Bipolar and memory loss

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 and mood?

Memory, attention and concentration can all be disrupted by the same neurotransmitter disturbances that cause mood swings.

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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.

We are not only going to discuss the “what” and the “why” of memory problems in bipolar disorder, but also some techniques that can minimize the problem.

Let’s begin by looking at how the different types of memory are affected by bipolar disorder. . .

Memory types and bipolar disorder

1. Bipolar disorder and the loss of semantic memory:

Semantic memory is a long term memory of facts, definitions of words, and other concepts that make up our general knowledge about the world.

Studies do not show 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.

A national study of over 14,000 bipolar patients found the lifetime prevalence of psychosis in manic and depressive episodes to be 19% and 15%, respectively.

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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.

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3. Procedural memory loss and bipolar disorder:

Procedural memory is all about remembering processes – how to do things. Again, bipolar disorder does not prevent this kind of memory: remembering how to take a shower and get dressed, or how to drive a car.

Of course if there is severe depression, we may not have the energy or motivation for a shower. If manic, we may dress more colorfully or in a more sexually provocative way.

In particular, driving when manic can be reckless and aggressive. All of this relates to the “mood” aspects of bipolar, not the “mind,” meaning 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 experience difficulties with working memory.

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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 prefrontal 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.

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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 (showing 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 methodology. The studies that show long term memory loss are only showing what we already know about problems with working memory.  People did not forget, 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 may even cause relationship problems.

Managing bipolar and memory loss

An excellent resource on this subject (and on living well despite suffering with 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 understand 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 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. Additionally, using index cards can be useful because steps can be rearranged and there is room to add notes. Doctors Brondolo and Amodor recommend 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 our brains already have context for it. If we go through the steps of anticipating what information a task will require, we have some idea in advance and 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 likely be improvement with resolution of the episode).

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.

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4. We can interrupt the bipolar and memory loss cycle by reducing stress.

5. Simple tools like lists and calendars can make a huge difference.  Instead of fighting bipolar and memory loss, accept that 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.