Where is My Short-term Memory Loss Coming From?
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Q:  Where is My Short-term Memory Loss Coming From?


Hi Dr. Phelps,

I am having considerable short-term memory loss and would like your opinion on what might be causing it.  I have trouble remembering conversations, recalling information that I just read, and coming up with words.

First, my background:

*Female, age 46
*Diagnosed with cyclothymia 2 years ago, recognizing symptoms all the way back to Jr. High age
*Took antidepressants alone until 2 years ago, and they would basically make me like a zombie, but still had anxiety & anger
*Started taking Lamictal 225mg 2 years ago, and it has made a remarkable difference in my moods & ability to handle stress. 
*I also take Effexor XR 37.5 mg which seems to ward off anxiety
*Started taking Seroquel 25mg at night 6 months ago to help me sleep, as I've had horrible insomnia for my entire adult life (waking up often), and it has helped tremendously
*Take Levoxyl for thyroidectomy

So my questions is: where do you think the short-term memory loss is coming from?  The lamictal?  The Seroquel?  The Effexor? The memory loss is becoming a pretty big issue because it is now affecting my job.

Also, I still have a tendency to battle the "zombie" or "blah" state.

I appreciate any feedback you can give!

Thanks,
 

Dear Ms. S' --

Unfortunately, there is one missing candidate on your list of possible culprits for explaining this memory loss: the mood problem itself.

Other people have just the same question you are asking, very commonly. We have to go through the same thought process you face here: is it the illness itself, or is it one of the treatments? I have to tell you that in most cases, it turns out to be illness. For some evidence along those lines, you could read my plain-English account of the molecular and cellular basis of depression, which documents the brain changes which are thought to be the basis of this memory problem: see Depression Is Not a Moral Weakness, and read
mini-chapter 6, in particular (perhaps others as you choose). 

However, as detailed in
mini-chapter 11 of that series, effective treatment is supposed to help reverse those brain changes and improve memory. That does not seem to be happening in your case, which strengthens the argument for examining each of the medications you name as a potential culprit. Unfortunately, there is no way to find out for sure except careful trials of tapering off one medication at a time -- conducted under the close supervision of your psychiatrist, with detailed discussion on exactly how you will know whether things are getting worse or better, and what your response will be (in other words, you definitely don't want to do this on your own).

Which is the most likely culprit, if it is indeed a medication? Lamictal is not famous for this kind of memory problem. It is widely recognized to cause difficulty finding words, usually at doses greater than 300 mg (although I have seen it in people taking 200 mg). But it does not seem to cause what you describe, dramatic difficulty with  conversation recall, or the recall of information you just read. Nevertheless, since it does cause problems with words, it probably has to stay on the list of possible culprits, maybe fairly high on that list (most unfortunate, because it sounds like it helped a lot; sometimes people can preserve much of the benefit of lamotrigine with just a tiny dose reduction to get under what seems like a "threshold" for these kinds of side effects.  In other words, sometimes much of the benefit can be retained, and all of the side effect eliminated, with a minor dose reduction.  However, again may I emphasize, do not do this on your own.  Talk about it with your psychiatrist first).

How about Seroquel? It sounds to me like this problem with memory probably started before the Seroquel was added, or your question would have been simpler. Nevertheless, it is still a candidate, but at 25 mg, for it to be the main problem would be really surprising.

Next: effexor. If that was added to Lamictal, you might have had the opportunity to see a worsening of the memory problem. If that was not seen, if XOR is -- obviously -- by a less likely candidate. However, if it has been there all along, preceding Lamictal, I think it should remain on the list. Here's why. If XOR itself is not generally thought to cause memory problems at all, and this is a very low dose, as you know. On the other hand, antidepressants can sometimes make bipolar disorder or worse in subtle ways. For example, they can exacerbate an underlying difficulty getting to sleep, and we know that impact sleep is a crucial ingredient in making the process of memory work correctly. Therefore, I think Effexor has to also remain on your list of possible culprits.

There, wasn't that useful? I didn't manage to eliminate any of the potential candidates, and instead added another one. With luck, it is Lamictal that is doing this, and a minor dose reduction will lead to a dramatic improvement without any loss of benefit. That would be a great scenario. DO NOT try this on your own, however. As you can see, thinking through what might be the basis of this problem and how you are going to address it could be much more complicated, and you need to have a well thought out game plan for maintaining the benefits you have experienced while you proceed through the candidates. Good luck with that process --

Dr. Phelps



Published May, 2008
 

 

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