Bipolar and memory loss can be a real problem! And to make matters worse, sometimes the cognitive symptoms of bipolar such as memory loss, lack of focus, and fuzzy thinking are made worse by medication, adding insult to injury.

So why does bipolar disorder create problems with thinking as well as mood?
Memory, attention and concentration can all be disrupted by the same neurotransmitter disturbances that cause mood swings.
This undermines our ability to study, to work, and even interferes with personal relationships.However, the better these problems are understood, the easier they are to deal with.
As well as discussing the what and the why of memory problems in bipolar disorder, we are going to discuss some techniques that can minimize the problem.
Let’s begin by looking at how the different types of memory are affected by bipolar . . .

Memory types and bipolar disorder

Reminder

Many people with bipolar disorder are extremely bright, so memory or other thinking problems can be extremely frustrating and confusing.

1. Bipolar disorder and the loss of semantic memory: Semantic memory is long term memory for facts, definitions of words, and other concepts that make up our general knowledge about the world.
Studies do not indicate a link between bipolar disorder and loss of semantic memory. For example, even during a profound episode of mania or depression, we are likely to remember that London is in England, that ducklings grow up to be ducks, and that a dictionary contains definitions for words.
2. Loss of sensory memory and bipolar: Sensory memory is the retention of stimulus received through our senses of sight, hearing, smell, taste and touch. Sensory perception is sometimes disturbed during bipolar disorder, for example the hallucinations experienced in bipolar psychosis.
However, this is not the same as a loss of sensory memory. Research in this area is lacking, but it seems that bipolar disorder does not interfere with how we remember the smell of roses, the color of the sky, or the softness (or crispness) of our favorite sheets.
3. Procedural memory loss and bipolar disorder: Procedural memory is all about remembering processes – how to do things. Again, bipolar disorder does not prevent us from remembering how to take a shower and get dressed again, or how to drive a car. (Of course if depressed, we may not have the energy and motivation for a shower. If manic, we may dress more colorfully and in a more sexually provocative way. And driving when manic can be reckless and aggressive. All of this relates to the “mood” aspects of bipolar, not the “mind” of cognitive processing and memory.)
4. Problems with working memory in bipolar disorder: Most of the memory and bipolar research has involved working memory. This research has shown that people with bipolar disorder do experience difficulties with working memory. Working memory is the short term storage of information while we are actually using it to perform a task. In a delightful definition, the “current contents of consciousness”. A popular theory is that people with bipolar disorder experience signalling problems in the prefontal cortex of the brain, which then does not communicate properly with the amygdala, leading to the mood swings, and disrupting executive functioning and information processing.
5. Long term memory loss and bipolar: There is conflicting evidence about whether or not bipolar disorder impairs long term memory. The theory I like about why the evidence conflicts comes from Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition, by Dr Fred Goodwin and Dr Kay Jamison.
They suggest that there may not be deficits in long term memory and that the reason the studies
conflict relates to problems with research methods. The studies that show long term memory loss are really only showing what we already know about problems with working memory – people did not forget. Rather, they
were never able to acquire the information in the first place.
How should we address the challenges caused by bipolar and memory loss?

As stated above, bipolar and memory loss makes it hard for us to study, work, and even causes relationship problems.

Managing bipolar and memory loss

An excellent resource on this subject (and on living well despite bipolar in other areas of life) is Break the Bipolar Cycle: A Day-by-Day Guide to Living with Bipolar Disorder by Dr Elizabeth Brondolo and Dr Xavier Amador. (Available from Amazon for around $12.)
For example, this book explained to me why my telephone phobia is related to my bipolar disorder and information processing problems.
I HATE to talk on the phone and this causes problems with friends which I feel guilty, ashamed and embarrassed about.
But no more!
Now I know I have an intuitive reluctance to use the phone because I may come across as dazed and stupid. This happens if stress cuts off my ability to think or if new and information comes up. My responses are slow and labored as I may miss a few beats while I put things in context.
So what can we do about bipolar and memory loss?
We can structure tasks to make them easier.
1. Take the time to analyze tasks and break them down into small steps. Although this takes time and effort we may feel we just don’t have, it will make life easier in the long run. The idea is to structure things into smaller pieces that put less strain on working memory. Do this in writing. Using index cards can be useful because steps can be rearranges and there is room to add notes. Doctors Brondolo and Amodor advise to keep breaking things down until each step is no bigger than a 4 if you imagine a rating scale of 1-10 in difficulty.
2. Plan! It is much easier to store and retrieve information if it our brains already have a context for it. If we go through the steps of anticipating what information a task will require, we have some ideas in advance are less likely to get stressed or overwhelmed.
THE GOOD NEWS ABOUT BIPOLAR AND MEMORY LOSS is that:
1. For some people the problem is very mild. Not everyone experiences the same amount of difficulty.
2. Bipolar and memory loss is largely episodic. When episodes of mania and depression abate, so will symptoms like memory loss and other cognitive difficulties. (Some research shows residual effects but still there will be improvement.) We can reduce the number of episodes we experience and increase the time between relapses. Therefore we can also reduce memory loss.
3. Lithium has been shown to increase gray matter in the brain and improve cognitive functioning.
4. We can interrupt the bipolar and memory loss cycle by reducing stress.
5. Simple tools like lists and calendars can make huge differences. Instead of fighting bipolar and memory loss, accept it may be a problem and plan accordingly.
Memory loss is just one problem – overall impaired cognition is also an important factor in bipolar disorder.

Bipolar disorder is a serious mental illness. The condition tends often involves sudden episodes of illness separated by remissions. The symptomatic phases involve mania or depression.
It can also affect the ability to think, including memory. Whether this is due to treatment or the condition itself remains unclear.

Contents of this article:

1. What is bipolar disorder?
2. Bipolar disorder: Effects on ability to think
3. Living with cognitive problems

What is bipolar disorder?

Bipolar may involve sudden episodes of mania or depression.

Bipolar disorders generally last for life. They tend to emerge sometime between the teenage years and the 30s.
The condition involves depression and mania. These tend to alternate in cycles. The cycles and symptoms vary. One person may have more depressive symptoms, while another has mainly manic episodes.

What are manic episodes?

For an episode of mania to be diagnosed, it needs to last for at least a week, or shorter if the patient is hospitalized and treated. It involves a high or irritable mood and an increase in goal-directed activity.
There must also be three or more other symptoms from among the following:

• High self-esteem or grandiose feelings
• Less sleep
• Talking far more than usual, with a rapid flow of speech
• Racing thoughts
• Being easily distracted and regularly moving from one focus of attention to another
• Risk-taking behaviors such as going on shopping sprees

The mania can also be psychotic, meaning that patients can have delusional ideas and sometimes hallucinations. They may see, hear, or smell things that do not exist.
Hypomania involves the same symptoms but in a milder form. It lasts for a shorter time.

What are depressive episodes?

When someone with bipolar disorder is depressed, the depression takes on a severe form that resembles major or clinical depression.
The person is likely to experience a range of depressive symptoms, including very low mood for most of the day, loss of interest in activities, and a loss of pleasure. The depressive episode must last for at least two weeks.

Causes and risk factors

It is not known what causes bipolar disorder exactly, but a number of factors are thought to play a role. These include genetic, biochemical, and external influences.
There is a strong pattern of heredity, suggesting a genetic element that runs in families.
A brain chemical disorder may be involved, and possible environmental triggers, such as stress. Drug use, including alcohol, may make the condition worse.

Bipolar disorder: Effects on ability to think

Cognitive ability refers to a person's ability to think and reason. Research shows that people with bipolar disorder face some cognitive challenges.
Examples include difficulties with:

• Working memory
• Verbal learning and memory
• Recall and recognition

Working memory is a type of short-term memory that allows us to store information for a short time while carrying out a mental task. It helps with learning.
It is used, for example, in mental arithmetic. It plays a role in processing different types of information, including audio, visual, and spatial data. It is important for concentration.
Short-term memory problems affect daily functioning. They can be subtle, and they may affect a person's ability to take in new information that is needed to complete complex tasks.
They may also make it harder to fit in socially.
While bipolar disorder is widely understood in terms of mania and depression, its effects on thought may have more impact on daily life, and especially working life.
Poor memory and difficulty concentrating can make it hard for a person with bipolar disorder to work and learn. These problems can persist between bipolar episodes.

How does electroconvulsive therapy affect memory?

ECT may be used to treat bipolar but some studies suggest it may have negative side effects.

Some people have electroconvulsive therapy (ECT) as a treatment for bipolar disorder. This treatment may lead to memory loss.
ECT may be used in cases of severe depression that does not respond to other treatment and to treat mania.
During ECT, an electric current is passed through the brain. This causes a seizure, or epileptic fit.
In the past, scientists have found that ECT may help people with epilepsy and depression to feel less depressed. The reason for this remains unclear.
ECT is given over several weeks. Individuals vary in the number of treatments that they will require in order to feel better.
Some evidence has linked ECT to memory problems.
Some people have reported memory loss for a short time immediately before and after the treatment. Some say that their long-term memory is affected.
The more a person undergoes ECT, the more likely it seems that they will have memory problems. It is not clear whether the problems are related to ECT, another treatment, or bipolar disorder itself.

Possible effects of lithium on memory

Lithium is a well-established medication for treating bipolar disorder. It has adverse effects, but the benefits usually far outweigh the risks.
Some reports suggest that lithium can affect thinking and memory.
It appears to have a subtle effect on verbal memory, making it harder to recall and use words. This could affect a person's ability to retell stories.
Conversely, lithium appears to protect against the memory disorder, Alzheimer's disease. 

Living with cognitive problems

Some research has suggested that people who have more episodes of illness are likely to have more cognitive problems than others.
Early diagnosis and good medical management of bipolar disorder may help to minimize the effects on memory and thinking.
However, most treatments focus on stabilizing mood rather than cognitive issues. This means that some people whose mood swings are treated may still have some problems with thinking.
Understanding the effect that the disorder has on thinking, and realizing that bipolar disorder is not only about mood swings, may make it easier for patients and their families to cope with the challenges.