Galantamine treatment of cognitive impairment in bipolar disorder: four cases

Objective:  To determine if galantamine is effective in the treatment of chronic cognitive impairment in bipolar disorder. Methods:  All charts of patients meeting DSM‐IV criteria for bipolar disorder treated with galantamine in an academic bipolar disorder specialty clinic psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impression scale for Improvement. Results:  Galantamine was effective in two of four patients, both of whom took at least 24 mg/day. It was ineffective in two patients who only took 8 mg/day. Sedation limited higher dosing in one patient, and a second patient experienced sedation and tremor. Improvement in cognition was not associated with improvement in mood. Galantamine appeared neutral in its effect on mood. Conclusions:  This pilot case series suggests that galantamine may have some utility in improving chronic cognitive impairment in bipolar disorder. Larger studies are required to clarify these initial pilot data.