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.1
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
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.2
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.3
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.