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[highchief]

Hi

 

Lately my working memory has been shot. It has been getting progressively worse over the past year.

I'm suspecting it has to do with the increasing stress levels of my life but who knows.

I'm diagnosed combined ADHD/ADHD-PI with co-morbid OCD and possibly MDD.

My question is really, as my emotional regulation has suffered to a great extent, where would I start looking for improvements; increase recovery (from distress) or increase training (of working memory).

I've recently read Dr. Brown's "Smart But Stuck" and he refers to impairments in emotional regulation being related to working memory.

Here's link to an abstract of a referred study:

http://www.ncbi.nlm....pubmed/19025300

 

J Pers Soc Psychol. 2008 Dec;95(6):1526-40. doi: 10.1037/a0013345.

Working memory capacity and the self-regulation of emotional expression and experience.

Schmeichel BJ1, Volokhov RN, Demaree HA.

Author information

 

Abstract

This research examined the relationship between individual differences in working memory capacity and the self-regulation of emotional expression and emotional experience. Four studies revealed that people higher in working memory capacity suppressed expressions of negative emotion (Study 1) and positive emotion (Study 2) better than did people lower in working memory capacity. Furthermore, compared to people lower in working memory capacity, people higher in capacity more capably appraised emotional stimuli in an unemotional manner and thereby experienced (Studies 3 and 4) and expressed (Study 4) less emotion in response to those stimuli. These findings indicate that cognitive ability contributes to the control of emotional responding.

 

 

I'm not sure if my working memory deficits are due to:

D-amp use - in therapeutic doses

Previous trials of anticholinergics - Bupropion, diphenhydramine

Less sleep

Changes in life situations

 

So really my question boils down to:

Where do I start looking for good sources of info? Would it serve me better to train working memory e.g. via Dual-N-Back? or would that be detrimental? I'm thinking along the lines of physical exercise = good at optimal amounts that would allow supercompensation to happen, not so good when chronically extended beyond recovery ability.

 

Thoughts, input?

Cheers

[Tom_]

Increased stress, in particular when it leads to depression (in your case sub-clinical, unless its hidden depression (mostly somatic complaints) major depression is not something someone misses) which happens to have a trade mark reduction in cognitive function - in particular working memory is always the most likely cause in an otherwise reatively healthy person.

 

Its very unlikely that D-amfetamine is causing working memory problems, typically it impoves it, in particular in the ADHD population. Ach does have a relationship with working memory but significant impacts are  ususally only obvious in mild dementia plus. Having used clinical doses of Diphenhydramine and Wellbutrin are very very unlikely to cause lingering problems. I took a massive overdose of Diphenhydramine, around 6 grams and even then within 6 weeks my cognitive function was back to realtively normal.

 

There is comparatively little evidence for Dual-Back training although there is some evidence suggesting it can help in ADHD. It can't hurt but don't expect magic.

Exercise (cardiovascular, weight training does not have the same evidence and when heavy weight training happens this often has a determental effect) has been shown to increase working memory and there is some indication it may be useful in depression. Its a good idea.

 

Exposure to stress...now this is the big one - the most relevent. Reducing stress in reasonable way possible is important. Also increasing tolerance to stress is very important. Combined you will of course find better results. Reducing stress can involve sleeping better (SLEEP HYGEINE), eating better, taking care of yourself generally and taking time for yourself (where it be to read a good book, mong out once a week infront of the tv or best of all engage in some social activity). Creating routine and sticking with it as best as possible is also important but don't make them so rigid that you feel like you are trapped. Talking things through with a trained person centered councilor or if you feel you need it more intesive treatment (CBT is always best to start with) (if they both cost the same go for the CBT). Certain books are great for stress management - the chimp paradox, CBT for dummies, Mindfulness for dummies. Start practicing mindfulness at least 4 times a week. Even if its only for 5 mins. Remember to much stress and your body responds with anxiety, depression, poor sleep, reduced metabolism. To little stress...exactly the same but to much sleep.

 

You mentioned the reduced sleep. This is a bit of a chicken and egg senario - reduced sleep is a stressor but stress can be causing reduced sleep. Some of the same mechanisms are involved. A rigid sleep hygine (this should be as ridgid as possible for at least 3 months and then you can start to relax it (somewhat)) is the only evidence based treatmeant for long term management of Insomnia, it can take a few weeks to have effect but its the very best idea. If the amfetamine is part of the problem here then look towards long release drugs. A swap to Methylphenidate which is equally as effective but a bit more healthy. If after a few months of sleep hygeine you aren't seeing approiate improvement then a short course of a sedative drug may be useful. Trazadone or Mirtazapine would be perfered options in your case (Clonidine or Guanfacine could be trialed as they are also effective treatments for ADHD). If the problem is simply you not giving yourself enough time to sleep then you MUST sort it out - nothing is worth going down that road.

 

If with all this (minus the sleeping drugs) isn't helping or you are getting worse. In particular look out for suicidal thoughts, pessimism, reduced energy levels, increased anxiety or even panic attacks, regular aches and pains, worse sleep (to much/little), jitteriness and guilt. Then an empirical antidepressant trial is the next step. Floxetine, Mirtazapine, Trazadone or Sertraline should be considered as first line treatments.