Summary
There is both remarkable challenge and opportunity at the intersection of bipolar depression and cognitive impairment. A pessimistic viewpoint would emphasize that, despite contributing to most of the personal and economic burden of BD, providers have few treatment options to offer their patients. Remarkably, only 3 agents are approved by the FDA for acute bipolar depression and no agents are FDA approved for cognitive enhancement.
An optimistic view would be that research has now identified shared determinants and treatment avenues for biological mechanisms that undergird bipolar depression and cognition, such as chronic inflammation. Work in this area has opened a host of novel pharmacologic and nonpharmacologic treatment possibilities that may simultaneously target these two pernicious aspects of the illness and point to preventive approaches to forestall cognitive decline. Available to clinicians are efficacious interventions that reduce health risks associated with both depression and cognitive impairment, such as physical activity, cognitive behavioral treatment of insomnia, and weight loss intervention. Novel psychotherapeutic treatments may circumvent or compensate for cognitive deficits through technology and could provide more substantial impact on bipolar depression. These opportunities make BD a model condition in which to enhance understanding and develop treatments for co-occurring cognitive impairment and depression.
SummaryThere is both remarkable challenge and opportunity at the intersection of bipolar depression and cognitive impairment. A pessimistic viewpoint would emphasize that, despite contributing to most of the personal and economic burden of BD, providers have few treatment options to offer their patients. Remarkably, only 3 agents are approved by the FDA for acute bipolar depression and no agents are FDA approved for cognitive enhancement.An optimistic view would be that research has now identified shared determinants and treatment avenues for biological mechanisms that undergird bipolar depression and cognition, such as chronic inflammation. Work in this area has opened a host of novel pharmacologic and nonpharmacologic treatment possibilities that may simultaneously target these two pernicious aspects of the illness and point to preventive approaches to forestall cognitive decline. Available to clinicians are efficacious interventions that reduce health risks associated with both depression and cognitive impairment, such as physical activity, cognitive behavioral treatment of insomnia, and weight loss intervention. Novel psychotherapeutic treatments may circumvent or compensate for cognitive deficits through technology and could provide more substantial impact on bipolar depression. These opportunities make BD a model condition in which to enhance understanding and develop treatments for co-occurring cognitive impairment and depression.
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