Neurochemical abnormalities in unmedicated bipolar depression and mania: A 2D 1H MRS investigation
Section snippets
Background
Bipolar disorder (BP) is a debilitating mood disorder with unpredictable cycles of depression (BPD) and manic episodes (BPM) interspersed with variable lengths of euthymia. The etiology of bipolar disorder is not clear, although a strong biological basis is suspected due to its hereditary nature. The occurrence of the diametrically opposite mood states of mania and depression is the most striking and perplexing aspect of the illness; therefore, investigating the similarities and differences in
Subjects
Medication-free bipolar depressed (BPD) (N=12, age: 37+10 years; 6 F) and bipolar manic (BPM) (N=12, age: 31+13 years, 9 F) outpatients were recruited from the outpatient clinic at University Hospital, Indiana University School of Medicine and by advertisement from the community. Healthy controls matched for age and gender (N=20, age: 31±9 years; 13 F) were recruited via advertisement. All subjects took part in the study after signing an informed consent form approved by the Investigational
Results
No differences were found between the three groups by either age (p=0.25) or gender (p=0.45). As expected, the YMRS score was significantly higher in the BPM group when compared to the BPD patients (p<0.001), while the HDRS score was significantly higher in the BPD group when compared to the BPM group (p<0.001) (Table 1). Bipolar subjects reported an early age of onset. This is consistent with recent reports which have shown that a majority of bipolar patients have onset of illness in late
Discussion
The results of this study show a significantly increased Lac/Cr in the BP group as a whole regardless of region. Lactate is important in brain bioenergetics and can be increased in states of brain injury, hypoxia or increased metabolism which are accompanied with a redox shift towards anaerobic metabolism (Dager et al., 2008). As reviewed in the introduction, a number of studies point to abnormalities of the brain energy metabolism in BP disorder. Decreased frontal lobe pH observed in BP
Acknowledgments
This project was funded by the NIMH to AA (R01MH075025). The following does not pertain to the conduct of this study but is provided in the spirit of full disclosure. In the past 2 years Dr. Anand has served on the advisory board of AstraZeneca, Pfizer Pharmaceuticals, Merck Pharmaceuticals and Dey Pharmaceuticals. Dr. Anand has been a speaker for Merck Pharmaceuticals. Dr. Anand has received Grant support from Astra-Zeneca and Lilly Pharmaceuticals.
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