What Happened to My Bipolar Brain and How Do I Fix It?

The most troublesome statement in Goodwin and Jamison's Manic Depressive Illness may be this: "Complete symptomatic remission does not ensure functional recovery." This is no small problem. For some 30% to 60% of patients with bipolar disorder, simply treating their mood symptoms is not enough to help them return to a full life.

There’s a third pole that needs to be addressed for that to happen: cognitive symptoms. These often persist even when patients are euthymic, and they range from problems with memory and attention to more subtle deficits such as picking up on social cues and making wise decisions. 

Chris Aiken's article, Eight Ways to Improve Cognition in Bipolar Disorder, opens with these paragraphs. Ironically, what Aiken calls troublesome, I find immensely reassuring. My experiences are real!

Several years back, my pension fund paid for a three-day psychiatric/psychological evaluation of my disability status. I went in with a diagnosis of Bipolar NOS. I thought that PTSD also fit. The pension fund wanted a second opinion and a prognosis. The shrinks asked what my goals were.

I wanted to know what had happened to what I called my Swiss cheese brain, my difficulties with concentration, reading comprehension, memory, word-finding. I was losing track of my thoughts in the middle of sentences. The day I messed up the buttermilk pancakes, an old family recipe, my wife was seriously concerned.

Well, they asked. But I wasn't footing the bill. So...

They ran their regular battery of tests, determined that I didn't have dementia, and that I was pretty smart. The good news is, there is nothing wrong organically, they said. Their conclusion: the cognitive difficulties were all dissociation, caused by my trauma history.

Okay, yes, dissociation is one of my best skills. But it was like I was an Olympic athlete who had gone for a post-injury physical evaluation and been told, You ran a five minute mile. That's really fast. Nothing wrong with you.

True, I was really smart. But I used to be brilliant smart. And the difference between before and after my brain blew up meant that I could no longer pursue my goals. I could not get my doctorate. I could not finish projects that were important to me. And in a variety of small and large ways, I just wasn't very good company anymore.

A speaker at a NAMI meeting described the consequences of his traumatic brain injury. And though I had not experienced a TBI, some of what he described matched my own experiences. I decided to treat my brain as though it were injured and needed to heal.

And it did heal. Not entirely, but it got a lot better.

  • First, I adjusted my expectations. A friend with similar experience recommended that I give myself five years to recover.
  • I gave myself rest, started following every good sleep strategy out there.
  • I improved my diet, less red meat, more veg.
  • I changed my meds. The people who did the evaluation recommended that I take small doses of Valium throughout the day prophylactically. It has never been addictive for me. But after a few months, I couldn't tolerate the brain fog anymore. My pdoc agreed that I could drop it.
  • While lamotrogine helped slow down my rapid cycling, it didn't slow it much. Nor did it relieve the depression enough for me to tolerate the word-finding issue. I was a writer, taking a med that took away my words? So I dumped that, as well. Eventually, once relatively stable, I found other meds that help me maintain that stability, including fish oil and CoQ10.
  • My wife found behavioral strategies for reducing the dissociation thing, like getting my clear attention and making me to write it down when she wanted me to remember something.
  • And I keep trying to take that pause between stimulus and response to let my frontal cortex catch up to my ever-alert amygdala. That one is hard, but an important social skill.

A number of these are strategies that Dr. Aiken recommends. This article was written for doctors, but in an accessible way that patients, even those who are no longer brilliant, can understand. He has recently joined Jim Phelps at Psych Education, a website jammed with information for patients about how to live a bipolar life to the fullest. Go there. Spend days there. You will The website is filled with what your doctor never bothered to tell you.

You can do better than you're doing right now.

May we all have doctors who pay attention to our quality of life and who help us pursue our goals.

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