The Cognitive Burden of Bipolar Disorder: A Case Report of A Patient Managed Successfully using Endoxifen
Abstract
Bipolar disorder carries a substantial long-term risk, and can lead to cognitive impairment. This can have farreaching impacts on both social and professional realms of life, thus contributing to increased disability. This case report describes a patient with bipolar disorder who was treated with lithium and suffered worsening cognition. Switching to endoxifen led to an alleviation of symptoms and restoration of cognitive function. It also enabled the discontinuation of lithium therapy within 4 weeks of initiating endoxifen. The case highlights the potential of endoxifen to be used as a primary mood stabilizer in patients with bipolar disorder in the presence of cognitive function.
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Introduction
Bipolar disorder is known to be a severe and debilitating condition, that affects 2.4% of people worldwide. The long-term psychological risk of bipolar disorder is substantial. Cognitive impairment is known to occur during mood states as well as during euthymia and leads to functional impairment.1 Furthermore, it has been suggested that cognitive impairment is a marker of bipolar disorder at onset, and is detectable in the early years of bipolar disorder.2 Apart from the direct impact of bipolar disorder on cognition, medications used for the management of bipolar disorder can also impact cognition. Lithium is one such mood stabilizer that is known to negatively impact cognition in the short term and in the long term.1
We present a case of a patient with bipolar disorder on treatment with lithium carbonate, who reported worsening cognition. Switching from lithium carbonate to endoxifen restored cognitive function, making endoxifen a useful option in the management of bipolar disorder.
Conclusion
Neurocognitive difficulties in bipolar disorder are known to occur with lithium treatment. In this case, neurocognitive difficulties due to lithium therapy impacted the patient’s ability to run his business as well as his profession. Treating the patient with endoxifen led to improvement in the patient’s neurocognitive dysfunction, and improvement of manic symptoms. This case also described an additional benefit of endoxifen including increased work productivity and reduced absenteeism, better decision-making, and reduction of caregiver burden. Furthermore, the side effects noted with lithium (hypothyroidism) were not noted with endoxifen. Overall, the benefits of endoxifen indicate that it is a an ideal choice for the management of bipolar disorder.