Q:  Difficulties with Memory & Concentration & Meds

Hello Dr. Phelps,

I am from Turkey, a man at the age of 29 and I am a bipolar since being diognosed in 2000.  I had 4 severe manic episodes and I went to Psychiatry service of horpital once during my depression. Although I have managed many problems I am well now apart from some points. I mostly control my life easily but I have tiny problems. I use lithium and olanzapin. I have difficulties in concentrating my mind and I often forget many things. The important thing is that I didn't have such problems before starting medication.

Would you explain these problems briefly and give me some advices about them.

Thank you very much.
 

Dear Mr. U-

Your experience is very common: many people with bipolar disorder experience increasing difficulty concentrating, and problems with memory. Unfortunately, it is often the occult to tell whether this is due to their medications, or the condition we are trying to treat. Both can cause these problems. Unfortunately, in many cases, in my experience, these problems often turn out to be the bipolar disorder itself.

Worse yet, the only way to be absolutely certain that these problems (concentration and memory difficulties) are not coming from one of these medications, is to gradually remove one (starting with the one we think might be more likely to cause such difficulties), and then, if that did not lead to improvement, repeat the process with the other one.

However, may I emphasize: you must not do this on your own. Many doctors would disapprove of my even talking about this, for fear that some patients will read this and start going off one or more of their medications on their own. This can be disastrous. You have already seen, from your experience, how bad a bipolar episode can be.

So, instead, the first thing to do is discuss with your doctor whether, in his or her opinion, it might be possible that the medication is part of the problem you describe. You should both believe that this is fairly likely before you start considering the idea of tapering one, or the other, to see if it is potentially part of the problem. Then you make a plan, with your treating physician, for careful management of any symptoms that might appear if you were to start to taper one of your current medications.

The worst part of this story is that we cannot guarantee people like you that if they go off one, or the other of their medications, trying to figure out if the medication is part of the concentration or memory problem, that if things get worse we will be able to get you back to where you were before this change. In other words, if you have improved 90% but we make such changes in your medications trying to address memory and concentration and then you get worse again, we cannot guarantee that we can get you back to that 90% recovery, even if we use the exact same medications that you are currently taking.

So before I start making such changes with my patients, I try to make sure that we have done the very best we can in controlling their mood symptoms. Sometimes when we do this, memory and concentration improved, because the illness itself is capable of interfering with them. You can see why this is, in general, a safer way to proceed.

Whatever you do, be careful, and above all, do not do this on your own. Good luck with that.

Dr. Phelps