From the Guidelines
Memantine is not a recommended treatment for bipolar illness, as the current evidence does not support its use for this condition. The provided studies focus on the effectiveness of memantine in treating dementia and Alzheimer's disease, with no mention of its use in bipolar disorder 1. In fact, the study published in the Annals of Internal Medicine in 2008 discusses the use of memantine in patients with dementia, highlighting its benefits in improving cognition and global assessment, but does not address its potential use in bipolar illness 1.
When considering treatment options for bipolar disorder, standard treatments such as mood stabilizers (lithium, valproate, lamotrigine), atypical antipsychotics, and sometimes antidepressants under careful supervision are recommended 1. The practice parameter for the assessment and treatment of children and adolescents with bipolar disorder, published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2007, emphasizes the importance of traditional mood stabilizers and/or atypical antipsychotic medications as primary treatment, with other psychotropic agents and psychotherapies used as adjunctive therapy or to address comorbid conditions and problems 1.
Key points to consider:
- Memantine is FDA-approved for moderate to severe Alzheimer's disease, but its use in bipolar disorder remains investigational
- Standard treatments for bipolar disorder include mood stabilizers, atypical antipsychotics, and sometimes antidepressants under careful supervision
- Memantine works by blocking NMDA glutamate receptors, which differs from the mechanisms of established bipolar medications
- Any off-label use of memantine for bipolar disorder would need to be carefully considered within the overall treatment plan, weighing potential benefits against limited evidence and possible side effects like dizziness, headache, and confusion.
From the Research
Memantine Use in Bipolar Illness
- Memantine has been studied as a potential treatment for bipolar disorder, with some studies suggesting its effectiveness in managing acute mania and preventing manic/hypomanic and depressive recurrences 2.
- Research has shown that memantine can block the development of supersensitivity and desensitization associated with depressive-like behavior, and has a sustained mood-stabilizing effect in treatment-resistant bipolar disorders 2, 3.
- A 12-month naturalistic trial found that memantine, as an augmenting agent, was associated with a clinically substantial antimanic and sustained mood-stabilizing effect, with excellent safety and tolerability profile 3.
- Memantine has also been proposed as a potential add-on therapy to mood stabilizers, with neuroprotective and neurogenesis effects that may help repair damaged neurons and improve treatment outcomes for bipolar II disorder 4.
Key Findings
- Memantine has been shown to be effective in reducing symptoms of mania and depression in bipolar disorder patients 2, 3.
- The drug has a good safety and tolerability profile, with few and light side effects 5, 3.
- Memantine may have neuroprotective and neurogenesis effects, which could help repair damaged neurons and improve treatment outcomes for bipolar disorder patients 4.
Study Limitations
- Many of the studies on memantine and bipolar disorder are naturalistic or open-label, and require further testing in blinded, randomized, controlled trials 2, 3.
- More research is needed to fully understand the efficacy and safety of memantine as a treatment for bipolar disorder, particularly in comparison to other mood stabilizers and treatments 6.