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Lithium and cognition in those with bipolar disorder

Paterson, Amelia; Parker, Gordon

International Clinical Psychopharmacology: March 2017 - Volume 32 - Issue 2 - p 57–62
doi: 10.1097/YIC.0000000000000152
Review Articles

Although a percentage of patients report cognitive side-effects when taking lithium, it can be difficult to determine from the literature whether any cognitive changes reflect lithium itself, the lithium serum level, residual mood symptoms, the underlying nature of bipolar disorder, or biological alterations such as hypothyroidism. This review was carried out to synthesize and evaluate relevant literature examining any cognitive impact of lithium in those with bipolar disorder. The effect of lithium in those with bipolar disorder was examined across the cognitive domains of attention, psychomotor speed, processing speed, working memory, intellectual functioning, verbal memory, visual memory, and executive functioning by reviewing the published empirical literature. Any impact of hypothyroidism and lithium toxicity was also examined. The literature supports the conclusion that lithium has a distinct impact on psychomotor speed in participants with bipolar disorder. In contrast, there appears to be no impact on attention. Any impact of lithium on memory in patients with bipolar disorder is unclear as the literature is contradictory and any such effect may be overshadowed by the greater impact of residual mood symptoms. The impact on processing speed, intellectual abilities, and executive functioning also remains unclear. Several clinical management strategies are recommended.

aSchool of Psychiatry, University of New South Wales

bBlack Dog Institute, Sydney, New South Wales, Australia

Correspondence to Amelia Paterson, BPsych(Hons), MClinNeuropsych, Black Dog Institute, Hospital Road, Randwick, 2031 NSW, Australia Tel: +61 42238519; e-mail:

Received June 17, 2016

Accepted September 14, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.