Q: Feeling "blocked" & Unable to Organize Tasks
I am bipolar Type I and had a severe manic crisis in August. I feel at the
moment quite depressed and have no will or desire to do things. I feel "blocked"
and can't organize my daily tasks. I looked for apragmatism, which term my pdoc
uses and there seems to be no treatment. I take an AD : Derexat and I started
Abilify (10 mg)+ lithium for 17 years. Is it exhaustion from the manic episode ?
Such an "invalidating" state makes me anxious an sad. I don't know what to do.
Thank you for your advice
I must be careful here, because my view might differ
from that of your psychiatrist. And she or he knows you and your situation,
where I do not. But I will just introduce one idea for you both to consider.
In my experience, antidepressant medications (in people with bipolar disorder)
can cause extreme difficulty with mental function. In English we might call this
a "scrambling", a difficulty focusing attention because no thought or
inclination lasts long enough to really follow through on. I wonder if this
might possibly be involved in what you described as "blocked".
I offer this possibility because it presents some significant hope that a simple
maneuver such as gradually tapering your antidepressant (which by your account
does not appear to be doing what it is supposed to be doing right now, anyway)
might address this "invalidating state".
Beyond that, I am not sure how to account for what you describe. But I can tell
you that my hypothesis above is based on seeing this phenomenon in many, many
patients. Indeed, when people are referred to me with very complex problems I
actually now hope that they are taking an antidepressant, because it presents
such a simple potential solution, namely tapering the antidepressant. In case
you and your psychiatrist decided to pursue this, I will mention that since I
learned to go extremely slowly with this tapering off process, I have seen much
better results. I heard an expert recommend taking at least four months to do
this, 25% per month, and I think that is extremely important.
In case you need a reference for your discussion with your psychiatrist, here is
one that is somewhat related: El-Mallakh. although the article does not
describe "blocked", these are the symptoms that I see in association with the
cognitive phenomenon. If you have some of them ("dysphoria", irritability, and
"middle insomnia" -- waking up in the middle of the night after falling asleep
okay), that would strengthen the hope that my idea might have value for you.
Published March, 2008