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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
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