mind.

i forget what my point is (okay i wish i was being funny)

oh yeah. it's all scary. we can all get some weird stuff that we end up putting up with because not wanting to die is much more desirable than remembering your point after four paragraphs. i think it's good to talk to each other about this weird stuff - about how to cope with it, about how to know when it isn't a "small deal" anymore, anything. because if we quit stuff every time we're scared, or we are alarmed by a new symptom, this forum would have more tumbleweeds left than people. we kinda don't survive complete avoidance of negative side effects. or if we do, we're too fucked up to care about writing about it in public.

so please don't let my descent into incoherence scare anyone away from lamotrigine (or anything else). this isn't a small deal for me, being this dumb. but it is also no small deal that i wake up every day wanting to stay alive.

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I wanted to emphasize that whatever cognitive issues arise from Lamictal are reversible, at least in my experience. When I went off Lamictal the first time I took it, the problems did go away after a few months. In view of this, I would not say the possibility of cognitive dulling is a reason not to take Lamictal, at least not to try it, given its efficacy for so many people. I would, however, say that it is a med for which taking the lowest possible dose to control symptoms is really desirable, given that cognitive dulling is associated with higher doses.

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The first time I tried lamictal, I had a lot of very noticeable problems with word finding and memory. For whatever reason, this time the issues haven't been nearly so severe. That said, I recently realized that, wheb I forgot to take my evening dose a couple of times, I woke up feeling just so much clearer and brighter. Hoping that decreasing my dosage from 200mg to 150mg will ameliorate this, without a return of symptoms.

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