Bipolar disorder, formerly known as manic depression, is a mental illness characterized by extreme shifts in mood and energy levels. People with bipolar disorder experience distinct episodes of mania (elevated moods and energy) and depression (low moods and energy). These episodes can last for days, weeks, or months at a time. An important question for those living with bipolar disorder is whether they will remember what happens during manic or depressive episodes. In this article, we will explore what the research says about memory and bipolar disorder.
Do People Remember Manic Episodes?
During manic episodes, people often feel euphoric, full of energy, restless, and impulsive. Their thoughts race, they talk rapidly, and they may have reduced inhibitions. Mania is often marked by risky behaviors like overspending, drug use, promiscuity, and other actions that are out of character.
Many people report patchy or incomplete memories of what happened during periods of mania. One study found that 64% of people had moderate to severe memory impairment during manic episodes.1 Another study showed that insight and judgment are impaired in up to 96% of people experiencing mania.2 With impaired judgment and lack of insight, actions are often not thought through, and consequences are not fully considered. This helps explain why risky behaviors are common.
Several factors contribute to spotty memory during manic episodes:
Distractibility
Attention and focus are reduced during mania. People are easily distracted by irrelevant stimuli and have difficulty maintaining attention on tasks. This makes it hard to form solid memories of events and actions.
Lack of Sleep
Mania often causes severe insomnia. Not getting adequate sleep impairs cognitive function and memory formation.
Neurochemistry
The manic brain is flooded with neurotransmitters like dopamine. Elevated dopamine levels are linked to psychosis and can make it hard to distinguish real memories from imagined ones.
Delusions
Mania is sometimes accompanied by delusions – fixed false beliefs like grandiose ideas about oneself. Delusional thinking distorts memories and sense of reality.
Do People Remember Depressive Episodes?
The symptoms of a major depressive episode include persistent sadness, loss of pleasure, changes in appetite and sleep, fatigue, feelings of worthlessness, difficulty concentrating, and thoughts of suicide.
In contrast to mania, most research indicates that episodic memory is largely intact during depression. Several studies have found no significant difference in memory test performance between depressed and non-depressed individuals.3
However, depression does impact certain aspects of cognition and memory:
Ruminative Thinking
Those with depression tend to ruminate – constantly dwelling on negative thoughts and memories. This rumination strengthens the encoding and retrieval of these unhappy memories.
Cognitive Difficulties
Depression makes it harder to concentrate, organize one’s thoughts, and engage in effortful cognitive processing. While memory remains largely stable, these cognitive deficits can make it feel like memory is impaired.
Memory Biases
Depression skews memory towards negative information. Depressed individuals better encode and recall sad memories compared to positive or neutral memories.4
So in summary, factual memory remains relatively intact in depression, but depressed thinking can make memory seem fuzzy.
Why Do Manic Memories Fade While Depressive Memories Persist?
The differences in memory between manic and depressive episodes may stem from differences in the underlying neurobiology.
Mania is associated with elevated levels of dopamine – a neurotransmitter involved in motivation, pleasure, and reward pathways in the brain. Too much dopamine may impair memory formation and lead to psychotic symptoms.
Depression, on the other hand, is linked to low serotonin – a neurotransmitter that regulates mood, sleep, appetite, and cognitive functions like memory and learning. Serotonin helps consolidate emotional memories. Low serotonin levels may explain why people vividly recall sad memories when depressed.
Brain imaging studies also show that different brain regions are affected in mania versus depression:
Mania
- Decreased activity in prefrontal cortex – involved in planning, judgment, insight
- Increased activity in limbic regions – regulates emotion and motivation
Depression
- Decreased activity in hippocampus – involved in memory formation
- Increased activity in amygdala – processes emotional reactions
The limbic hyperactivity of mania may lead to uncontrolled emotion and behavior, impaired insight, and unreliable memory encoding. The hippocampus and amygdala changes seen in depression may strengthen emotional memory despite cognitive difficulties.
Other Factors Influencing Memory of Mood Episodes
In addition to the direct effects of mania and depression, other factors influence whether someone remembers what happened during a bipolar episode:
Medications
Mood stabilizers, antipsychotics, and antidepressants used to treat bipolar can cause memory problems as a side effect. These medications dampen emotions, which may also dull memories.
Concurrent Substance Abuse
Up to 60% of people with bipolar disorder have co-occurring substance abuse issues.5 Drug and alcohol use further impair memory and cognitive function.
Frequency of Episodes
Frequent mood episodes may make it hard to distinguish memories between periods of mania, depression, and normal mood. Long-term bipolar disorder is associated with progressive cognitive decline.
Age of Onset
Earlier onset of bipolar disorder is linked to worsened cognitive deficits over time. Childhood and adolescent onset may disrupt key stages of brain development.
Psychosocial Functioning
The social and occupational impairment resulting from bipolar episodes can compound cognitive difficulties. Loss of structure further hampers memory.
Strategies to Improve Memory During Bipolar Episodes
While memory problems are common during bipolar mood swings, some strategies may help strengthen recall:
Take Notes
Keep a diary or journal during manic and depressive episodes detailing thoughts, feelings, behaviors, and events. Review these written records later for reminder of what happened.
Set Reminders
Use apps, calendars, alarms, and other prompts to provide cues about important activities and appointments during episodes. Rely on checklists to aid functioning.
Talk to Loved Ones
Check in with close friends and family after a bipolar episode ends. Their accounts can fill in gaps in your own memories.
Record Important Conversations
Use a voice recorder or smartphone to capture crucial conversations, agreements, or transactions made during mood episodes. Review the transcripts later as a memory aid.
Practice Mindfulness
Mindfulness meditation training may improve working memory and cognitive flexibility in bipolar disorder.6 Try to be fully present and aware in the moment.
Prioritize Sleep
Aim for regular, sufficient sleep during mood episodes to optimize cognitive function. Maintain consistent sleep/wake cycles.
Stay on Medications
When prescribed, take medications as directed to stabilize mood and minimize episodes. Avoid abrupt medication changes without medical oversight.
Conclusion
In summary, memory impairment during bipolar episodes is common and results from the biological and cognitive changes accompanying mania and depression. Manic episodes are associated with moderate to severe amnesia, while memory remains more intact in depression. Various strategies can help improve recall of events. With proper treatment and management, it is possible to gain control over bipolar disorder and improve functioning, including memory difficulties. Consistent care from a mental health professional is key.
References
- Cahill, C.M., Malhi, G.S. (2007). Does lithium protect against cognitive impairment in bipolar disorder? Bipolar Disord, 9, 931–952.
- Ghaemi, S.N., Rosenquist, K.J., Ko, J.Y., Baldassano, C.F., Kontos, N.J., Baldessarini, R.J. (2004). Antidepressant treatment in bipolar versus unipolar depression. Am J Psychiatry, 161(1), 163-165.
- Burt, D.B., Zembar, M.J., Niederehe, G. (1995). Depression and memory impairment: a meta-analysis of the association, its pattern, and specificity. Psychological bulletin, 117(2), 285.
- Gotlib, I.H., Joormann, J. (2010). Cognition and depression: current status and future directions. Annual review of clinical psychology, 6, 285-312.
- Swann, A.C. (2010). The strong relationship between bipolar and substance-use disorder. Annals of the New York Academy of Sciences, 1187(1), 276-293.
- Stange, J.P., Eisner, L.R., Hölzel, B.K., Peckham, A.D., Dougherty, D.D., Rauch, S.L., Simon, N. (2011). Mindfulness-based cognitive therapy for bipolar disorder: effects on cognitive functioning. Journal of psychiatric practice, 17(6), 410-419.