Posted by Rick on October 17, 1999, at 23:21:07
In reply to getting stupid??, posted by v on May 11, 1999, at 5:23:35
> i'm noticing that i suddenly can't remember the names of people, places, things, words etc... i suppose it's the dreaded "word finding difficulty" i've heard about.
>
> i've been on 150mg effexor xr for the past 5 months and have recently begun adding 25-50mg topamax at night.
>
> would it be the topamax that's doing it? would nutritional supplements like dmae or ginko help?
>
> thanks
-----------Folks, the only stupidity is not checking elsewhere on this wonderful site. In the Tips section (see links at top of page), checking "cognitive problems" in the "psychiatric problems" provides lots of answers to this question. Based on this, I wouldn't be so quick to put the blame on the Topomax; SSRI's seem to be the most-cited culprit.
To make things easy for everyone, I've pasted the entire section below (unfortunately it came out sqooshed...or is that squished?). BTW, as a veteran absent-minded word-loser myself, I'm just razzing my fellow Babblers. Truth is I just happened to run across this stuff while doing a Google search a few days ago. And frankly, I think this is one of those things that dwelling on makes worse. I wouldn't sweat it unless it gets REALLY bad, which isn't likely. (My own 2 cents, not professional advice.)
O.K., HERE'S THE THREAD FROM "TIPS":
Dr. Bob's
Psychopharmacology Tips
Word-finding difficulties from medication
Date: Fri, Oct 28, 1994 5:50 PM
Subject: Word-finding difficulties from SSRIs
From: Ivan Goldberg
On October 20, 1994, Ivan Goldberg wrote:
In a few people in whom I did full neuropsychiatric work-ups prior to SSRI rx, I have been able to confirm the patients' complaints of memory and word-finding problems by deterioration in their performance on the Boston Naming Test and the AVLT.
On Fri, 28 Oct 1994 PMBrig@aol.com wrote:
I also have been hearing more and more complaints of memory problems from patients on SSRIs. More details on the nature of the impairment found in your testing would be helpful.
The Boston Naming Test presents a series of 60 drawings that the patient is asked to name. When administering the test to adults only the more difficult 30 drawings are presented. Among the more difficult objects pictured are a trellis, palette, yoke, and protractor. When adults are retested after an interval of a few months, they usually score as well or better than when tested the first time. When patients taking Prozac are retested they often show a deterioration in their performance on this test. Some of those who show such a deterioration do not mention a memory deficit until they become aware that they did less well on the test the second time.
Rey's Audio Verbal Learning Task presents a list of 15 words to the patient after telling the patient that one will ask for the words immediately after the entire list is presented. This is done five times. The sixth presentation is of another list of words. After the patient responds to that list, one asks for how many of the original words are still remembered. It is expected that not more than three words that were remembered after the 5th presentation are forgotten when the patient recalls the words after giving the words remembered from the 6th trial.
Again, patients do not show deterioration on this task when tested a few months after the first testing. Many people on SSRIs, TCAs, and lithium show a deterioration in their ability to perform on this task when compared to their pre-drug performance.
Date: Sat, Oct 29, 1994 6:38 PM
Subject: Memory difficulties from fluoxetine
From: Raymond Behr
There is a pertinent case report in the Nov/Dec 1994 Journal of the American Academy of Child and Adolescent Psychiatry by Mark Bangs, M.D., et al. The case study describes a 14 year old who complained of memory difficulties on fluoxetine. The patient showed impairment on all 5 scales of the Wechsler Memory Scale-R during treatment. Three of the scales -- verbal memory, visual memory and general memory -- showed statistically significant improvement after the medication was withdrawn.
Date: Sat, 10 Jun 95 08:27 MST
From: dvweiss@amug.org (Dennis V. Weiss, M.D.)
Subject: Word-finding difficulties from SSRIs
Word-finding difficulties in patients taking SSRIs is not uncommon, and has been described as a serotonin-overload effect.
My approach would be to lower the dose and, if necessary, shift to another antidepressant (even a different SSRI, which may not have the same effect).
Date: Sun, 11 Jun 1995 15:30:14 -0400 (EDT)
From: Charles S Berlin
Subject: Word-finding difficulties from fluoxetine
I have a patient who is a writer and has found fluoxetine the most helpful of many agents for her depression. However, every time she goes back on this medication she notes that she then experiences word finding difficulty, even for many simple words (an obvious problem for a writer). When she first reported this to me, I was unsure if this was a definite side effect. However, she did a search and found a number of reports of this, and noted that other patients on the internet patient support newsgroups reported this. When this problem arose every time she went on the medication and cleared every time she went off, there was no doubt about the linkage.
Date: Mon, 12 Jun 1995 23:09:57 -0700 (PDT)
From: "Kristin E. Zethren"
Subject: Word-finding difficulties from SSRIs
I have seen word finding or accessing difficulties with fluoxetine, paroxetine and sertraline, completely unrelated to dose. It was unfortunate to discontine a drug that was working so well in every other respect.
Date: Tue, 27 Jun 1995 20:51:24 -0700 (PDT)
From: Ivan Goldberg
Subject: Memory difficulties from SSRIs
I have seen profound memory disturbances sometimes accompanied by a dysnomic aphasia (profound word-finding difficulties), in both men and women of all ages. This side-effect seems to be dose-related and clears a week or so after the dose has been lowered.
From: PMBrig@aol.com (Peter M. Brigham, MD)
Date: Fri, 4 Aug 1995 08:47:38 -0400
Subject: Word-finding difficulties from SSRIs
I have found occasionally that patients will have a word-finding difficulty on any of the SSRIs, e.g., can't recall the name of someone they know well, etc. At times patients complain of other cognitive problems also.
From: BakerFam@aol.com (Howard Baker)
Date: Sat, 26 Aug 1995 17:24:30 -0400
Subject: Word-finding difficulties from stimulants
I have had a number of patients who are taking stimulants for AD/HD complain that they have transient problems with word finding. They can get the word, but it takes a bit longer than they are used to. It is possible that it is actually a symptom of the AD/HD, but these patients did not notice it before taking the medication. Of course, there are many things that they did not notice before taking the medication, so that could also be an explanation -- i.e., that they had it in the past without noticing it.
Date: Sat, 2 Dec 1995 16:49:12 -0500
From: bb281@freenet.carleton.ca (Ann Van Regan)
Subject: Word-finding difficulties from nefazodone
A woman in her 40s with post traumatic stress disorder and panic disorder has both word-finding difficulties as well as word-substituting (snoring for snowing) problems appear when she gets to 150 mg nefazadone. It seems to be effective in handling her dysthmia and PMS. She's very successful and finds that this is causing lack of self-confidence and making her feel "stupid".
Date: Sat, 2 Dec 1995 22:50:19 -0700
From: ckuttner@proaxis.com (Charles Kuttner)
Subject: Word-finding difficulties from TCAs
This is a frequent side effect of tricyclics; I always heard it said that it was due to anticholinergic actions interfering with cholinergic pathways. I have not seen this side effect with nefazadone, but the drug is so complex to use that I save it for close to a "last resort."
Date: Sun, 03 Dec 1995 12:20:26 EST
From: MWKR59A@prodigy.com (Dr Frederick C Goggans)
Subject: Word-finding difficulties
I would think that the psychiatrist as a person with medical training could ... at least do more detailed mental status and neurological exams to check for other signs of brain integrity. The main point is that a number of conditions that affect the CNS can present with depression first and then slowly in other ways so when atypical things do emerge we need to rethink the diagnosis. I personally had a case like this once where the diagnosis turned out to be Creutzfeldt-Jakob disease in a patient around 40 years of age.
Date: Sun, 3 Dec 1995 10:47:40 -0800 (PST)
From: Ivan Goldberg
Subject: Word-finding difficulties from medication
Dysnomia and paraphasic errors together with other indicators of cerebral dysfuntion are not at all atypical when people take therapeutic doses psychopharmaca. These effects are particularly common with lithium, the other mood stabilizing drugs such as valproate and carbamazepine and antidepressants.
From: RMRich1@aol.com (Roberta M. Richardson, M.D.)
Date: Fri, 3 May 1996 22:39:30 -0400
Subject: Memory difficulties from sertraline
I treated a woman in her fifties who developed memory problems significant enough to impair her on the job, on sertraline. It reversed completely when sertraline was stopped.
This was not a word-finding or apathy problem. She complained of neither of those. It was forgetting things that she had been told or even things she had done.
Date: Sun, 16 Nov 1997 20:59:13 -0500 (EST)
From: "Adele Tutter, M.D., Ph.D."
Subject: Word-finding difficulties from lamotrigine
I am using Lamictal (lamotrigine) quite a bit, mostly as monotherapy in depressed patients in the bipolar spectrum. However, I find that many patients complain of short-term memory disturbance, name- and word-finding difficulties, and a sort of overall cognitive blunting. This doesn't seem to be too dose-related, e.g., patients will report it at 100-200 mg and it doesn't seem to worsen with increased dose (or get better with decreased dose). In some people it gets better with time -- or maybe they just get used to it.
Date: Sun, 16 Nov 1997 23:47:26 -0500
From: Ivan Goldberg
Subject: Word-finding difficulties from lamotrigine
It has been my impression that all mood stabilizing medications induce cognitive changes in many of the patients whom we give such drugs.
Complaints about short-term memory changes or difficulties with word-finding seem common in patients taking lithium, carbamazepine, valproate, gabapentin and lamotrigine.
It seems to me that memory or word-finding changes are no more common with lamotrigine than with other mood stabilizers.
poster:Rick
thread:5922
URL: http://www.dr-bob.org/babble/19991016/msgs/13358.html