For some people with bipolar disorder, poor memory and difficulty concentrating can make it hard to function in everyday life, including at work and when studying.
However, this is not true for everyone.
The authors of a 2012 study have pointed out that one of the key features of bipolar disorder is the wide range of potential ability that exists among people with the condition.
Effects on thinking and memory
Bipolar disorder can affect a person's thinking and memory, making it harder to work and study.
Some people with bipolar disorder may find it harder to think, to reason, and to remember things.
Changes in thinking that can occur as people go through the different phases include:
- changes in attention span and focus
- racing thoughts during a high, or manic, phase
- difficulty remembering things
- in some cases, psychosis, including delusions and hallucinations
Studies report that some people with bipolar disorder have complained of memory impairment during high moods, low moods, and at times in between.
As a person's mood shifts, they may report changes in their memory, too. As the mood becomes more extreme, memory problems can increase.
How does mood affect the brain and memory?
Scientists have suggested that some people with bipolar experience memory problems due to changes in the brain.
These could involve changes in:
The prefrontal cortex, which plays a role in planning, attention, problem-solving, and memory, among other functions. (https://www.nature.com/subjects/prefrontal-cortex)
The hippocampus, which plays an essential role in storing memories.
The anterior cingulate cortex, which has links to both emotional and cognitive functions in the brain.
Imaging tests have shown that as a person's mood shifts, variations in the way that blood flows into corresponding areas of the brain also occur.
Some people with bipolar disorder may find they face challenges with different kinds of memory function.
Here are some types of memory where problems might occur:
Working memory: This stores information for a short time while a person carries out a mental task.
Verbal learning and memory: This enables us to remember the words we see or hear.
Executive functioning: Is vital for planning and prioritizing tasks.
Declarative memory: Is necessary for recalling and explaining past events.
Spatial working memory: Enables people to recall shapes, colors, locations, and movements.
What does the research say?
A 2017 systematic review found that people may experience changes in the working memory processes of update and recall, both during and between bipolar episodes. This can make it hard for people to function in work or study.
A study published in 2007 found that some people who experience psychosis in bipolar disorder may have difficulty with executive functioning. This can affect their ability to plan or carry out tasks.
Other researchers have described impairment in executive functioning as a "core dysfunction" that some people may experience when they are between high and low phases.
People with bipolar disorder who experience psychosis are more likely to experience problems with verbal-declarative memory and spatial working memory, compared with those who do not have psychosis. This can make it hard to recall and retell events and stories from the past.
Treatment and memory
The changes that occur with bipolar disorder may affect a person's memory, but some of the treatments for the condition can also have an impact.
Some medications can affect memory, but people should not stop using them without first speaking to a doctor.
Lithium is an important treatment for bipolar disorder. It can help to control moods, but it can also have adverse effects.
Some reports suggest that lithium can affect thinking and memory.
Newer drugs, such as lamotrigine, carbamazepine, valproate, topiramate, and zonisamide, may also impact a person's cognitive ability. Research suggests that, of these drugs, lamotrigine may have less of a negative impact.
However, more studies are needed to confirm how these drugs affect thinking and memory.
If a person finds that a drug is affecting their memory, it is essential to speak to a doctor before stopping the treatment. they may be able to offer another option.
If a person has severe symptoms that do not respond to other treatments, a doctor may recommend electroconvulsive therapy (ECT).
Research published in 2017 suggests that ECT is safe and effective for people with severe bipolar symptoms in any phase of the condition.
Out of 522 people with bipolar disorder who had not responded to other forms of treatment, two-thirds had a positive response to ECT, including almost 81 percent of those with catatonic depression.
However, one possible side effect of this treatment is memory loss.
Scientists have raised concerns about the impact on:
- remembering things that happened before the treatment
- forming new memories after the treatment
- remembering personal facts and events
- verbal and working memory
These impairments continued to affect people when they were between high and low moods.
More research is needed to find out exactly how ECT affects a person's memory. However, for people who experience severe bipolar disorder, the benefits of this treatment may still outweigh the risks.
Living with cognitive challenges
Post-it notes or a smartphone can help people keep track of appointments and other tasks.
Not everyone with bipolar disorder will experience problems with memory, but some people do. Early diagnosis and good medical management may help to minimize these effects in those who are at risk.
If a person is having difficulty with short-term memory, the following tips may help.
- Record all appointments and contacts on a smartphone.
- Keep a book to record things you want to remember, for example, a record of spending.
- Make a to-do list each week or keep a wall calendar with space to write on.
- Stick post-it notes with reminders by the front door or other strategic places.
- Keep a chalk board, for example, in the kitchen, to write reminders on.
- Have a special place to keep important things like keys, glasses, and wallet.
- As far as possible, establish a routine, including regular bedtimes and mealtimes. This will also help to maintain healthful sleeping and eating habits.
Knowing what effects bipolar disorder can have on a person's ability to think and remember, and understanding that mood changes are not the only feature of the disorder, may make it easier for individuals and their families to manage the many challenges that bipolar disorder presents.
Overview: Bipolar disorder
A person who receives a diagnosis of bipolar disorder will have the condition for the rest of their life. However, they may not always experience mood alterations or show obvious symptoms. Symptoms often emerge sometime between the teenage years and the 30s.
The mood cycles and symptoms vary between individuals. One person may have more depressive symptoms, while another has mainly manic episodes.
A manic episode can involve the following:
- a high sense of self-esteem or the belief that the person is very important
- difficulty sleeping
- talking more than usual, with a rapid flow of speech that jumps suddenly between topics
- racing thoughts
- being easily distracted
- moving quickly from one focus of attention to another
- risk-taking behaviors, such as reckless driving or shopping sprees
During a low mood, the person may:
- lose interest in activities
- have no pleasure in things they usually enjoy
- be unable to focus
- sleep more or less than usual
- believe something terrible is going to happen or has happened
- talk about, think about, or attempt suicide
Some people may become completely inactive, or catatonic. If a person speaks about or attempts suicide, or if they become unable to move or react, someone should seek urgent medical help for the person.
- If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Call 911 or the local emergency number.
- Stay with the person until professional help arrives.
- Remove any weapons, medications, or other potentially harmful objects.
- Listen to the person without judgment.
- If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.
In either phase, a person may experience psychosis, involving delusions, hallucinations, or both. They may see, hear, or smell things that do not exist or believe that something is true when there is no evidence that it is.
The causes of bipolar disorder remain unclear, but genetic, biochemical, and environmental factors probably play a role. Stress may trigger an episode, and using alcohol or other substances can make the symptoms and the impact of the condition worse.
Click here to find out more about possible links between alcohol and bipolar disorder.
Some people with bipolar disorder experience impairments in memory and thinking, although this is not true for everyone.
Memory problems may be more likely to develop if the person's symptoms are severe, or if they experience many manic episodes, psychosis, or both.
Anyone who shows signs of bipolar disorder should seek medical help.
Treatment, including medication and counseling, can help a person to overcome the challenges of this condition.