title: Pharmacological approaches in bipolar disorders and the impact on cognition: a critical overview.
abstract: OBJECTIVE
  Historically, pharmacological treatments for bipolar disorders (BD) have been associated with neurocognitive side-effects. We reviewed studies which assessed the impact of several psychopharmacological drugs on the neurocognitive function of BD patients.
  
  
  METHODS
  The PubMed database was searched for studies published between January 1980 and February 2011, using the following terms: bipolar, bipolar disorder, mania, manic episode, or bipolar depression, cross-referenced with cognitive, neurocognitive, or neuropsychological, cross-referenced with treatment.
  
  
  RESULTS
  Despite methodological flaws in the older studies and insufficient research concerning the newer agents, some consistent findings emerged from the review; lithium appears to have definite, yet subtle, negative effects on psychomotor speed and verbal memory. Among the newer anticonvulsants, lamotrigine appears to have a better cognitive profile than carbamazepine, valproate, topiramate, and zonisamide. More long-term studies are needed to better understand the impact of atypical antipsychotics on BD patients' neurocognitive functioning, both in monotherapy and in association with other drugs. Other agents, like antidepressants and cognitive enhancers, have not been adequately studied in BD so far.
  
  
  CONCLUSIONS
  Pharmacotherapies for BD should be chosen to minimize neurocognitive side-effects, which may already be compromised by the disease process itself. Neurocognitive evaluation should be considered in BD patients to better evaluate treatment impact on neurocognition. A comprehensive neuropsychological evaluation also addressing potential variables and key aspects such as more severe cognitive deficits, comorbidities, differential diagnosis, and evaluation of multiple cognitive domains in longitudinal follow-up studies are warranted.
authors.affiliation: Bipolar Disorder Research Program, Faculty of Medicine, Hospital Santa Maria, University of Lisbon (FMUL), Lisbon, Portugal. v.dias@campus.ul.pt
authors.forename: V V
authors.initials: VV
authors.lastname: Dias
authors.forename: V
authors.initials: V
authors.lastname: Balanzá-Martinez
authors.forename: M G
authors.initials: MG
authors.lastname: Soeiro-de-Souza
authors.forename: R A
authors.initials: RA
authors.lastname: Moreno
authors.forename: M L
authors.initials: ML
authors.lastname: Figueira
authors.forename: R
authors.initials: R
authors.lastname: Machado-Vieira
authors.forename: E
authors.initials: E
authors.lastname: Vieta
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D003071:Cognition / Q000187:drug effects*; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008568:Memory / Q000187:drug effects
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium