Cognitive Recovery from Mania

Cognitive recovery from mania or depression seems to lack behind the improvement in mood symptoms. In our experience full cognitive recovery may take up to three months after the mood symptoms have remitted. One way of thinking about this is that an episode of mania, or depression, upsets the normal function of the brain and it takes a while for that normal function to recover.

One thing that seems to predict slower recovery is the presence of what are called “subthreshold” symptoms. Someone who no longer qualifies for hypomania or mania but has some persistent symptoms of mania, or who no longer meets criteria for major depression but still has some mild depressive symptoms, is likely to take longer to recover for cognitive function.

An illustration of this is to be seen in these two neurocognitive tests done on a patient who had an episode of mania in August that mostly resolved in September and was followed by a minor dip into depression in October.

In November, he did not have significant depressive or manic symptoms but he complained of “medication side effects” which had him worried about whether he should be tapering his medications. Compounding this, his employer was increasingly insistent about having him return to work now that his “symptoms” were resolved.

As you can see in the picture below his cognitive function was significantly impaired in November, given that he had been a high performing software engineer before he developed the mania in August.

November CNS VS

His brain had significant slowing (reaction time) and trouble handling any complex task. Based on these results we were able to make a strong case that he needed more time to recover.

Two months later, in January, he finally had nearly full cognitive recovery.

January CNS VS

You can still see a slight slowing in reaction time and processing speed but he was now ready to resume work.

Julie Fast wrote about this recently in Bipolar Hope:

My friend Dr. Jay Carter, author of The Complete Idiot’s Guide to Bipolar Disorder, told me, “Mania seems to cause significant brain dysfunction, which can take six to eight weeks to resynchronize—the same amount of time a bone takes to heal after it has been broken.” And yet, how often are we expected to just get right back to being the partner, parent, friend, and coworker we were before, as though nothing has happened?

Society expects so much from us. I still expect way too much of myself. But if I don’t take the time I need to heal, my bipolar may go away—but it doesn’t go far, and not for long.

True healing is not just about getting rid of mood swings; it’s about letting the brain and body get back on track over time.

Mood swings whittle away at my cognitive functioning, work ability, relationship availability, and even my immune system. YES, I know the feeling of “I have to get back to work or I will lose my job!”—but I’ve also lost work because I tried to go back too soon. I wish we could come out of mood swings quickly and immediately pick up our lives, but we rarely do. No matter what your age, physical health, or even how much support you have, everyone needs time to get well.


Volkert J, Schiele MA, Kazmaier J, Glaser F, Zierhut KC, Kopf J, Kittel-Schneider S, Reif A. Cognitive deficits in bipolar disorder: from acute episode to remission. Eur Arch Psychiatry Clin Neurosci. 2016 Apr;266(3):225-37.  doi: 10.1007/s00406-015-0657-2. Epub 2015 Nov 26. PubMed PMID: 26611783.

The Bipolar Disorder Marathon. BP Hope. Julie Fast.