Q:  Short Term Memory Loss & Lithium

Dear Dr. Phelps,
 I was diagnosed bipolar right after high school. I was put on lithium which turned  my life around completely and may have saved my life in many ways!  It has enabled me to be as normal as I can be considering the battle I face everyday. This is all  great on the surface, but slowly starting to see a very debilitating side effect that I cannot find much info on!!!!!!

Background:  During high school things came easy to me. I was incredibly intelligent with an incredible memory. I spent every day either intoxicated or high off of every drug you could think of to self medicate.  I was on the national honor roll, received academic scholarships, and credentials from my school. All on drugs!!!???? Don't know how.  My drug use led me to counseling and my bipolar diagnoses. Which eventually became my battle between academic excellence and the ability to achieve healthy relationships and sanity.  I blame lithium for this.

The problem seems to be clear cut to me, but the more I try to bring it out, the more crazy I sound?  Viscous circle I suppose. Basically I have lost a significant amount of short term memory since I began lithium. It has made it difficult to function at times, remember things, and continue schooling. I do horrible because I cant remember anything!

This completely contradicts the memory models research has brought out on lithium. It seems that my medical savior is also the demon that controls the future of the one thing that I have ever been able to have that many people would die for. It's not fair! I am slowly trying new medications (lamictal) which are working wonders. But the question remains; is the memory deterioration permanent? Is there hope? Have you heard of this in any other patients?  Please help! 

This dilemna sometimes gives subconscious warrant to give up medication and to give up career dreams and hopes. Without my most sophisticated tool for the future, is it possible to ever be normal and functional again?

From the pitfalls of heaven and hell,


Dear RR -- 
First thing to do is add the possible explanation that it isn't lithium that's caused the deterioration in memory and performance, but rather the illness itself (or the drug use, but that might be harder to do anything about). The point there is that you'll have to be careful about assuming that the changes you've seen while on lithium are due to lithium.  It would actually be much more common that it turns out to be the bipolar disorder that's affected memory and performance. Which is very bad news, compared to your lithium theory, so I wouldn't want you to assume that this is true either. You have to carefully and systematically evaluate what lithium is or isn't doing, as it sounds like you and your doctor are working on now.  

Suppose it was bipolar disorder, and not lithium, that's the basis of the change you describe, what then? Again, you mustn't assume that this means your magic charm is lost, your magic speed and intelligence.  We don't know enough about bipolar disorder and the long term course to know that. People come bounding back from tremendous changes. But you're right, lithium is supposed to be good for brain growth and improved memory. Of course it's also common that for some people it is just way too "dulling", they slow down to a crawl.  Then there are the many people (this is probably the majority, maybe the large majority) who feel slower than they used to be, not as whipsmart as they used to be (especially at times), but overall it's clear they're functioning way better on the lithium than before they went on it. Unfortunately that doesn't sound like what you're describing. 

So it sounds like the key right now is to slow down on drawing conclusions and be very systematic about your consideration of each of several potential explanations. Good luck with that. 

Dr. Phelps