From the Guidelines
Treating cognitive symptoms of bipolar disorder requires a comprehensive approach that prioritizes medication, therapy, and lifestyle modifications to improve morbidity, mortality, and quality of life. The most recent and highest quality study, 1, published in 2022, emphasizes the importance of psychosocial treatments, such as family psychoeducation plus skill building, in conjunction with pharmacotherapy to improve mood symptom severity and psychosocial functioning. Key treatment strategies include:
- First-line medications: mood stabilizers like lithium, valproate, or lamotrigine to stabilize mood and indirectly improve cognitive function
- Atypical antipsychotics: quetiapine or lurasidone to help with cognitive symptoms
- Cognitive remediation therapy: structured exercises to improve attention, memory, and executive function
- Lifestyle modifications: regular physical exercise, adequate sleep, and stress management techniques like mindfulness meditation to reduce inflammation, promote neuroplasticity, and protect against neuronal damage. As noted in 1, traditional mood stabilizers and atypical antipsychotic medications are primary treatments, with other psychotropic agents and psychotherapies used as adjunctive therapy to address comorbid conditions and problems. However, the most recent study 1 takes precedence, highlighting the significance of psychosocial treatments in managing cognitive symptoms of bipolar disorder.
From the Research
Treating Cognitive Symptoms of Bipolar Disorder
- Cognitive deficits in bipolar disorder involve attention, executive function, and verbal memory, and are evident across all phases of the disorder 2.
- Differentiating medication- from illness-induced cognitive dysfunction requires comprehensive assessment with an appreciation for the cognitive domains most affected by specific medications 2.
- No current pharmacotherapies substantially improve cognition in bipolar disorder, although preliminary findings suggest some potential value for adjunctive stimulants such as modafinil and novel experimental agents 2.
- Cognitive Behavioral Therapy (CBT) is recommended as an evidence-based adjuvant therapy in all stages of bipolar disorder except acute mania 3.
- A systematic review of randomized controlled trials found that currently, no intervention (i.e., pharmacologic, neurostimulation, cognitive remediation) has demonstrated robust and independent pro-cognitive effects in adults with bipolar disorder 4.
Pharmacological Interventions
- Mood stabilizers, such as lithium, valproate, and lamotrigine, are commonly used to treat bipolar disorder, but their effects on cognitive symptoms are not well established 5.
- Antipsychotic agents, such as quetiapine, aripiprazole, asenapine, lurasidone, and cariprazine, are recommended for treating bipolar disorder, but some are associated with weight gain and other side effects 5.
- Antidepressants are not recommended as monotherapy for treating bipolar disorder, and their use may be associated with increased risk of manic episodes 5.
Non-Pharmacological Interventions
- Cognitive Behavioral Therapy (CBT) has been shown to be effective in reducing symptoms of bipolar disorder and improving cognitive function 3.
- Cognitive remediation and neurostimulation therapies are being studied as potential treatments for cognitive impairment in bipolar disorder, but more research is needed to establish their efficacy 4.
- Psychoeducational tools and screening instruments can be used to assess and track cognitive problems in individuals with bipolar disorder, and to inform treatment decisions 6.