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Re: any namenda/memantine experiences?

Posted by g_g_g_unit on March 11, 2012, at 3:10:15

In reply to Re: any namenda/memantine experiences?, posted by Tomatheus on March 10, 2012, at 14:55:48

Here's the study I was thinking of .. My only hesitation is that I'm aware that there seems to be a stimulant-effect at lower doses which might account for a rapid improvement in cognition. I noticed something similar during my week spent at 5mg. However, the girl in the first case study did continue to experience gains over a month ..

Dear Editor,

Bipolar patients can often show cognitive deficits, which are sometimes not associated with acute affective episodes.1 In the most severe cases, cognitive deficits are disabling and may interfere with treatment adherence.

Cholinesterase inhibitors are used in patients with Alzheimer Disease in order to delay cognitive impairment. Donepezil was reported as a useful add-on medication in treatment-resistant bipolar patients in a case series report.2 However, there have also been reports of mania, induced by donepezil and galantamine.3-4

Memantine is an effective drug for the treatment of moderate-to-severe cognitive impairment related to Alzheimer Disease.5 We are reporting two cases of treatment-resistant bipolar disorder patients who showed substantial cognitive and mood symptom improvements.

Case 1 (Table 1): a 29-year-old female fashion stylist with bipolar disorder type II and bulimia nervosa, who used to read and had been able to write short stories, was suffering from severe depression over the last 2 years, having spent most of her time in bed. She was unable to read a newspaper or to write a single letter. Lamotrigine and lithium were useful for 2 years, but they lost their efficacy. Other mood stabilizers (divalproex, carbamazepine, oxcarbazepine) were tried with no success. She did not tolerate some atypical antipsychotics, such as aripiprazol, olanzapine, quetiapine, risperidone and ziprasidone, due to severe tachycardia or reported lack of effect of these medications. In August 2005 she received memantine as an add-on treatment up to 20 mg/day. During the first week following treatment with memantine, she could go to the computer and wrote a short story, spending most of the time out of bed. After one month's treatment, she showed a moderate improvement in psychomotricity and depressive mood, along with cognitive gains.

Case 2 (Table 2): a 32-year-old male judge (retired), with bipolar disorder type I, who had recently suffered from treatment-resistant mixed states, mostly with depressive symptoms. He reported mental incapacity, difficulty in concentrating and in performing abstract reasoning. He also reported hypomanic episodes characterized by compulsive shopping, binge eating and lack of insight. Previous unsuccessful treatments had included divalproex, oxcarbazepine, olanzapine, ziprasidone and haloperidol. The introduction of memantine up to 10 mg/day, in November 2005, promoted a rapid improvement in depressive symptoms, concentration and performance of tasks that were hitherto considered impossible, such as reading. Despite the maintenance of impulsivity, his insight into the compulsive shopping behavior and binge eating improved.




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