Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice

Qualitative analysis of the literature on cognitive side-effects of lithium in patients with a bipolar disorder identified four of 17 studies that ful filled criteria of adequate methodological quality. Analysis of these four studies showed that lithium had a negative effect on memory and speed of in formation processing, often without subjective complaints or awareness of m ental slowness. The consequences of these findings for daily practice are d iscussed, in particular with respect to driving performance. When neurocogn itive complaints or deficits are present, lithium plasma level, thyroid fun ctions and degree of mood disturbance should be assessed. In cases where al l these parameters are within normal limits and neurocognitive complaints s till persist, dose reduction of lithium, thyroid hormone addition, prescrip tion of a slow release preparation or replacement of lithium by another moo dstabiliser should be considered. Guidelines are suggested with respect to further neuropsychological screening. Int Clin Psychopharmacol 14:167-171 ( C) 1999 Lippincott Williams & Wilkins.