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Bipolar Disorder Presents Abnormalities in the Brain Over Time

Mar 7, 2023 | Blog, Bipolar

Bipolar disorder is a disorder that presents periods of depression or mania. A study made in the prestigious journal, Biological Psychiatry, has found that changes in the brain’s structures and functions may accompany it.

Small cross-sectional brain imaging studies of people with bipolar disorder have hinted at changes in the brain. However, this method is limited to analyzing data from one point in time.

The study has shown changes in the brain of people with bipolar disorder, involving a large international multi-center team of over 70 researchers from the ENIGMA Bipolar Disorder Working Group.

John Krystal, MD, Editor of Biological Psychiatry, has noted the ENIGMA Bipolar Disorder Working Group report shows the power of collaborative research, involving many centers worldwide. Though cross-sectional surveys of the brain are challenging to create, the study used 14 distinct data points to examine how manic episodes impact neurotoxicity, especially in bipolar sufferers.

The study has shown MRI imaging and clinical information from 307 people with bipolar disorder and 925 people without the condition. These two control groups can offer vital information about differences in the cerebellum. They looked at data from two different points in time to evaluate the participants.

The most striking finding was that the cortex, the brain’s outermost layer, thinned over time to a greater extent in people who experienced more manic episodes. The changes were most clear in the prefrontal cortex, an area that’s associated with executive control and emotional regulation.

Senior author Mikael Landén, MD, Ph.D., Professor and Chief Physician at the Institute of Neuroscience and Physiology, University of Gothenburg, Sweden, stated that a thinner cortex can be observed in patients with manic episodes and stresses. 

Compared to those with healthy controls, people with bipolar disorder experienced a faster enlargement of brain cavities. In areas outside the prefrontal cortex, participants with bipolar disorder showed slower thinning than those without.

Lead author Christoph Abé, Ph.D., Assistant Professor, Karolinska Institutet, Sweden, said: “The abnormal ventricle enlargements and importantly the associations between cortical thinning and manic symptoms show that bipolar disorder may in fact be a neuro progressive disorder, which could explain the worsening of bipolar symptoms in some patients.” 

One potential explanation for why bipolar disorder patients may have more resistance to thinning of the cortex compared to healthy controls is that lithium, a medication used to treat the disorder, can have neuroprotective effects. That could mean it gives them some extra strength to preserve their cortical thickness. Even though this study does not provide answers about the cognitive consequences of bipolar disorder, it provides valuable insights into how brain structure changes.

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