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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on February 27, 2012, at 21:16:59
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
> My daughter is just distraught. Her functioning has been impaired for so long. She got started on assignments, and is just overwhelmed because she does not feel like she is comprehending anything. She has been complaining about this since before the Saphris.
>
> But.. which do you think would be more likely to cause this thing? Lithium... or Saphris?
>
> Solstice
Cognitive impairments might be the result of a mixed-state rather than medication side effects. Such impairments are very common with depression, which is a component of a mixed-state. Does the appearance of cognitive impairments coincide with the onset of her present mixed-state?
- Scott
Posted by Solstice on February 27, 2012, at 21:54:55
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by SLS on February 27, 2012, at 21:16:59
> > My daughter is just distraught. Her functioning has been impaired for so long. She got started on assignments, and is just overwhelmed because she does not feel like she is comprehending anything. She has been complaining about this since before the Saphris.
> >
> > But.. which do you think would be more likely to cause this thing? Lithium... or Saphris?
> >
> > Solstice
>
>
> Cognitive impairments might be the result of a mixed-state rather than medication side effects. Such impairments are very common with depression, which is a component of a mixed-state. Does the appearance of cognitive impairments coincide with the onset of her present mixed-state?
>
Yes. And that's helpful to know, because she's been thinking it's the meds.. which is distressful to her. She's a perfectionist and the grandiosity she's got going on exacerbates her unreasonable self-expectations. I've been trying to get her to understand that her intensely high self-expectations are getting in the way of her getting well.oh.. when she was fretting about her cognitive impairment, I told her I was writing the board to ask. One minute later, she asked if I'd gotten a response :-) I told her we'd have to wait until someone saw it, and I told her "I hope Scott sees it because he has a lot of personal experience with these meds." Anyway, so when I just checked in and saw you posted - I said "Oh! Scott responded!" I read it to her, and she said "Tell Scott I said Hi.. and that I like cats" :-)
It's really stressful to watch her go through mood swings so quickly. Right now she's just rattling on at a fast pace about a million random things..
Solstice
Posted by herpills on February 27, 2012, at 21:59:18
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
> My daughter is just distraught. Her functioning has been impaired for so long. She got started on assignments, and is just overwhelmed because she does not feel like she is comprehending anything. She has been complaining about this since before the Saphris.
>
> But.. which do you think would be more likely to cause this thing? Lithium... or Saphris?
>
> SolsticeWell, if she noticed it before she started Saphris, wouldn't it be likely that it was the lithium causing this?
Posted by SLS on February 27, 2012, at 22:11:32
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by herpills on February 27, 2012, at 21:59:18
> > My daughter is just distraught. Her functioning has been impaired for so long. She got started on assignments, and is just overwhelmed because she does not feel like she is comprehending anything. She has been complaining about this since before the Saphris.
> >
> > But.. which do you think would be more likely to cause this thing? Lithium... or Saphris?
> >
> > Solstice
>
> Well, if she noticed it before she started Saphris, wouldn't it be likely that it was the lithium causing this?
How long has she been on lithium?How long has she been affected by cognitive impairments?
How long has she been experiencing a mixed-state?
- Scott
Posted by Solstice on February 27, 2012, at 22:20:53
In reply to Re: Saphris/Lithium - effect on comprehension - » herpills, posted by SLS on February 27, 2012, at 22:11:32
>
>
> How long has she been on lithium?
Ok.. she started taking Lithium on January 30 - so it's been about 4 weeks
>
> How long has she been affected by cognitive impairments?(based on consultation with my daughter)... since the beginning of the school year.. so probably about the same time the mixed state escalated enough to become noticeable. My high tolerance for pain resulted in it escalating to a crisis state which forced me to recognize that something was terribly wrong. That was in early January, which is when she started the Latuda.
>
> How long has she been experiencing a mixed-state?
>
The mixed state has been going on since probably September/October.Solstice
Posted by SLS on February 27, 2012, at 22:43:34
In reply to Re: Saphris/Lithium - effect on comprehension - » SLS, posted by Solstice on February 27, 2012, at 22:20:53
You see where this is going, right?
:-)
The cognitive effects appeared at the beginning of the school year. The mixed-state appeared in September.
- Scott
>
> >
> >
> > How long has she been on lithium?
>
>
> Ok.. she started taking Lithium on January 30 - so it's been about 4 weeks
>
>
> >
> > How long has she been affected by cognitive impairments?
>
> (based on consultation with my daughter)... since the beginning of the school year.. so probably about the same time the mixed state escalated enough to become noticeable. My high tolerance for pain resulted in it escalating to a crisis state which forced me to recognize that something was terribly wrong. That was in early January, which is when she started the Latuda.
>
>
> >
> > How long has she been experiencing a mixed-state?
> >
>
>
> The mixed state has been going on since probably September/October.
>
> Solstice
Posted by SLS on February 27, 2012, at 22:45:27
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by SLS on February 27, 2012, at 22:43:34
Out of curiosity, what symptoms appeared when Geodon stopped working? When was this?
- Scott
Posted by Solstice on February 27, 2012, at 23:18:41
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by SLS on February 27, 2012, at 22:43:34
> You see where this is going, right?
>
> :-)
>
> The cognitive effects appeared at the beginning of the school year. The mixed-state appeared in September.
>
>
Yeah... I saw it as soon as I saw your questions :-) And it was good to see, because it is extremely helpful to think of the cognitive impairment being related to the bipolar not being addressed - rather than being due to the medications that I really hope will hit the target.Sol
Posted by Solstice on February 27, 2012, at 23:44:18
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by SLS on February 27, 2012, at 22:45:27
> Out of curiosity, what symptoms appeared when Geodon stopped working? When was this?
>
>
> - Scott
Irritability for sure. When the Geodon was working, the irritability was very minimal. So when it got more than minimal, because she was sixteen years old, I just attributed it to her age. She was able to keep it in check at school; she saved it all for me and her brother at home. It gradually escalated, but because it was gradual, I continued to attribute it to her age. When it got my attention, though, was when she had an all-out melt-down that included some very illogical thinking. Her perceptions were so grossly distorted. This was in December. When it started dawning on me that this was more than just an adolescent girl thing, I realized that there were a lot of grandiose features to her thinking, and that her reactions to things really were very out-of-proportion. Then I realized that her normal talkativeness was more than just talkative. It was pressured speech with its accompanying random associations. So by the time I realized what was going on, it had been going on for several months.Does that bring any thoughts to mind for you?
Solstice
Posted by papillon2 on February 28, 2012, at 3:51:32
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
> But.. which do you think would be more likely to cause this thing? Lithium... or Saphris?
Lithium can certainly cause cognitive impairments in some people. I have unipolar depression, not bipolar disorder, but when my Lithium level was .8 it felt like there was a brick wall in my brain blocking any sort of comprehension. It was so bad I would literally stand on the spot staring at whatever was in front of me. But as Scott says, bipolar disorder can also cause confusion. And the Saphris website lists confusion as a side effect, too.
So, once your daughter's Saphris dose is leveled out, perhaps she can perform a little experiment by lowering her Lithium dose (no need to cut it out completely). If the cognition problems get better, you'll know it was the Lithium. If it's the same, then it's her illness or the Saphris. I must stress though that it's very important to change medication doses only one at a time, if more than one is changed you won't know what is helping and what isn't.
Lithium side effects are largely dose-dependent. At a lower dose, your daughter might retain some of the benefits of Lithium with fewer (or no discernible) side effects. It probably wouldn't be enough for Lithium monotherapy, though.
Always speak to your psychiatrist before making any such changes.
Posted by SLS on February 28, 2012, at 6:47:32
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
The information given to you about lithium along this thread is accurate, and the advice sound.
As the irritability emerged, your daughter could have entered a mixed-state (dysphoric hypomania) with attendant depressive characteristics, including irritability, but not necessarily depressed mood. My thinking is that the escalation of psychosocial stress added to her conscious experience by having to suffer the depressive state might have made worse the manic component and brought on delusional thinking and thought disorganization. Not only can stress make worse depression, but it can also worsen mania.
It might be necessary to treat the depression/dysphoria with a drug that has antidepressant properties. Lamictal is the drug that I had thought might be good to add if, after optimizing your daughter's current drug regime, there is residual dysphoria. Lamictal can make a good complement to the prophylactic properties of lithium as well as the antidepressant effects that some antipsychotics exert; Abilify, Geodon, and Zyprexa being perhaps the most effective of these drugs at reducing depression.
Lamictal might put on 5 - 10 pounds of body weight, if that. Lamictal can, but not always, produce cognitive and memory impairments at higher dosages. More often, the lower dosages used for depression will not cause these side effects. 200 mg is usually the optimal dosage of Lamictal for treating bipolar depression. Lamictal, unlike standard antidepressants, is unlikely to produce or worsen mania.
Anyway, that's the thought I had just before going to bed last night.
- Scott
Posted by Solstice on February 28, 2012, at 7:01:33
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by papillon2 on February 28, 2012, at 3:51:32
> Lithium can certainly cause cognitive impairments in some people. I have unipolar depression, not bipolar disorder, but when my Lithium level was .8 it felt like there was a brick wall in my brain blocking any sort of comprehension. It was so bad I would literally stand on the spot staring at whatever was in front of me.This is EXACTLY how she describes it! Word for word. She said she will have a paper in front of her, and just stares at it - like it's a blank page. She calls her mind a blank page when she's trying to comprehend something. She said it's so frustrating, because it's like her brain just *won't* comprehend - and there's nothing she can do - and all the while she gets further and further behind.
Thanks for confirming that description, papi
Sol
Posted by Solstice on February 28, 2012, at 7:08:29
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by SLS on February 28, 2012, at 6:47:32
> The information given to you about lithium along this thread is accurate, and the advice sound.
>I felt like I was getting good stuff, and it's helpful that you confirmed it.
She started Lamictal shortly before she started Lithium. She just got up to 300mg. Since my older daughter has to take a high dose, the dr. thought it might take higher doses for this one too. And as you suggested, I told her last night that I think her psychosocial stressors - her beliefs about what she is supposed to be producing that she's not meeting - are interfering with her getting well. Thing is that we can talk about it, and she'll seem to get on board.. and I can almost feel her relief, but she forgets all about it when she's back at school and we start all over again with her believing that the symptoms she's experiencing mean that she's stupid.. which then makes her feel despair.
sigh.
We did Saphris last night.. but no lithium. I'll let you all know how it goes!
Solstice.
Posted by Phillipa on February 28, 2012, at 9:56:34
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by Solstice on February 28, 2012, at 7:08:29
I think I read it more simplistically. When I saw Scott's question of what happened in Sept my first thought was school was just beginning. Could something like school be the problem? What was your Daughter feeling like during summer vacation? I know it's too simplistic. But if don't ask? Phillipa
Posted by Solstice on February 28, 2012, at 10:52:21
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by Phillipa on February 28, 2012, at 9:56:34
> I think I read it more simplistically. When I saw Scott's question of what happened in Sept my first thought was school was just beginning. Could something like school be the problem? What was your Daughter feeling like during summer vacation? I know it's too simplistic. But if don't ask? Phillipa
I think her illness was just evolving, and academic stressors either triggered her current episode, or escalated an episode that had already started.My desperate feelings about it center around my worries about this episode flipping her into bipolar depression - which she has not had to deal with in the past.
Solstice
Posted by Phillipa on February 28, 2012, at 12:03:35
In reply to Re: Saphris/Lithium - effect on comprehension - » Phillipa, posted by Solstice on February 28, 2012, at 10:52:21
I understand what you are saying she deserves a life with her peers a normal teen life. Does she get any down time during classes might that help. A bit of relaxation during the school day. Couldn't too much stress trigger it? As you know I really don't know. I've googled her physical compenent of disease and maybe didn't get a good site but it's hard to understand. I do feel for you all. Phillipa
Posted by papillon2 on February 28, 2012, at 14:54:42
In reply to Re: Saphris/Lithium - effect on comprehension - » Solstice, posted by Phillipa on February 28, 2012, at 12:03:35
I assume you're in the US? Does your daughter have an IEP or 504?
Posted by linkadge on February 28, 2012, at 19:21:31
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
lithium
Posted by Phillipa on February 28, 2012, at 20:01:54
In reply to Re: Saphris/Lithium - effect on comprehension - » Phillipa, posted by Solstice on February 28, 2012, at 10:52:21
Is the medical part sometimes called POTS? Phillipa
Posted by Raisinb on February 28, 2012, at 20:09:44
In reply to Saphris/Lithium - effect on comprehension -, posted by Solstice on February 27, 2012, at 21:07:02
It is hard to tell what is the illness Nd what iis the medication. I experienced severe cognitive impairment on lithium. I couldn't read or think.
Posted by SLS on February 28, 2012, at 20:27:03
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by Raisinb on February 28, 2012, at 20:09:44
> It is hard to tell what is the illness Nd what iis the medication. I experienced severe cognitive impairment on lithium. I couldn't read or think.
Not fun.
Do you recall what your dosage and blood levels were?
- Scott
Posted by Solstice on February 28, 2012, at 20:36:20
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by papillon2 on February 28, 2012, at 14:54:42
> I assume you're in the US? Does your daughter have an IEP or 504?
Yes.. she has 504 accommodations. She's been in a lot of AP and pre-AP classes during high school and has done very well. Unfortunately, 504 accommodations don't apply to AP and pre-AP classes.. which wasn't a problem during her freshman and sophomore years.
The good news is that the school administration and all of her teachers just adore her. Her last class of the day is Latin, and there have been a couple of times in the last week that she's just burst into tears in that class and went to the nurse's office. She told me yesterday that she found out that her Latin teacher went to the nurse and counselor's office after school to check on her - he was so worried about her. They have all been told that she's been undergoing complex medication changes. Anyway, she's an 'overachiever,' which I think is hurting her right now. But her counselor's best friend has bipolar, so she's well-versed, really gets it, and is working hard on my daughter's behalf to work with the teachers to help her recover from all the months she's lost (and continues to lose).
It's just really tough when, as a student, you are missing so much instruction time. It's really no different than any other chronic disease that needs treatment. Say she had to have months of chemo that put her out of commission.. or some other long term treatment for a medical condition. A bipolar manic episode and experimentation with medications is no different. Anyway, her counselor and I discussed it yesterday, and we are all talking to my daughter about realizing that she has not asked to have this problem, and her being out of commission is not a reflection on her intelligence or her effort. And if she has to take an extra year to graduate - it's really no big deal. I'd rather her take an extra year and get through it feeling good, than to try to do it on time and feel tortured the entire time. But it's really hard for her.
Solstice
Posted by papillon2 on February 29, 2012, at 2:49:33
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by Solstice on February 28, 2012, at 20:36:20
I understand. From what you have written, I was/am in many ways similar to your daughter, minus the bipolarity.
I feel a great deal of empathy for her.
And you're right in that she didn't ask for any of this, but it still sucks. Both the illness, the treatment, and the fact that it can't just be ignored.
I wish I could tell her that it gets better, but no one can make that promise -- we don't know the future. As she gains experience and skills though, it will become easier to handle.
Hang in there, girl. xx
Posted by Raisinb on March 1, 2012, at 16:37:08
In reply to Re: Saphris/Lithium - effect on comprehension - » Raisinb, posted by SLS on February 28, 2012, at 20:27:03
Yes, 1050 mg per day and blood level of .8
Posted by SLS on March 1, 2012, at 17:04:31
In reply to Re: Saphris/Lithium - effect on comprehension -, posted by Raisinb on March 1, 2012, at 16:37:08
> Yes, 1050 mg per day and blood level of .8
Thanks.
- Scott
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