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Subject: A Dwindling of Performance and Perhaps Mental Func

The question was submitted 22 May 2010

Hello. I have recently discovered this website through the educational materials sent me by Lundbeck, alongside around 14 free tablets of Lexapro. I have been on medication with the said drug for around two months now; but I daresay, I cannot cope with regularly taking my medical panaceas since prescription drug prices tend to soar much these days. Although, really I am thankful for the medical freebies I've recently received.

My medical condition has always been somewhat in shambles, with different verdicts on my condition. Concurrently I am also taking Keppra with Lexapro (the latter tied w/ Valparin such that my mood swings may be further controlled) since I have previously underwent a succession of seizures. Last 2005, I have also been diagnosed with Bipolar Disorder, and with that I have been given Lamictal. As far as I can note, my condition seems to adapt fairly well when I am not usually in a hurry to do things. However, it cannot be denied that I need to work so as 1) I would not get easily bored, since boredom poses a negative effect on me; 2) I would like to do something whereby I would know that I am still capable of doing something worthwhile; 3) My basic needs and finances can still be addressed, most particularly my daily medications. Yet it seems that no matter how I try, my attempts to go back to work always seems futile: I have been to almost six (6) workplaces, and the first two to four months would prove a-OK for me until I'd have the chest palpitations, seizure attacks, then bouts of my psychiatric illnesses (bipolar disorder aftermaths and a depressive state which could last for months). Hence, it had always been inevitable that I change jobs frequently, plus a lingering trepidation on my part that my next venture into the workforce would be the same as always.

Yes, I do have the drive to work; but why does it appear palpable to never refute the fact of my abilities'/capabilities' descent? I had never stammered, but ever since I had been diagnosed with depression, pseudo-seizures and bipolar disorder, I had begun doing so frequently? I could not even read a simple novel without re-reading a certain page for three times since I'd begin forgetting certain vital details within the text as I go along. My graduate studies have also suffered, and I could not usually go past a year's second semester. I have always been a person who knows what I want to achieve in life and invoke that fully in myself constantly so as I could be successful in a way. But ever since all these happened, simple tasks such as working normally or talking or writing like I used to always deteriorates day by day. There are also instances whereby I would forget familiar places or even grammar. Well, of course, complicated by a quite chaotic domestic environment where quarrellings have always become the norm.

I just need to work, and finish grad and post grad school. I just want to live normally. But why isn't my brain functioning as it had been before, prior to all the symptoms of my malady? It's quite difficult to explain in detail... but I just feel I don't have the stamina or enthusiasm to do what I would like, or make my aspirations come to pass. Everyday, I'd be confused especially with the idea that I could not successfully maintain a job because of my frequent sicknesses. I am getting restless and temperamental. I feel as though I cannot work like people my age who have somehow have fulfilled their dreams appropriate or near to their chosen career already.

I just want this to stop. I do take my medicines but why do my mental mechanisms continue to slide down? Is there something wrong? Or am I already suffering from side effects?

Thanks.

Answer from DepNet

The answer was published on DepNet 03 June 2010

Dear reader,

You presented several issues that need to be addressed. You mentioned that you had seizures and also pseudoseizures. It is essential to determine if what you had were truly seizures since this will matter in the management of your case. Additionally, your awareness is important so that you'd know the impact of this condition in your life. Regarding your frequent change of work, I doubt that this is secondary to your thinking problems because you mentioned that you do well in the first 2-4 months. It is possible that stress  or problems at work trigger your mood disorder which is why  you have "chest palpitations", "pseudoseizures" and other symptoms later on which lead to deterioration in work performance.

It seems that your memory and attention have declined, greatly affecting your studies.  Bipolar disorder, seizures and your current medications can all contribute to the thinking (cognitive) problems.  Medications for seizures, especially Valparin-which you are taking, are frequently associated with cognitive impairment.  However, recurrent seizures and episodes of Bipolar Disorder can also cause this.

I suggest that you go to a neurologist and psychiatrist so that you can be enlightened about your condition.  Primarily, the presence of seizure disorder must be confirmed since you are receiving several anticonvulsants.  Anticonvulsants are also used in the management of Bipolar Disorder but if seizure disorder can be ruled out then your medications can be kept to a minimum, thereby lessening drug interactions and side effects.  Another clarification is about your mood disorder-it seems that you have frequent recurrence/relapse.  Your psychiatrist can help in determining the reason for this.  You will definitely benefit from working but you need to know which type of work best suits you and how you can cope with the daily problems that you encounter at work and in daily life.

Sincerely,

 Encarnita Ampil, MD for DepNet.ph