On Side Effects and Self-Medication

As my dose of mood stabilizer has increased, the side effects have evolved.

At first, the main side effect was a very dry throat and mouth and a little numbness in my lips and tongue. Those are still there, but have either improved or I’ve adjusted to them.

As my dose increased, I found myself getting lost in both space and time. I had to work harder to think through tasks with multiple steps and to keep track of time. I would get lost going to familiar places, like the eye doctor and my children’s music lessons, even with the GPS on. I got lost in tasks around home, intending to do one small thing and then losing all track of time. I would get lost in the day, miscalculating how long basic activities would take, like if it was 7:30a.m., and I needed to leave the house at 7:45, I would think I had enough time for a half-hour walk. Then I would feel like an idiot because even if I’m hypomanic, I can’t walk for a half-hour and have it take only fifteen minutes. Natural laws still apply regardless of my mood.

The getting lost has improved, or maybe I’m just getting used to working harder. But what hasn’t improved is the feeling that I’m stupider than I was before I started medication.

Now, I’m not bragging, but I’m pretty intelligent. That’s just a fact, and I have the consistently high IQ scores to support that claim. I’m accustomed to thinking quickly and logically and making mental connections that others don’t see. That’s not just my impression of myself; others have described me like that (without prompting, threats, or bribery).

But since the most recent dosage increase, I feel slower at making logical connections. My attention span has decreased, and I’ve begun temporarily losing simple words.

I’ll try to say, “Put the milk in the fridge,” but I’ll lose the word “fridge.” I’ll say, “Put the milk in the…” and get stuck because the words that come to mind are microwave, garage, cupboard, and I know those aren’t right. I usually get around it by describing the thing I can’t name.

“Put the milk in the big cold thing with the doors,” I’ll say, and then I’ll remember what it’s called.

It kind of reminds me of when my husband’s grandfather was recovering from a stroke and would say numbers when he was trying to think of words. He would get so frustrated that he couldn’t get out what he wanted to say. Mine’s not that pronounced and my guesses are still in the same category of the word I’m trying to find, but it’s still frustrating.

It bothers me enough that I’ve started questioning my need for the medication, but luckily I have years and years of journals to consult to remind me why I went to the psychiatrist in the first place, so I’m still on it, and I suspect my dose should actually increase a little more before all’s said and done. The medication I’m on is supposed to have some of the lowest cognitive side effects of the mood stabilizers, so maybe I shouldn’t complain, but I really want to keep my mental acuity. I find that I base a lot of my self-identity on being able to think clearly and logically and to have easy recall of facts, even trivial ones.

So, I’ve begun to explore ways to improve the situation without decreasing my dose of mood stabilizer.

What aids cognition? Consistent adequate sleep is a big factor. I can try that one, but it’s one I’ve struggled with since adolescence. As many others have noted, consistency is a bit of a challenge for someone with bipolar disorder. Well, it’s a challenge for anyone, but someone with bipolar has a physiological excuse (even if it’s one they haven’t fully identified yet) and perhaps a more pronounced difficulty with maintaining regular schedules. I do really, really well at it for a week or sometimes even a couple of months, but then I drop the routine and stay up late and make lots of lists and commit to all kinds of ambitious plans and all of the classic hypomanic things.

Bipolar is a condition of extremes. Hence the name.

So, adequate sleep isn’t a reliable means of improving cognition for me.

Exercise improves cognition, too. That’s one thing I do consistently, even when I’m depressed. For some reason, I can always get myself to at least walk around the neighborhood or lift weights. I’ve probably jinxed myself by saying that and won’t exercise for a month now.

So, exercise: check!

That brings us to psychostimulants. These are substances that stimulate the central nervous system. They work in different ways, but most influence the concentration of dopamine and norepinephrine to improve attention, alertness, and concentration. Prescription psychostimulants include Ritalin and Adderall, and are highly unlikely to be prescribed for me by my psychiatrist given my challenges with anxiety. Non-prescription psychostimulants include caffeine, nicotine, and cocaine. Two of those three aren’t terribly appealing to me for various reasons, but the caffeine is something to consider.

I’ve avoided caffeine for twenty years, since it started to make me feel very ill every time I consumed it. I haven’t had a soda in I don’t know how long. I drink coffee and tea, but it’s always decaf. I try to keep that under my hat, though; coffee drinkers stigmatize decaf drinkers almost as badly as our culture stigmatizes serious mental illness.

But a friend gave us a pound of really nice locally roasted French roast, and when my husband made up a pot, I tried about two ounces of it. The effect was striking. My husband and I had a conversation about psychopharmacology, and I felt more mentally nimble than I have in a long time. I kept track of the details of the conversation and participated in what my husband confirmed was an active and insightful manner. It felt great.

So, I’ve decided to self-medicate with caffeine. My aim is improved cognition with minimal side effects. Two ounces worked well this morning, but I like to savor my coffee for a little longer than that. I’m opting to combine caffeinated and uncaffeinated coffee and try to find the right proportion to keep that nimbleness without getting me jittery, nauseated, and/or sweating profusely. Half caff is too much caffeine, so I’ll try quarter caff next. (Starting high and decreasing is probably the wrong direction to go, but half caff is the easiest to measure.)

I’ll keep working on that sleep thing and keep exercising, but I’ll also add a little of the real stuff to my daily decaf and see how things go. I suspect I need a very small dose of caffeine to get the desired effect.

(The photo above is of forget-me-nots, which I thought apt for this post.)