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Potential drugs for cognitive impairment in Bipolar Disorder. 2023 Review


Senior Member
I found this review interesting as I've already tried some of these meds with some success and many in this list are regularly discussed here on PR, like Aripiprazole, Tetracyclines, Mifepristone, etc!



Cognitive impairment is a core feature of bipolar disorder (BD) that impedes recovery by preventing the return to optimal socio-occupational functioning and reducing quality of life. Presently, there are no efficacious treatments for cognitive impairment in BD, but many pharmacological interventions are being considered as they have the potential to target the underlying pathophysiology of the disorder.

Areas covered​

This review summarizes the available evidence for pharmacological interventions for cognitive impairment in bipolar disorder. We searched PubMed, MedLine, and PsycInfo from inception to December 1st, 2022.

Traditional treatments, such as lithium, anticonvulsants (lamotrigine), antipsychotics (aripiprazole, asenapine, cariprazine, lurasidone, and olanzapine), antidepressants (vortioxetine, fluoxetine, and tianeptine) and psychostimulants (modafinil), and emerging interventions, such as acetylcholinesterase inhibitors (galantamine and donepezil), dopamine agonists (pramipexole), erythropoietin, glucocorticoid receptor antagonists (mifepristone), immune modulators (infliximab, minocycline and doxycycline), ketamine, metabolic agents (insulin, metformin, and liraglutide), probiotic supplements, and Withania somnifera are discussed.

Article highlights​

  • Cognitive impairment is a core feature of bipolar disorder that persists in all illness phases, including euthymic periods

  • Developing treatments for cognitive impairment should be a clinical and public health priority.

  • Several causal factors may play a role, such as brain structural abnormalities, medical comorbidities, genetic predisposition, and neuroprogressive processes

  • Interventions with demonstrated procognitive effects in BD are lithium, lamotrigine, aripiprazole, asenapine, cariprazine, lurasidone, olanzapine, fluoxetine, tianeptine, ketamine, erythropoietin, probiotic supplements, galantamine, donepezil, pramipexole, mifepristone, Withania somnifera, intranasal insulin, metformin, liraglutide, infliximab, and minocycline

  • It is difficult to draw conclusions from the literature due to a lack of high-quality studies

  • Need to investigate the interventions discussed in this review with high-powered, randomized, placebo-controlled trials that control for concomitant medications, patient subgroups, and affective states

  • Future studies should refer to the International Society for Bipolar Disorders (ISBD) Targeting Cognition Task Force methodological guidelines to improve quality, validity, and replicability of BD cognition trials

  • Preliminary evidence from non-pharmacological interventions warrants further research as it is likely a combination of pharmacological and non-pharmacological treatments will be needed to address the full scale of cognitive impairment in BD