Loss of mental acuity: Stress/Anxiety or hormones?

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Merry Christmas, Happy Hanukkah, and Happy Holidays everyone!

Thanks to all those that have posted their trials and tribulations in effort to get through anxiety, depression, and the attendant terrible symptoms. I am here to seek some insight, especially for those that may be in the same or similar boat. I would like to preface this by letting you know that what I'm about to write will probably be quite lengthy.  I'm also saving a copy for my therapist.  I hate to impose on your patience, but I would appreciate any advice any of you may have. 

I'm a 46 year old male. About 7 months ago (May 2016) I underwent a great deal of stress -- mainly work related with continued rotating shifts (day, evening, midnight shifts) while also orchestrating many managerial-level outreach-related activities.  Meanwhile, during this time I had also been applying for a new job (one I ultimately withdrew from) -- which for about 7-10 days took a great deal of time and effort in preparing the application packet. Was I exhausted and sleep deprived? Probably. But what happened the week of May 16th had such a profound effect on me that even 7 months later I still have more questions than answers.

The "stress" I was going through at work culminated in a very busy week in mid-May, when I (among other shift-duty responsibilities) was responsible for hosting a workshop with several internal customers of our agency.  Once the prep work was done and we "finally" got to the workshop, I vividly recall feeling "fuzzy and out of it" -- to the point where I couldn't even totally comprehend what folks were saying.  It was like my head was stuck in the mud.  The workshop ended up going fine, thanks to some of my cohorts bailing me out, but I went home that weekend still feeling 'dazed and confused'.  Thus began a terrible OCD that has since never truly gone away (though is much more mitigated nowadays). I remember coming across a vocabulary word that I didn't quite understand.  So I looked it up.  I was startled that I had to look it up, but whatever, it didn't bother me right away.  However that weekend I recall looking up more and more words, and in doing so, questioned my cognitive recall ability.  Was I really forgetting things, or making it worse by continuously going through this ritual of validation? 

This pattern (brain fog, dizziness, and now increased anxiety) continued until late June, and culminated in a full-blown panic attack. Full disclosure: the panic attack could very well had to do with the fact that I was on day 4 of Effexor – something I was willing to try through my GP as my family (brother and father) have a history of anxiety and depression.  Putting it mildly, I did NOT handle this SSRI very well.  Anyway, while I have no doubts stress and lack of quality sleep no doubt were contributors, I really do believe the "anxiety" as in the heightened cortisol, panic, etc., did not happen until AFTER the fogginess/lack of mental clarity commenced.  Anyway, after this acute panic attack in late June (June 22 I think), for whatever reason, just like that, my cognitive symptoms all but vanished.

I recall taking the dog for a walk on June 23rd, looking at any inanimate object I could see, and for the first time in over a month, I did not have to "pause" to think about what it was. "Cul-de-sac", "trailer hitch" -- anything I could see in front of me while walking I could identify right away, intuitively, and (this is important) without hesitation.  I was "back".  And I was literally in tears, because such an ordeal -- the thought of losing my intelligence -- was frightening.

Over the next 60-90 or so days (July, August, and much of September), I was doing much better. Still going through the routine every once in a great while of looking up a word or two I wasn't familiar with, but certainly not to the OCD-extent I was doing in May and June (up to 100 words a day, sometimes the same word multiple times).  This was generally a good time for me -- outside of one little thing.  I started getting occasional periods of insomnia.  Not sure why, though again I suspect working rotating shifts didn't help matters. What's worse, I started getting insomnia after night shifts -- up until then that had NEVER happened!  Anyway, yeah, I got a little panicky, did the whole pacing routine, but once I realized that that I couldn't stay awake forever, I eventually fell back to sleep.  But still, even on my days off, I could no longer "sleep in" as long as I wanted or used to.  I do not have sleep apnea issues (had been through a sleep study to verify).

Anyway, once we got to late September, I recall quite well going camping with my wife and 2 boys and their Cub Scout pack.  We stayed over one night -- which I fell asleep fine, but then woke up at 2 am and couldn't get back to sleep.  The next day I was fuzzy, and once again began having issues with recall.  I remember one of the scout leaders asking me to pull the end of an elastic band and secure it back on one of the corners of a rain canopy. I did, but I started to panic because I wasn't quite sure what "elastic" was.  Oh, and he didn't say canopy -- I actually had to look that one up.  As in, "hey, what is this thing we're standing under?"

A gradual uptick in anxiety ensued, which peaked in the early part of November.  "Here we go again" I thought.  Only this time, it wasn't gone in 4-6 weeks.  While not at any point as severe as I had experienced in May-June, this go-around was still a 6-8 out of 10.  Enough for me to try another SSRI (Lexapro).  Nope, could not deal with the side effects.  Tried Wellbutrin.  Nope, made me even more spacey (if that were possible!)  So, beginning in early December, I began a regimen of increased magnesium (mg glycinate), while also supplementing with ashwagandha, holy basil, and phosphatidylserine to go along with what I would normally take (omega 3s, vitamin D, B6 and B12, and zinc).  I also, for a long time, have cut down on the caffeine, as I try to stick with just chamomile tea.  The anxiety has lessoned considerably over the past 3-4 weeks; however, there are still occasional bouts of “fear” that creep in when something doesn’t register in my brain right away.  The other day, it was “dust pan”.  I needed to sweep up some crumbs off the kitchen floor, grabbed the broom, and thought “where is the….uh….scooper that goes with this broom?”  Scooper?  Do you mean dust pan?  When something like this happens, fear and (probably) anxiety increases a bit.  My symptoms seem to be at their worst when I’m at work, *fearing* I’m going to forget how to accurately do my job, articulately write my technical discussions, or communicate effectively with my co-workers.  If I start going “down that rabbit hole” in letting these fears take a firm grip, my thinking becomes more clouded, and it gets to the point when I find myself second guessing whether or not I “know” certain words (often technical) coming out of my coworkers conversations.  I hear “out of phase” – and ask myself do I really know what that means.  Play on words (idioms especially) are particularly tough, because we aren’t supposed to dwell on the meaning, because they’re not literal.  Still, I hear “shoot the breeze” and ponder what is the connection of those words to communicating excessively.  Or other word combinations that, when together, mean something different than their individual components.  “Virtue” means moral righteousness; so how on earth do we get “by virtue” to mean “because of”?  These are just one of the many, many, many examples of the mind games that go on when I’m feeling at my worst. When I have moments of mental clarity, I don’t ask “why” or feel the need to look up the definition of words – “it is because it is, and I say it means (this) and I don’t need a dictionary to tell me otherwise.”  I also find that I don’t freak out just because I couldn’t immediately come up with the term “allen wrench” when I’m looking for a hex wrench, or “precision screwdriver” when I instead say “small screwdriver”.  However, when I’m going down that rabbit hole, and cannot think of what the wooden kitchen floor is made of (laminate), I start to freak out.

 

So, after all of this (again, thank you for your patience!), I am left with the presumption that this is NOT dementia related.  The blood test results I’ve had up to this point would also confirm no autoimmune issues, nor thyroid.   So it comes down to the question I have in the title of this thread: is it due to anxiety/stress, or hormonal?  While I mentioned I’m a 46 year old male (“middle age”), I should also point out that my free testosterone level is around 270 – under “low” normal for a guy my age (300).  Could this have something to do with the brain fog/lack of mental clarity/lack of mental confidence??  My Endo wants to draw a new blood panel next month, but isn’t really enthused with the idea of going on synthetic testosterone replacement therapy. 

 If you’ve gotten this far, thank you all in advance!

Brian

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  • Posted

    I am a Pensioner now and I suffer a Chronic Short Term Memory Disorder. Early this year I went through five weeks of tests and examinations to prove I did not have dementia.

    In the best I was able to multi task and this eventually fell away as Middle Age progressed, this started when I reached my mid/late forties. As we get older these problems increase and it becomes more difficult to think on our feet, this is normal and if we have to much on our minds we can suffer problems with the names of things and their uses. This was not related to my short term memory disorder it was in ways age related especially when we have to much on the go, we expect that we can still undertake multiple problems and basically we start to loose that gift.

    Personally I feel we need to give the brain more time to remember things and sometimes we may need to pass some of our thoughts from our short term memory into the mid term memory of the brain. There are ways to remember names of things and there are books explaining how to do it, try Amazon.

    I found the more I push the more I forget, so I slow down and give myself time to place my thoughts into an index and to remember tools or people. I look for something notable about the person, tool, or activity, the sillier the better.

    Talk to your GP regards your problems and remember there are many types of problems associated with what you have described and it may need tests. and some medications to help.

    We are not health Professionals so your GP will help. If you are overworked or suffering Anxiety those problems will cause memory lapses

    BOB

     

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    • Posted

      Thanks Bob, I really appreciate you taking the time to reply with such sound advice.

      I'm not overly enthralled with my GP, only because I believe this may be on the outskirts of his medical expertise. However, he's a terrific listener, and certainly can point me in the right direction in terms of seeing a particular specialist (or multiple).

      I'm glad you replied because I needed to hear from a middle age guy with perhaps the same hormonal issues. I am thinking, upon collaboration with my GP of course, that I will first look at seeing a hormonal specialist -- especially since they would go through a more rigorous protocol in evaluating the blood work than my Endocrinologist would. I know I have low testosterone (fact) -- it's only in the past year that the symptoms in terms of mental clarity have surfaced. So perhaps there is something else (chronic fatigue, especially given rotating shifts?). Again though, such a diagnosis would still fall out of a complete hormonal assessment.

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  • Posted

    Brian Sorry to hear all this. Have you been checked for adrenal stress or fatigue? The saliva cortisol tests are more accurate.

    Take care.

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  • Posted

    I wanted to add a post script -- today (12/26) was a bit of a setback compared to the last several days. Having a bout of insomnia last night probably didn't help (about 6-7 hours of broken sleep, never more than 2 hrs at one time). Te spaceyness and overall disoriented feeling peaked between late morning and mid afternoon, when cognitively speaking I felt like I was stuck in the mud, even (once again) not quite grasping right away words I should know.

    What else was different today, other than the insomnia? Things didn't start going downhill until after I took my supplements. It was the normal stack of mg, zinc, Omega 3 fish oil, Ashwagandha, and holy basil. However today I added a multivitamin along with 5000 IUs of Vitamin D and half (500 mcg) of sublingual vitamin B12, along with the regular vitamin B Complex. Now I'm beginning to wonder if I'm getting too much vitamin D and/or B. Especially the D. For months I had been taking 2 5000 IU softgels, only recently going down to one or (even more recent) no added D3 outside of a multivitamin.

    Thoughts??

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    • Posted

      Ice,

      Yeah, about that...

      So today I went without the 5000 IUs of vitamin D, or the B complex, and just took the multivitamin along with the omega 3 fish oil, zinc, and Mg glycinate.  Much, much better in terms of cognition and certainly anxiety. I still catch myself testing/challenging what I know at times -- which includes me second guessing what I have stated.  I think that's a function of doing this sort of thing for so long now (several months).  But the undeniable fact is I felt much better today than I have in a long while -- still not quite where I'd like to be (again I think that's a function of how long this has gone on -- it's not something that can go away overnight). I'm really wondering if I was taking too much D and B.  On the surface it wouldn't appear so --then again perhaps my body was saying I didn't need to supplement these many months.  I mean, wow, I had been taking 10,000 IUs or 2 of those 5,000 IU gels of vitamin D for at least 3 years, only recently going down to 5,000 in October.  Perhaps this was a contributing factor.  (??)

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