Could Abilify and Lamictal Affect Motivation and also Ability to Think?
[Home] [Bipolar News] [Bipolar Disorder] [Medications] [Treatments] [Bipolar Disorder/Job/School] [Disabilities] [Ask the Doctor] [Ask David] [Self-Injury] [Personal Stories] [Graham's Column] [Steven's Column] [Storm's Column] [Columnist Archives] [Suicide] [Community Support] [Family Members] [Expressions] [Greeting Cards] [Books] [Awards] [Links & Rings] [About Us] [Contact Us]

 


Q:  Could Abilify and Lamictal Affect Motivation and also Ability to Think?


Dr. Phelps, 

I was diagnosed with bipolar disorder over a year ago. I am on 7mg abilify and 200 mg lamictal daily. For a long time, I have suspected that the drugs are affecting my ability to think clearly (I am an academic and do quite abstract thinking on a daily basis and so I would be particularly sensitive to this issue). My first question is this: could these doses be affecting my thinking, or are they too low to have that sort of effect?  

Also, since being on these drugs, I have noticed an extreme lack of motivation. Everything is forced -- eating, showering, exercising, cleaning. I don't know whether that is residual depression or whether it is due to the medication. I suspect it is the medication, since it has a completely different character from the kind of anhedonia and apathy I experience when I am depressed. Plus, more often than not, I do not have any sadness or negative mood accompanying it. I also have only ever had this kind of lack of motivation since being on the medication. So my second question is this: could the lamictal or the abilify be causing this lack of motivation?  

I ask because I have been struggling with trying to get my psychiatrist to really listen to me about this. She seems to either deny that any effect on my thinking could be significant or that the lack of motivation must be depression. But I know myself, and I definitely think the drugs are doing this. But I wanted to get another opinion. I feel that I am stuck on the current medication regime, even though I want to get off the meds, just to see if it makes any difference. However, I don't want to go against my psychiatrist's recommendations.  

Thanks for your time.
Heidi 


 

Dear Heidi --

Let's take 2 questions from this: which if either of these medications might be affecting your ability to think clearly, and your level of motivation?  And secondly, what should a person in your circumstances do, when it seems like you are having difficulty getting your psychiatrist to listen? 

First, ability to think: at 400 mg per day, lamotrigine is well known to cause a rather subtle difficulty thinking.  Often it first shows up as a difficulty in finding words (it has been dubbed "Word searching"), simple words that everyone knows -- and there you are, trying to think of the word for "table".  But some people can tell, there just is something wrong with the way they are thinking.  Sometimes one can see this effect at 300 mg.  And I have had a few patients where we were not sure, but we were wondering if it might even be there at 200 mg.  So I think it is possible that lamotrigine needs to be on the list of potential culprits. 

Likewise, aripiprazole (Abilify) can also cause a change in the way people think.  At lower doses, such as those you are taking (compared to "antipsychotic" doses, which might be more like 10-15 mg, or more), it is uncommon for people to be bothered by how the medication is affecting their thought process.  But I have seen it happen, for sure.  So it goes on the list also. 

Obviously, when you consider trying to lower or switch away from these medications, that must be done in the context of knowing your options and how likely they are to work (for example, if you have already been through many other medications, and only these were really getting good symptom control, it makes it harder to consider changing); and in the context of how severe your symptoms might be were they to recur (based on your prior experience).  And then, there are numerous other factors like cost and when you are going to make this change, relative to your current life circumstances, and so on.  That's where having a psychiatrist can you trust can really help, so there you have an opportunity to brainstorm with someone who might be able to help you evaluate all that. 

That brings us to your second question, which could be regarded as "how do I go about getting a second opinion?"  In an ideal world, you could seek that opinion from another psychiatrist who might be in a position to continue to work with you if her style and her competence seem equal to or better than your current psychiatrist.  If that's possible for you, it would be a reasonable step.  I encourage all my patients to seek a second opinion at any time.  The problem is, often it is very difficult to find another psychiatrist whom you might see, at all; sometimes because there are none, sometimes because of insurance issues, and so forth.  Finally, before you take that step, you could ask your psychiatrist to make it explicit her concerns about your making any changes in these medications.  She may have some good thoughts about why turning them down, or moving on, is not such a hot idea. 

Good luck with the process --

Dr. Phelps



Published January, 2009

 
 

Bipolar World   1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014
Owners: 
Allie Bloom, David Schafer, M.Ed. (Blackdog)
Partners:  John Haeckel, Judith (Duff) 
Founder:  Colleen Sullivan
 

Email Us at Bipolar World

 

About Us  Add a Link  Advance Directives  Alternative Treatments  Ask the Doctor   Ask Dr. Plyler about Bipolar Disorder   Ask The Doctor/ Topic Archives  Awards  Benny the Bipolar Puppy  Bipolar Chat  Bipolar Children  Bipolar Disorder News  Bipolar Help Contract  Bipolar World Forums  Book Reviews  Bookstore  BP & Other mental Illness   Clinical Research Trials & FDA Drug Approval   Community Support   Contact Us  The Continuum of Mania and Depression   Coping   Criteria    Criteria and Diagnosis  Criteria-World Health Disabilities,  DSMV-IV   Dual Diagnosis  eGroups  Expressions (Poetry, Inspiration, Humor, Art Gallery, Memorials  Family Members   Getting Help for a Loved One who Refuses Treatment  Greeting Cards  History of Mental Illness  Indigo  Job and School  Links  Manage Your Medications  Medications   Medication and Weight Gain    News of the Day  Parent Chat  Pay for Meds  Personal Stories  Self Help  Self Injury  Significant Others  Stigma and Mental Health Law  Storm's Column  Suicide!!!  The Suicide Wall  Table of Contents   Treatments  Treatment Compliance  US Disability  Veteran's Chat  What's New?