Can Bipolar Disorder Cause Cognitive Impairment & Affect Memory?
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Q:  Can Bipolar Disorder Cause Cognitive Impairment & Affect Memory?

Apart from the actual depression, does Bipolar actually damage your intelligence/cognitive ability/memory/recall etc. I am in no doubt that mine has been affected so much so that I can barely hold conversations or hold anything relevant in my head (that i used to) and have thus become socially avoidant which in turn fuels the depression?? My mind is a mess.

The intrusive thoughts that are mentioned, are these often the same repetitive thoughts? (negative self-critical ruminations and self-berating at every opportunity)?

Many thanks for any help.

Yours desperately,

Dear Mr. C-

Unfortunately, there are at least three major ways in which bipolar disorder can cause cognitive impairment and affect memory. The problem is, figuring out which is the basis of such impairment in a given person can be difficult.

The three are: mood effects on cognitive ability; medication effects; and the ongoing decrease in cognitive abilities sometimes seen with bipolar disorder itself. Obviously, one could have all three at once. But knowing whether one's limitations are coming from the disease itself, which unfortunately can happen, requires ruling out the first two as the basis. I generally try to assume that the first two might be the problem, before concluding that it is simply the ongoing decrease in abilities which affects many people with this disease.

In your case, the intrusive, repetitive, negative self-critical ruminations and self-berating (which very well describes an extremely common experience in this illness), suggests that at least some of the difficulties you are experiencing might be associated with yet-to-be-fully-controlled mood symptoms (depression, at a minimum; and perhaps some degree of a manic-side component, although that cannot be determined from what you have written here). Ironically, that is good news, in the sense that this means there is something obvious that can be done about it (namely, treat those symptoms and see how much improvement might come along, cognitively).

Secondly, one would have to examine the medications you are taking and see if any might be associated with some of the limitations you are experiencing. Nearly all of the medications that we use for bipolar disorder can have this effect in some people. Careful now: sorting out which one, if any, might be doing this to you, requires extreme caution and a very deliberate plan that you work out in advance with your treating physician, largely at her or his guidance (in other words, you--and other readers--definitely should not try doing this on your own).

Unfortunately, it is now well documented that bipolar disorder in itself can cause cognitive decline over time. However, it is definitely not clear how much near-perfect symptom control might keep that from happening. There is definitely a possibility that by controlling mood cycles, one can markedly limit is not completely stop this process. That is an open question. For now, I assume that the process can be completely stopped if I keep working with my patients toward complete symptom control Come on as long as we can do that without too much medication burden. For example, fish oil may play a role here in optimizing a regimen without much the side effect risk, except for the number of pills one has to take, which itself can become a burden.

The first thing for you then, given the sound of your second paragraph, would be to work on getting your symptoms under control. In the meantime, you should, as much as possible (this is extremely difficult) try to put off any judgment about what kinds of cognitive abilities you will have when your symptoms are controlled; it could be that you will see a marked recovery, as I have definitely seen that with my patients, quite frequently, enough to keep me going in efforts to improve such problems with memory and intelligence). Good luck with that process.

Dr. Phelps

Published March, 2007

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