new bipolar medicationIt is well known that some people with bipolar disorder experience a variety of neuro-cognitive deficits (problems in areas such as attention, learning, and memory) in addition to their emotional and behavioral symptoms.

Because many of the medications used to treat bipolar disorder can cause cognitive problems as a side effect, psychiatrists have often debated whether these problems with learning and thinking are due to medications or are related to the underlying brain changes found in bipolar disorder. It seems likely that both factors are at play.

Some ongoing studies are looking at a medication called galantamine (Razadyne is the trade name), which is FDA approved for treating the cognitive deficits in Alzheimer’s disease. An open label study published in 2009 in the journal CNS Neuroscience Therapeutics suggested that this medication could in fact improve function in areas of attention and specific memory tasks, and the researchers reported positive changes on brain scans:

RESULTS: Compared to healthy volunteers, bipolar subjects had higher baseline subjective cognitive deficits and lower scores on objective tests of attention (Conner’s CPT) and verbal episodic memory (CVLT). After treatment, bipolar subjects experienced significant improvement of subjective cognitive scores and on objective tests of attention (Conner’s CPT) and verbal episodic memory (CVLT). In the left hippocampus NAA increased and choline (Cho) decreased in bipolar subjects during treatment.

NIMH is recruiting subjects now for a more rigorous study of this medication in people with bipolar disorder. See “Efficacy and Safety of Galantamine for Improving Dysfunction in People with Bipolar Disorder.”

The current findings are preliminary and do not suggest that we should start routinely using this medication in people with bipolar disorder. We have some concerns – one being that people diagnosed with bipolar disorder already take many medications – adding another one that has not been well tested yet could make things worse instead of better.

Also, the improvements in cognitive function overall in medications for Alzheimer’s are not thought to be robust, so we need to see that this medicine results in clinically significant improvements before we use it in our patients. Scientific significance isn’t always the same as clinically significance; a change in a lab result doesn’t always translate into meaningful changes in real life.

At this point, the research is something to follow but not necessarily act on. We need further studies that show stronger evidence that galantamine would be valuable tool for people with bipolar.

Photo by Lucy Reynell, available under a Creative Commons attribution, non-commercial license.