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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Mila S on July 28, 2003, at 23:44:39
Hi, I'm working towards a Phd and I have noticed that my language skills are extremely poor yet my intellectual ability to grasp complex issues is in tact. It is very stange. I feel I can understand and follow complex theories, yet I myself cannot express that understanding in words. I beleive this might be related to years of psychotropic drug trials I've had to undergo to treat depression (which has been severe).
Outside of my field, I have difficulty carrying on conversations about politics or anything else for that matter because my ability to access words and formulate sentences is impaired. Often, I sound like a child when I speak.
It has been extremely frustrating. I am disinclined to be social because of it. I am embarressed to hand in papers to my professors as they are so badly written. I end up handing in work late as I need to spend a great deal of time trying to formulate sentences that sound half-way decent. Even then, my writing comes off like that of an under graduate student.
I also teach undergraduates, and have the same troubles when I lecture. When I study for exams, I find I have to write out notes on everything I read and memorize phrases or whole sentences because I cannot formulate them on my own during an exam. It is incredibly time consuming having to do this in addition to merely studying the content of the material.
Worst is the impact on my confidence and self-esteem. I come off rather unsophisticated in conversation. Most of the poeple I meet are academics having good language skills. I avoid discussing my own field because I come off so "dumb". Yet, I am not "dumb" of course. My ability to register complex arguments is in tact. Thus I cannot convey who I really am. I feel 'stuck', isolated, and more depressed. In the last several years, the closest friednships I have had are with men I dated. None of these relationships lasted however. I have no other close friendships (depression makes it hard to be socially appealing).
Anyone else out there with similar problems? any suggestions on what can be done about this. Presently, I am only taking strattera to help with energy, attention, and concentration. I'm afraid to take anti-depressants due to the cognitive difficulties I've been having --not to mention that they (remeron, effexor, paxil, lithium, prozac, risperdol, zyprexa, lamictal, celexa, wellbutrin, and many more) have so often been unhelpful or intolerable.
I feel isolated, friendless, pessimistic about my career, and mentally exhausted from trying so hard get through school without the langauge skills I need. Any advice would be much appreciated.
Posted by BekkaH on July 29, 2003, at 0:35:07
In reply to cognitive decline impeding life, posted by Mila S on July 28, 2003, at 23:44:39
Hi Mila,
How does Strattera affect your speaking ability? Your writing certainly doesn't seem to be impaired. Your post is well thought-out, coherent and expressive.
I found that nearly all antidepressants impaired my speech to some extent. Some caused "speech blocking." I knew what I wanted to say, and I would try to utter the words, but parts of words or sentences would be blocked. I am interested to know how Strattera affects your speech. What dose are you on now? Have you ever gone through a medication-free period of weeks or months? If so, how was your speech during that time? Have you ever taken amphetamines and, if so, how was your speech then? In clinical studies, some patients with stroke-induced speech impairment have shown improvement while on low dose amphetamine. I'm not suggesting that you take amphetamines, but it would be useful to know what you are like when you are not on any medicine and whether there is some medicine that actually reverses some of the difficulties you describe. Have you discussed this problem with your psychiatrist? If so, what does he or she say?
I am sure there are many of us here who can relate to the problems you describe, but I want to reiterate that the "cognitive decline" you believe you have is not evident in your post. I wonder whether your depression is lowering your self-esteem to such a degree that you are unable to accurately assess your abilities?
Bekka
Posted by CC67 on July 29, 2003, at 9:31:50
In reply to cognitive decline impeding life, posted by Mila S on July 28, 2003, at 23:44:39
Hi Mila,
I Find myself dealing with conveying my thoughts
when I understand what I would like to express.I have noticed this happening when on antidepressants and at differnt dose levels.I found that very low doses of xanax in conjunction with my stimulant doses,as well as cutting out the caffeine have helped me.
I no longer take any antidepressants or strattera.I have found that I also have to eat on schedule and I take basic vitamin supplements,this all helps me stay more focused on present tasks before me.
Hang in there! Please let me know if I can elaborate,I relate and truely understand the embarrassment!
You are alot further along then me I have no degree,and have been in the same profession for over 17 years.I plan to stay in this profession,however I could not even make it through this post without a dictionary.LOL.
Good Luck!! CC
Posted by Mila S on July 29, 2003, at 18:45:48
In reply to Re: cognitive decline impeding life - Mila, posted by BekkaH on July 29, 2003, at 0:35:07
>How does Strattera affect your speaking ability? >Your writing certainly doesn't seem to be >impaired. Your post is well thought-out, >coherent and expressive.
I don't know if strattera is causing any of the cognitive problems, however, since I stopped anti-depressants, I have not seen much of an improvement in my language skills. I still struggle with word access, and I have trouble holding a decent conversation. I do not think I have any speech impariment. I think it is only with langauge that I have the problem. As far as my post is concerned --yes I write fairly clearly when it comes to simpler thoughts, though it takes some effort. However, I have noticed that I cannot get across more astute or complicated insights anymore. For example, I had wanted to say more in my post, but I refrained because it was taking too long for me to come up with words, and the experience of trying to think yet just hitting a cognitive wall is so energy consuming and frustrating -- (I remember my firends in college who were not very good with languge displaying this sort of frustration when they had to write papers. They would stare at the computer and often could not come up with anything to say. I on the other hand found it easy and could write papers fairly easily. Now I seem to be in the same boat they were in. Only I have the ideas, just not the words).
>
>I am interested to know how Strattera affects >your speech. What dose are you on now? Have you >ever gone through a medication-free period of >weeks or months? If so, how was your speech >during that time?I am taking 60mg a day presently. As I said I do not think i have a speech problem. I have been medication free for 2-3 weeks at a time in the past, however, I did not notice an improvement. Often I was depressed during the time so I was not engaging in life and thought much at the time. If such cognitive 'problems' usually go away after the medication is stopped, then perhaps my problem is not medication induced or not as real as i think it is.
>Have you ever taken amphetamines ... Have you discussed this problem with your psychiatrist? If so, what does he or she say?Yes, amphetemines did not seem to make much of a difference, however, I was taking them along with anti-depressants. My pdoc says it is not unusual that I have been having cognitive difficulties (I also have attention problems). He thinks it is from the depression. He does not seem to think it is as severe as I make it out to be though. I will be pressing the issue again when I see him next.
> I am sure there are many of us here who can >relate to the problems you describe, but I want >to reiterate that the "cognitive decline" you >believe you have is not evident in your post. I >wonder whether your depression is lowering your >self-esteem to such a degree that you are unable >to accurately assess your abilities?Yes, you may be right here. And I do think "cognitive decline" is too strong a phrase. And yes, I think I have a tendency to under-rate myself. However, I am convinced that my language skills have deteriorated as writing and speaking is so much harder then it used to be for me. And my experience of having content in my head but no words or inadequate words to express it is particularly distinct. But I am sure my being self-conscious about this has made it worse especially in conversational situations. The need to memorize phrases and such, and the trouble with writing for school however seems like the result of a genuine problem. Not sure how to prevent things from getting worse out of shear panic and worry over it though. The moment I screw up in conversation, which happens very early on, I become overly self-conscious of the problem and become unrelaxed and unable to focus.
Thanks for your input. I will also talk to my pdoc about my worries about this making things worse for mself.
Posted by Mila S on July 29, 2003, at 18:52:28
In reply to Re: cognitive decline impeding life, posted by CC67 on July 29, 2003, at 9:31:50
Thanks CC,
The vitamin idea sounds like a good one. I will look into that. I also read on an older post the following:
"Aricept or one of the other anticholinesterase inhibitors such as Excelon may help. The most respected psychopharm/mood disorders expert in my region of the country told me that they could improve cognitive functioning regardless of the cause. Excelon works best for me." -- CJ
I'm a bit weary about taking more drugs, but if my problems continue, I think I i will look into the above suggestions. If you have tried them or anything similar, I'd be interested to hear about it.
About your own experiences, do you find that being self-conscious about the problem exacerbates it? This si a big problem for me and I'm not quite sure how to overcome it.
Thanks
Posted by CC67 on July 29, 2003, at 23:38:51
In reply to Re: cognitive decline impeding life, posted by Mila S on July 29, 2003, at 18:52:28
> Thanks CC,
>> no problem.
> The vitamin idea sounds like a good one. I will look into that. I also read on an older post the following:
>
> "Aricept or one of the other anticholinesterase inhibitors such as Excelon may help. The most respected psychopharm/mood disorders expert in my region of the country told me that they could improve cognitive functioning regardless of the cause. Excelon works best for me." -- CJ
>> I have never heard of Excelon,Interesting.Also I have not tryed the Aricept.
> I'm a bit weary about taking more drugs, but if my problems continue, I think
I i will look into the above suggestions. If you have tried them or anything similar, I'd be interested to hear about it.
>
> About your own experiences, do you find that being self-conscious about the problem exacerbates it? This si a big problem for me and I'm not quite sure how to overcome it.
>> Mila,I find that being self-conscious does exacerbate it.I have checked out books on ways of being more concise.I too am actively working through this issue.
> Thanks
>>I will keep you posted if I find any other ways that work for me,or suggestions.
Take care!! CC
Posted by foucault on July 30, 2003, at 13:29:52
In reply to Re: cognitive decline impeding life, posted by CC67 on July 29, 2003, at 23:38:51
I can't even begin to explain to you, Mila, how much I understand what you're going through. And it's funny, isn't it, that we've both become teachers--a profession that requires an inordinate amount of language fluency? (Although I've played it safe and taught high school ESL and French.)
I am pursuing a philosophy degree these days, reading deleuze, nietzsche, spinoza, etc., and although I can understand abstract, complex ideas with considerable ease, when I try discussing even the simplest ideas and arguments with others, I sound juvenile, disjointed, and confused.
I have spent quite a few years agonizing over this discrepancy, wondering if I have some language processing impairment, but that path, of course, led nowhere. So now I'm trying a different approach-- trying to let go of all the self-incrimination and self-consciousness, and in place of that, I'm attempting to come up with solutions that will circumvent whatever kind of block this might be.
Here's one of my approaches... When I read any text, I underline the important sentences in pencil. However, I do it in a particular way-- underlining the sentences in phrases to help my brain focus on the segments of vocabulary that others have put together. Then I will make up my own sentences using these underlined words or phrases. (At one time, even trying to use the verbs "to examine" and "to constitute" in my speech or writing seemed foreign to me, even though these words appeared very concrete and understandable to me when I read them.)
So that's one thing I do, and it seems to be helping me enormously. (Although I'm still reluctant to read a passage and then try putting it into my own words-- even to myself! Pretty absurd, huh, what fear of failure with words will stop us from doing?)
So for me, I think that there could indeed be a processing malfunction in my brain when it comes to the output or sequencing of language. But dammit, I don't want to live that 'narrative' all my life, so I'm trying to get past the shame and just keep putting the words out there. And perhaps one day I'll come to realize that much of this 'disability' is simply a powerful yet sneaky performance anxiety that makes my mind go blank when I'm asked to express myself.
I hope this at least helps to know that there's someone else out there who is struggling with the same thing that you've described. All the best...
Posted by avid abulia on July 30, 2003, at 14:45:03
In reply to Re: cognitive decline impeding life, posted by foucault on July 30, 2003, at 13:29:52
Hey there,
I can totally sympathize with your problem... though for me, it resolved upon discontinuing any meds with sedating properties, along with adding 3 tbsp of lecithin granules to my breakfast (usually oatmeal or rice or some such, or a soy protein plus fruits and veggies shake) plus a vitamin-B 100mg complex with breakfast and extra folic acid and vitamin B12 throughout the day.
Also, after waiting through the period of time it takes for the sedating effects of Keppra to wear off, it seems to have increased my cognitive abilities (a few studies support the idea that this is fairly common, at least in studies with animals and human epileptics, and Keppra is related to nootropic drugs like piracetam). Also, have you tried Vivactil? I just started taking it, when I was at 10mg qhs in the morning, it significantly enhanced my abilities to concentrate, but now I've gone up to 20mg for the past 3 days and am finding a paradoxical effect so I am going to drop back to 10mg tomorrow. But, it has some studies backing it's use as a more effective stimulant in cases of brain injury for patients who do not respond to, or cannot tolerate, dopaminergics like amphetamine/amphetamine analogs, or bromocriptine. It is the TCA with the least anti-cholinergic and anti-histamine effects. Here is a link to a study:
http://www.biopsychiatry.com/protriptyline.htm
Also, it may be worth noting, that if you go to sign yourself up (whether falsely or not, they don't check these things) to Medscape, and select as your specialty psychiatry and put in bipolar disorder as at least one of your areas of special interest, you will find that there is an article currently on it about cognitive decline in bipolar disorder... and it says that frequently, the patients with the most subjective impairment have the least objective impairment, and vice-versa... so it may be at least *partially* a self-esteem issue as noted above. Also, as noted above, Aricept has at least one study (that I have seen, anyway) backing its efficacy in treating medication-induced cognitive dysfunction, but I've never tried it.
Anyways, best of luck to ya!
~AA
Posted by Mila S on July 30, 2003, at 21:01:08
In reply to Re: cognitive decline impeding life, posted by foucault on July 30, 2003, at 13:29:52
Dear foucault,
Wow it has been an incredible help reading your post. I do philosophy too! I'm concentrating in analytic philosophy, particularly language and mind.
Your post is very comforting for one problem I have had is feeling like 'its all in my head'. Perhaps it is to some degree, but the fact that you have to pay attention to phrases and words as you do vindicates my experience even if it is primarily 'in my head'(that is, even if the difficulty is caused by performance anxiety, it is a _real_ difficulty. Most people I talk to seem to fail to acknowledge this). Another problem is that I speak adequately when it comes to simple ordinary matters (although one time I did come home irritable about having stepped on some gum exclaiming "some idiot put the gum on my shoe!" after trying find the right words and failing). Because I can speak _adequately_ about ordinary matters, my pdoc does not seem to realize I have a problem. Philosophy and anything intellectual is a whole different ball game though. I will be getting some neurological tests done. I am concerned that the problem will not come out if the testing is geared toward speech in ordinary contexts. The problem is subtle in this respect. but then again this may indicate that it is indeed a matter of performance anxiety (even though it extends to writing as well).
I have tried your method of underlining phrases and sentences in texts --though I did not go so far as to come up with my own sentences. And I sympathize with the reluctance to put things into your own words. I would hit a cognitive wall every time that I tried and it would immediately cause anxiety and pain. I just need to be more courageous. I'm sure improvement will follow once I get over that hurdle. But boy do I hate spending time on that as opposed to learning and thinking about philosophy!
Thanks for sharing your experiences!
Posted by Mila S on July 30, 2003, at 21:05:46
In reply to what's helped me, posted by avid abulia on July 30, 2003, at 14:45:03
AA, thanks for the advice.
I have been on vivactil. however, I was taking it with other meds at the time and became very sick (it lasted months). So I stopped all those meds.
Perhaps I'll give vivactil another try at some point.The aricle on bipolar depression sounds interesting. I may be bipolar (very mild mania at times, primarily depressed). I'll check it out.
Posted by BekkaH on August 2, 2003, at 0:37:53
In reply to Re: cognitive decline impeding life - Mila, posted by Mila S on July 29, 2003, at 18:45:48
Mila, When you combined amphetamines with antidepressants, which antidepressant were you on? Did the combination help for a while and then stop working, or was there never any improvement?
Posted by Mila S on August 2, 2003, at 16:42:17
In reply to Re: cognitive decline impeding life - Mila, posted by BekkaH on August 2, 2003, at 0:37:53
> Mila, When you combined amphetamines with >antidepressants, which antidepressant were you >on? Did the combination help for a while and >then stop working, or was there never any >improvement?
It seems that the amphetamines, which I have taken alone as well as with anti-depressants work for a while and then stop. I'm not quite sure if anti-depressants have really helped. I have taken them alone and they did not seem to do much. When amphetamines were added, I improved as far as sleepiness was concerned, but the effect would not last. So ADs have not done much on their own or in combo wiht amphetamines. But the latter has helped moderately for brief periods.
Posted by BekkaH on August 2, 2003, at 22:01:17
In reply to Re: cognitive decline impeding life - Mila, posted by Mila S on August 2, 2003, at 16:42:17
Do you remember which antidepressants you combined with stimulants? I wonder whether there might have been some adverse interaction between the stimulants and the particular antidepressants that you took. I mention this because in another post you mentioned your recent illness from a drug combination and your improvement when that drug combination was stopped. Perhaps you have read about the cytochrome P450 liver enzymes, or perhaps your doctor has mentioned them? Many people lack or have deficient versions (called genetic polymorphisms) of liver enzymes that are critical for metabolizing psychiatric drugs and other drugs. Some drugs, when taken together, compete for the same liver enzymes. And if that isn't complicated enough, many drugs inhibit the activity of the liver enzymes that are necessary for the metabolism of other drugs. This makes drug cocktails very difficult, and often dangerous, for those of us with genetic polymorphisms. I wonder whether this might be the cause of some of your difficulties.
Posted by Mila S on August 3, 2003, at 14:49:10
In reply to Re: cognitive decline impeding life - Mila, posted by BekkaH on August 2, 2003, at 22:01:17
> Do you remember which antidepressants you combined with stimulants?
Bekka, thanks. I was taking lamictal, vivactil, welbutrin, adderall, and an anti-chlorigenic to combact some of the side effects. I had never taken so many meds at once. The lamictal seemed to help but we thought that it was probably what made me sick eventually. We are not sure though. I just stopped everything some time after stopping the lamictal because I was not getting better after several weeks. I got many tests done and nothing showed up. I was so weak I could hardly walk. mostly I just lay around feeling weak and nauseous for weeks on end. I also went to a neurologist but he said I did not seem to have neurological problems although he did not conduct any tests (He did look at my test results done by other doctors -- apparently many tests were done by them based on blood samples).
Eventually it went away. However I still have energy problems and nausea, and focus/attention difficulties in addition to my being cognitively inactive.
I have taken many anti-depressants before this but only on their own or with one other medication like a mood stabilzer. None has worked. Recently it seems that strattera which I am taking now, has stopped working. However i had added lexapro to it (I have stopped the lexapro for 2-3 weeks now). Perhaps it reduced the effect of the strattera. However, I have tried provigal and adderal on their own and they seemed to reduce in effectiveness fairly quickly. when I first take them, they really keep me awake -more then I want. But after 1-2 weeks, I am tired and sleepy all the time as usual. Now the same thing is happening with the strattera but I am not going to stop it as it may have some anti-depressant effects (I have many problems including anxiety, however, I am less deeply depressed these days. But this may be a natural change, or a change precipitated by a slight improvement in my life conditions).
The information you have mentioned is interesting. It could explain why I have been so unresponsive to all the meds I have tried. I will check into it. My old tests might have the liver information. Any other suggestions would be appreciated. Thanks for the info!
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