Lithium is the standard treatment for patients with bipolar disorders. One of the side effects of lithium is the cognitive impairment. I want to compare between quetiapine and lithium as a monotherapy in improvement of cognitive performance in people following first episode mania?
Not a professional on the subject, but as a patient, one another statistic:
Quetiapine is a good mood stabilizer for Major Depression (in a medium dose range - along with an SSRI), and does not cause any cognitive impairment.
The sedation wears out after 8 hours of sleep.
As the name would suggest, it actually quiets the mind, in a way - improving cognitive clarity.
Well, it sounds interesting.
Lithium, in contrast to the long upheld beliefs is really pro-cognitive. I have published on that topic. Mechanistically, it promotes hippocampal neurogenesis in rodents, increases BDNF, increases N-acetyl aspartate which is a putative marker of neuronal viability, increases grey matter volume, inhibits glycogen-synthase kinase-3 beta, inhibits pro-apoptotic protein P53 and beta-catenin, induces the anti-apoptotic Bcl-2, boostering cortical cholinergic tone, etc ... Besides, trials of Li in neurodegenerative diseases e.g. amyotrophic lateral sclerosis and Alzheimer's disease (negative for the former but positive for the latter) ... Lack of direct sedation is also contributory. This is a real bonanza in a disease like bipolar mood disorder that takes its toll on cognition with data suggesting more cognitive deficits with more episodes even during euthymia.
Quetiapine, also, mechanistically, might posses pro-cognitive actions. Its metabolite, norquetiapine inhibits NE transporter, which improves vigilance and alertness. It has 5HT1A agonistic activity and 5HT7 antagonistic activities that subserve pro-cognitive actions (amongst others). Atypical antipsychotics, including quetiapine, has been shown to increase BDNF and to confer neuroprotection by promoting neurogenesis in subventricular zone.
But, as Nassir Ghaemi has always advised, lithium is the only disease-modifying drug in psychiatry, I would vote for lithium.
Unfortunately I'm not sure about pro-cognition but hopefully this information might be helpful as well: for the treatment of mania and prophylaxis of inhibiting future mania, lithium is superior to quetiapine. On the other hand, for mixed mania or bipolar depression, quetiapine is superior to lithium. I agree with Ahmed Naguy that Lithium is actually pro-cognitive in the long run.
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