Most people, over the course of their lives, get some idea how smart they are. They go to school, see other people do better than they do at some things, and get an idea of their limitations, and what undertakings are realistic for them.

IQ tests rub a lot of people the wrong way. They don't like being told, flat-out, in a short time, as a number, how smart they are. There is a very big faction that doesn't want IQ tests used by society. So much so that in the United States it is illegal for employers to give job applicants such a test.

At the same time, there is no other test that a psychologist can give to a mentally healthy person in the same amount of time, with as much predictive power for their future life outcomes.

And for most of the population, your intelligence stays roughly constant throughout your life.

If you're taking psych meds, your intelligence may change every time you switch meds. You can't afford the time to go through years of school to get a new self-estimation.

I've heard people say "Can't you *feel* how smart you are?" People cannot really gauge that. I once gained 10% of my weight and didn't know it until my doctor weighed me during a routine checkup. And weight is much simpler to judge than intelligence.

Who hasn't been trapped in conversation with a blithering drunk who was sure that they were absolutely brilliant? Go to any horse racetrack and you'll find a group where 90% of the people think they're smarter than the rest. It wasn't until after I had experienced years of career failure, that I started to suspect that it was Lithium that was undermining me.

If you're not measuring your intelligence, you aren't going to be able to detect the change caused by most meds within a few months, unless the difference is drastic.

I've met a lot of people in support groups who found that the mood stabilizer Topamax made them very, very noticeably dumber. This was certainly the case with me. It has a drastic negative impact. It reduced my IQ by at least 40 points.

Lithium varies a lot from person to person. I know a guy, Peter, who got a PhD in electrical engineering from Cambridge while he was on Lithium. I knew another guy, Ron, whose life was completely destroyed by it. He couldn't hold down any job. He said that the side effects of Lithium were "worse than the illness". Then he switched to Depakote, and was OK. The last time I talked with him, he'd been able to hold down a good job at a chemistry lab for 5 years.

I met a guy in a mental hospital in 1988 who had gone off his Lithium (at the time, it was the only mood stabilizer available). He seemed to me to be a bright guy, but he told me that when he was on Lithium, he was too dumb to read a book. He would just live on disability and not work. His parents pitched in (he was in his late twenties). "It's like being a non-human primate" he told me. No wonder he tried to go off his meds. But once off his meds, he went psychotic and got carried away with some ridiculous conspiracy theory and flew to another city. He was extremely confused, and his best friend had to go get him and escort him back and check him into the hospital where I met him.

After I went on Lithium in 1988, my rate of coding slowed down considerably.

In 1989, on Lithium, I developed a database. It was my invention, something I had had in the back of my head for years. It worked to support a product. But when I intended to adapt it to support another product, it turned out to have a problem. The problem was solvable, but it took me so long to fix it, that another approach was adopted, and I was disgraced in front of basically everyone at work.

In 1996 I went to a presentation about a company that had a database based on the exact same idea. They'd never heard of me, and when I did my database I'd never heard of them, we both invented it independently of one another. Theirs was better because they had a whole company and not just one person, working on it. So while I was on Lithium, my ideas were sound and people talking to me had the impression that I was reasonably intelligent. t just took me too long to get anything done.

So while I was on Lithium, I could talk about ideas intelligently. I just couldn't sustain focus long enough to implement things fast enough.

Eventually, my employer lost patience with me. I went to the Philippines to teach computer programming at a university and hopefully figure out how to improve my programming productivitity problem. I figured out how to teach reasonably well, but came back without having solved my productivity problem. I did so badly at my next job that I concluded that I couldn't be a programmer any more on Lithium.

So the 13 years I was on Lithium, from 1988-2001, were like a wasted period of my life. I wound up spending most of the dot-com bubble of the late nineties unemployed, and most of my friends were work friends, so I lost nearly all of them.

In 1994 I tried a new drug, Depakote, to replace Lithium, but it wasn't strong enough. I got a little manic and offended everybody at my volunteer work job and was suspended. I had a girlfriend who wound up breaking up with me, screaming insults at me over the phone. I had to go back to Lithium.

It was kind of funny how I lost my volunteer job. I was working at an Episcopalian outfit that was helping the homeless, and I started having lots and lots of ideas, and of course I thought they were all brilliant ideas. I started rearranging everything without clearing it with my superiors. When they sat me down and talked with me about it, I said, in my defense, that "This place has so much room for improvement." For some reason, they didn't see it that way.

On the plus side, I had a sure-fire strategy for not losing any money when the tech bubble of the late nineties crashed. I'd been unemployed so much that I was nearly broke, and didn't own any stocks!

Eventually I got a job doing software quality assurance, which was less demanding and I was able to do it OK, but I didn't like it anywhere near as much as when I was a successful computer programmer.

In August 2001, I suffered an accidental Lithium overdose. My kidneys suffered as a result. By this time there were quite a few other mood stabilizers on the market, so I began trying them.

I tried a couple of them which didn't seem to work very well -- I was getting manic, in fact, I got manic enough on one that I checked myself in to a mental hospital for a weekend.

I tried Topamax, which was a disaster. It made me radically dumber. I took a couple of programming classes at a local junior college that should have been a breeze for me and failed them. I started to suspect that I was much less intelligent than I had been for most of my life. I bought a bunch of "test your own IQ" books on Amazon and concluded that my IQ was about two thirds of what it had been before. At the time, I thought it was probably irreversible brain damage from the Lithium overdose a few months before and I was suicidal about it.

I wondered if it might just be the Topamax blunting my mind, so I switched off it.

I was one of the first people to try Topamax. In the years after that, I heard from a lot of people in support groups that they noticed that Topamax made them a lot dumber. And these are people who were living on disability, not people trying to do intellectually challenging work. For someone in that position to notice the difference, it must be a massive difference.

I tried Depakote again. As in 1996, I was clearly manic, not enough to be locked up, but problematic. I remember being really exuberant at a bipolar support group, which entertained everybody there. Later on, the moderator of the group, who was not herself mentally ill, said I had a "manic break" at that meeting. I said no, "It's not a 'break' unless you have to be strapped down."

But the Depakote was doing some good, so we decided to add another drug to the cocktail. My shrink prescribed Geodon, telling me "You're the first person I've ever prescribed this drug to." That was in about March of 2002.

The cocktail controlled my mania well enough, and my IQ went up again.

Shrinks don't normally talk a lot about cognitive impairment. I suspect that they feel that discussing it will make people more likely to go off their meds. A lot of patients are reluctant to take their meds, and that's usually a really bad thing. If someone winds up in the mental hospital, everybody points fingers at the shrink. If someone's career goes down the toilet (and their social life with it) because of the cognitive impact of their medication, not so much.

I've seen a lot of research papers that discuss ways in which bipolar people are at a cognitive disadvantage compared to healthy controls. However most of these papers are clueless in they don't consider the fact that a bipolar person will be not only medicated, but the more seriously ill they are, the more heavily they will be medicated. While it would be simple to medicate healthy people and test the cognitive impact on them, this seems to be rarely done.