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Imaging Differences Between Bipolar And Unipolar Depression
In addition to functional differences, there are also structural differences between unipolar and bipolar depression. Compared with bipolar depressed subjects, those with MDD had fewer deep white-matter hyperintensities, reflecting a lesser degree of white-matter impairment. Additionally, bipolar depressed subjects had increased corpus callosum cross-sectional area and decreased hippocampus and basal ganglia relative to unipolar patients. Both disorders manifested a larger lateral ventricular volume and increased rates of subcortical gray-matter hyperintensities compared with healthy controls .
Early Identification And Intervention Improve Outcomes
Treatment interventions that improve PFC modulation might improve outcome
Can we find the molecular basis of BPD1 to enable therapeutic intervention and improve the lives of people with BPD1, asked Professor Strakowski.
Imaging and other measures can be used to identify those patients at high risk of BPD1, and treatment interventions that improve PFC modulation might be able to impact the course of the illness, Professor Strakowski said. Decreases in brain activation have been observed in patients being treated for BPD1, providing evidence for potential neuroanatomic treatment response markers in first-episode BPD1.2
The natural course of the illness is shortening intervals between episodes of BPD1 over time. Lateral ventriculomegaly is greater in BPD1 patients, who have had repeated manic episodes and is associated with the number of previous manic episodes.5 This is probably part of the progressive course, said Professor Strakowski. A similar finding has been found in the cerebellum, but further work is needed to clarify the changes.
The biggest predictor of treatment response is prior treatment response, concluded Professor Strakowski. Most importantly, patients who adhere to early treatment and who avoid recreational drugs and alcohol have much better outcomes, and most can lead normal lives with good management.
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Brain Imaging In Bipolar Disorder
Structural and functional brain imaging studies in bipolar disorder lend direct, support to the indications of prefrontal cortical pathophysiology from studies of neurocognition. Classic studies of patients with secondary mood disturbance as a consequence of organic pathology like stroke or tumor reported increased prevalence of depressed mood following damage to the left, frontal cortex and the left, basal ganglia., Cases of secondary mania arc unsurprisingly less common than poststroke depression, but, are reported to show the reverse pattern of laterality, associated with right-lateralized damage to the frontal cortex and basal ganglia. These data highlight the connectivity between the frontal cortex and basal ganglia, and this frontostriatal circuitry is thought, to support, many aspects of attentional, executive and emotional function. Neurological patients with basal ganglia pathology also show elevated levels of depression, compared with other patient, groups with disorders matched for level of disability
Alternative Options For Classifying Bipolar Disorder
The proper classification of mood disorders in general, and in particular, bipolar disorder has been a longstanding conundrum. As is currently the case, in the absence of the basic scientific data that would allow a more biologically based classification system, interested observers can only suggest improvements on our current, somewhat arbitrary system. With that caveat, there may be other methods of classifying bipolar disorder.
An example of an alternate method of classifying bipolar disorder utilizes predominant polarity as the central factor, initially described by Angst and revisited and updated more recently by others . Predominant polarity reflects the relative number and severity of manic vs. depressive episodes within individual patients, defined by at least twice as many episodes of one pole vs. the other . Patients may be mania predominant, depression predominant or neither, when neither pole dominates the clinical course. Rates of PP differ markedly across different populations but, in general, depressive PP patients outnumber manic PP patients .
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Let Us Help You Manage & Treat Bipolar Disorder
As debilitating as bipolar disorder can be, it doesnt have to control your life. Here at StoneRidge Centers, we have programs that can help you manage the mood disorder and any other co-occurring disorders you may be living with. Were passionate and focused on restoring the brain to its optimal state of health. Thats why we have designed our programs to include the best of what brain science has to offer.
At the same time, we know that living with and managing a mood disorder can be challenging and overwhelming, so our approach to care is compassionate and comprehensive. Call us today at 928-583-7799 if you or a loved one are living with bipolar disorder and are ready to manage it in a healthy, wholesome way.
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What Is Bipolar Disorder Exactly
Everybody goes through mood ups and downs, but in bipolar disorder, a person experiences pronounced episodes of lows and highs .
These mood swings can interfere with day-to-day life, making it hard to do right by your relationships, function efficiently at your job, and take care of your own everyday needsgetting the laundry or grocery shopping done, getting enough sleep, that sort of thing.
The good news is that treatment can make a huge difference.
In order to be diagnosed with bipolar, you must have experienced at least one episode of mania or hypomania, a milder form of mania. If thats the case, then docs can delve deeper to find out which of the four types of bipolar you have:
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Bipolar I: This is the most severe type. People with bipolar I typically experience severe cycles of mania and depression.
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Bipolar II: Bipolar II comes with that milder form of mania, hypomania, as well as the typical depressive episodes.
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Cyclothymic Bipolar: Both the depression and mania are on the mild side.
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Unspecified Bipolar: Here, the symptoms are like bipolar, but theyre not frequent or lengthy enough to warrant the diagnosis of one of the other types of bipolar.
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How Can I Help My Child Or Teen
Help begins with the right diagnosis and treatment. Talk to your family health care provider about any symptoms you notice.
If your child has bipolar disorder, here are some basic things you can do:
- Be patient.
- Encourage your child to talk, and listen to your child carefully.
- Pay attention to your childs moods, and be alert to any major changes.
- Understand triggers, and learn strategies for managing intense emotions and irritability.
- Help your child have fun.
- Remember that treatment takes time: sticking with the treatment plan can help your child get better and stay better.
- Help your child understand that treatment can make life better.
Ological Issues In Appraising The Evidence
When appraising RCTs of maintenance treatments in BD, it should be acknowledged that follow-up rates are low-as low as 10% in some cases, with people excluded from trials after experiencing worsening of symptoms, such as recurrence of a mood episode. This limits interpretation of results, given that natural history of illness may require prolonged treatment with prophylactic medication before beneficial effects may be seen. A related issue is the detection of effects on depression episodes-inclusion criteria for trials is an initial episode of mania and given that initial polarity may predict future episode polarity, the ability to detect effects on depression may be affected, as a result of inadequate statistical power . As above, most trials of antipsychotics adopt an enriched design, where participants are stabilized on the antipsychotic before randomisation, i.e. preferentially choosing responders-though this probably reflects clinical practice. It is worth bearing in mind that those taking part in these studies have generally had poor responses to lithium or valproate . Observational studies are notoriously difficult to interpret, given the effects of confounding factors, and selection bias. It may therefore be helpful to examine aetiological mechanisms and the biology of treatment response.
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According To The National Alliance On Mental Illness 23 Million People In The United States Suffer From Bipolar Disorder
Every year, 2.9% of the U.S. population is diagnosed with bipolar disorder.1 But what is this condition? Bipolar disorder, or manic depression, is a serious brain disorder that causes extreme shifts in mood, energy, or functioning, and can range from episodes of mania to episodes of depression . These mood swings can range in severity and may last for hours, days, or months. But what causes these mood swings? How does bipolar disorder affect the brain?
Subcortical And Medial Temporal Activation
In addition to studies of prefrontal cortex, functional abnormalities in striatum and other subcortical structures have been reported in bipolar disorder. Specifically, compared with healthy subjects, Baxter et al observed decreased caudate metabolism in depressed bipolar patients. However, after adjusting for hemispheric metabolism, which was also decreased in depression, the specific regional specificity in the striatum was less clear. OConnell et al reported increased blood flow in the basal ganglia, with right-sided flow greater than left, in bipolar patients during mania. Blumberg et al partially replicated this finding as they observed increased blood flow in the left head of the caudate in manic compared with healthy subjects. These latter investigators also compared a group of bipolar adolescents with healthy controls and found increased signal in the thalamus and putamen. However, the mood state of patients in this latter study was not described. Together, these findings suggested that state-dependent changes in activation occurred in striatum during the course of bipolar disorder that mirrored those in the prefrontal cortex.
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Can Children And Teens With Bipolar Disorder Have Other Problems
Young people with bipolar disorder can have several problems at the same time. These include:
- Misuse of alcohol and drugs. Young people with bipolar disorder are at risk of misusing alcohol or drugs.
- Attention-deficit/hyperactivity disorder . Children and teens who have both bipolar disorder and ADHD may have trouble staying focused.
- Anxiety disorders. Children and teens with bipolar disorder also may have an anxiety disorder.
Sometimes extreme behaviors go along with mood episodes. During manic episodes, young people with bipolar disorder may take extreme risks that they wouldnt usually take or that could cause them harm or injury. During depressive episodes, some young people with bipolar disorder may think about running away from home or have thoughts of suicide.
If your child shows signs of suicidal thinking, take these signs seriously and call your childs health care provider.
If you think your child is in crisis and needs immediate help, call 911. You also can call the National Suicide Prevention Lifeline at 1800273TALK , or text the Crisis Text Line . These services are confidential, free, and available 24/7.
Imaging Studies Of Bipolar Depression
The limited number of imaging studies in bipolar depression have also highlighted changes in prefrontal and subcortical activity A resting state positron-emission tomography study in a notably large group of patients with bipolar depression reported decreases in prefrontal cortical metabolism, and increases in subcortical metabolism, compared with healthy controls. Both of these effects were correlated with depressive severity on the Hamilton scale. Using cognitive activation designs, decreased activation in the prefrontal cortex has also been reported, where attentional or executive tasks have been employed. In addition, resting state activation in the subgenual cingulate region was positively correlated with target detection performance on a CPT performed outside the scanner. Decreased blood flow in medial prefrontal cortex was also reported during a sad mood induction in remitted and depressed patients with type 1 bipolar disorder, although this study did not, include a healthy comparison group.
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What Are The Symptoms Of Bipolar Disorder
Mood episodes in bipolar disorder include intense emotions along with significant changes in sleep habits, activity levels, thoughts, or behaviors. A person with bipolar disorder may have manic episodes, depressive episodes, or mixed episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that often last for several days or weeks. During an episode, the symptoms last every day for most of the day.
These mood and activity changes are very different from the childs usual behavior and from the behavior of healthy children and teens.
Children and teens having a manic episode may:
- Show intense happiness or silliness for long periods of time.
- Have a very short temper or seem extremely irritable.
- Talk fast about a lot of different things.
- Have trouble sleeping but not feel tired.
- Have trouble staying focused, and experience racing thoughts.
- Seem overly interested or involved in pleasurable but risky activities.
- Do risky or reckless things that show poor judgment.
Children and teens having a depressive episode may:
Bipolar Runs In My Family I Think I Might Have It Can It Skip A Generation Do I Have It
My grandma had bipolar and my 2 uncles have bipolar.
Ive had depression/anxiety most of my life. I go through periods and highs and lows daily. Ive tried anxiety and depression meds once and those triggered bad thoughts and I have never wanted to go back to meds.
Ive also had insomnia most of my life. I can go days without sleep and have gone the last 3 months with averaging 2-4 hours of sleep. I cant shut my brain off and have loads of energy. I also have adhd.
One thing my uncles get is they get such highs that they feel like they can rule the world. I have never seen this side of them but my mom says they are both on meds. I have highs, but Im generally realistic. I do have gambling problems, but I dont bet more then I can afford to lose. I also binge eat. My depression gets bad where i just stay isolated but never thoughts of self harm.
My mom 100% does not have bipolar. So if I did, it would skip a generation? Can that be possible?
With my Depression/Anxiety/ADHD and insomnia, coupled with family history, I am a little worried. I defiantly do not have extreme highs like my uncles. Does this sound like bipolar?
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I will be seeing a psychiatrist hopefully in a month regarding my insomnia and I will bring up bipolar. So I gonna get seen. Just wanted thoughts.
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Is Bipolar Disorder Genetic
Many studies of bipolar patients and their relatives have shown that bipolar disorder sometimes runs in families. Perhaps the most convincing data come from twin studies. In studies of identical twins, scientists report that if one identical twin has bipolar disorder, the other twin has a greater chance of developing bipolar disorder than another sibling in the family. Researchers conclude that the lifetime chance of an identical twin to also develop bipolar disorder is about 40% to 70%.
In more studies at Johns Hopkins University, researchers interviewed all first-degree relatives of patients with bipolar I and bipolar II disorder and concluded that bipolar II disorder was the most common affective disorder in both family sets. The researchers found that 40% of the 47 first-degree relatives of the bipolar II patients also had bipolar II disorder 22% of the 219 first-degree relatives of the bipolar I patients had bipolar II disorder. However, among patients with bipolar II, researchers found only one relative with bipolar I disorder. They concluded that bipolar II is the most prevalent diagnosis of relatives in both bipolar I and bipolar II families.
S Of The Brains Hippocampus Are Diminished In Size In People With Bipolar Disorder
2016 Young Investigator Grant
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An analysis of the hippocampus, a part of the brain involved in memory and emotion, has identified specific regions that are diminished in size in people with bipolar disorder.
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Brain imaging reveals hippocampus shrinks in people with bipolar disorder. Tweet >
In people with schizophrenia, the hippocampus, a part of the brain involved in memory and emotion, tends to shrink. Scientists have wondered whether this is also the case in mood disorders.
Now, a team led by NARSAD 2016 Young Investigator Bo Cao, Ph.D., at the University of Texas Health Science Center at Houston, have taken a closer look at the hippocampus in people with mood disorders, comparing the size of specific parts of the brain structure in different groups of patients. Their analysis has revealed that in people with bipolar disorder, certain parts of the hippocampus are smaller than they are in both people with major depressive disorder and in people without mood disorders.
The findings were published on January 24 in the journal Molecular Psychiatry. Jair Soares, M.D., Ph.D., a 1997 and 1999 Young Investigator and 2002 Independent Investigator at University of Texas Health Science Center, was the senior author of the paper.
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Amygdala And Ventral Prefrontal Cortex Dysfunction Underlie Bpd1
Amygdala dysfunction leads to increased risk-taking and reward-seeking behaviors
Within the brain, the amygdala is the reaction center that responds to threats, and the striatum is the reward center. The amygdala develops earlier than the prefrontal cortex and is associated with quick emotional responses.
In mania, it appears that the amygdala is not sending appropriate signals and is providing misinformation, explained Professor Strakowski.
The increased risk-taking and reward-seeking behaviors and associated ventral striatal and medial PFC hypersensitivity in adolescence also appears to depend on social context, Professor Strakowski added.1 During adolescence, ventral PFC modulation of approach-and-avoidance neurobiology in the striatum and amygdala matures, particularly in socioemotional contexts but this is disrupted in BPD1.2
A meta-analysis of neuroimaging studies revealed that amygdala volumes in BPD1 are smaller in children and adolescents compared with controls, but not significantly different in adults from control adults
Manifestations of the dysfunctional ventral PFC networks underlying BPD1 include:
- amygdala hyperactivation to emotional expressions during mania, and this may predate onset of BPD1
- ventral PFC hypofrontality
- reward hypersensitivity , which is relatively specific to mania.