Q: Asks for Information on Specific Treatments for Cognitive Deficits
Dear Dr. Phelps,
I am a 44 year old female diagnosed wth BP. My initial dagnosis
was when I was thirty but I didn't receive treatment until I was forty. I am
fairly certain I developed pre pubescent based on my childhood memories an my
nieces diagnosis at 13. I have been identified as having a high IQ but I have
started to demonstrate severe cognitive deficits. From my research I have found
that the type of cognitive deficiencies are normal for BP even in euthymic
I take 20 mg of Lamictal daily but most data suggests that no
additional deficit in cognitive function has been attributed to this medication
at that dosage. The dysfunction appears to be progressively increasing and has
begun to affect my daily functioning. I am a trainer at my job and my verbal and
word retrieval dysfunction is interfering with my ability to affectively
transfer knowledge to my trainees. Also, my husband has become more and more
frustrated with my response delay to questions and slowed thought
processing. I can not find any information on treatment nor suggestions on
how to improve functioning either using medication (which I must admit I shy
away from fearing a the treatment will mess up the positive effect of the
Lamictal in controlling the moods) or some other form of retraining to alleviate
some of the symptoms. I am afraid I am destined to become a Gomer and it
terrifies me. If you could please make a suggestion as to where I might find
some information on specific treatments for cognitive deficits I would truly
Thank you for your time and consideration.
Dear Allison --
An interesting case series was just published on this question, to which I will
refer you in a moment.
However, first things first: if you're still having symptoms, I think most mood
experts would agree that the first step is to get those symptoms under control,
then reevaluate your cognitive function. In the process you will of course want
to make sure that your thyroid function has been assessed and found to be not
only normal, but perhaps nearer the "hyperthyroid" end of the normal range.
From my experience, I would be particularly interested in how you are sleeping.
If you have difficulty falling asleep or staying asleep, that might be a good
sign, ironically. If so, if you took steps to normalize your sleep pattern,
that might have a significant impact on your daytime concentration and memory.
At least there is good reason to hope so; and that is a treatment step you would
probably want to take anyway.
Likewise, if you're still having "cycling", suggesting that the bipolar process
is not completely under control, then additional steps to decrease cycling --
hopefully to 0 -- might also lead to improvement in cognitive function. I think
most mood experts would agree that these steps are worth taking first before
thinking about this next idea.
Dr. Tam Kelly, a psychiatrist in Fort Collins, Colorado, would probably answer
your question by referring you to a paper he just published: Is donepezil
useful for improving cognitive dysfunction in bipolar disorder?
As you can see from the
summary , two thirds of the 58 patients he treated with this approach showed
improvement. He did see some worsening of symptoms in some cases, suggesting
that this approach warrants caution.
Good luck with the process --
Published August, 2008