Reviewed by Aaron Horn, LMFT
There is a lot that researchers can learn from scanning the brain of someone with Bipolar Disorder. There are measurable differences for the brain of someone with bipolar disorder than someone without. Some of these differences are small and insignificant, while many can truly inform healthcare professionals about key aspects of bipolar disorder. This article will help go over a few of the most interesting findings and some background on brain scans themselves.
Types Of Brain Scans
There is a plethora of different types of brain scans. Some of the most common scans are CT, MRI, and MRS scans. CT (aka CAT) scans, which stands for computerized axial tomography, and MRI scans, which stands for magnetic resonance imaging, look into brain structures. MRS scans, which stands for magnetic resonance spectroscopy, investigates how the brain functions.
All three of these types of scans are utilized in researching bipolar disorder. In the medical setting, brain scans are used for two primary reasons: clinical work and research.
Do I Need To Have A Brain Scan For Bipolar Disorder?
While the vast majority of bipolar patients are told that they do not need brain scans, you can always ask your doctor to be sure. Diagnoses do not require the use of brain scans for treating bipolar disorder, and they are almost exclusively used for research purposes. Currently, diagnoses are based on a clinical review and the history of a patient.
However, sometimes doctors feel it necessary to check newly diagnosed patients for signs of brain trauma or abnormality, which could include a tumor, multiple sclerosis, or a stroke. Sometimes symptoms of these other illnesses manifest similarly to bipolar disorder. This is exceptionally rare, but sometimes doctors are cautious to cross every box before diagnosing the patient with a mental illness.
On the whole, there is no brain scan currently in use that can diagnose somebody with bipolar disorder definitively. Brain scans are mostly used for research purposes. This may someday change as the science continues to develop. This article contains some of the brain scan progresses currently being made with regards to bipolar disorder.
If you would like to take the first step on being diagnosed with bipolar disorder, check out our self-diagnostic tool at https://www.mind-diagnostics.org/bipolar_disorder-test. It is a great way to explore if you have bipolar disorder, which is the first step towards getting help and walking down a path to better health.
A Future Hope: Early Detection
Though researchers and clinicians do not have these tools now, a major hope for scanning the bipolar brain is to determine if someone is in the early stages of bipolar disorder. Theoretically, this could be done by recognizing structures and processes that indicate the early development of the bipolar disorder. This could greatly enhance the treatment of the disease by affording doctors the opportunity for early intervention. If people with bipolar disorder could receive treatment before developing serious symptoms, then everybody would benefit.
Bipolar Brain Scans As Research Tools
Through these scans, researchers can learn about the structure and chemical processes that guide the symptoms of bipolar disorder. There is much to be learned about what is happening underneath the struggling bipolar patients’ distress. Researchers can learn more about what parts of the brain are affected by episodes, how the bipolar brain is structured differently, and the differences between bipolar brains and other brains.
The information gained from these scans can be somewhat of a scattershot. As researchers try to pin down what is true overall, they seek to find commonalities through many different brain scans of bipolar people instead of drawing sweeping conclusions from just a few scans. Thus, some of the following bits of information may seem hyper-specific but rest assured that researchers are making progress.
A Global Map
In 2017 international researchers took thousands of MRIs. They were able to begin developing the “Global Map” of bipolar disorder by showing clear differences between the bipolar brain and a neurotypical brain. In total, the researchers took 6,503 scans (2,447 had bipolar, and 4,056 were controls).
The lead author, Ole Andreassen of the Norwegian Centre for Mental Disorders Research at the University of Oslo, stated, "We created the first global map of bipolar disorder and how it affects the brain, resolving years of uncertainty on how people's brains differ when they have this severe illness."
Researchers were excited about this study's extent because it helped to lay out some major consistencies between people with bipolar disorder. Bipolar disorder comes in many shapes and sizes. People with bipolar disorder are a very diverse group. This study was a landmark because it helped to illustrate significant commonalities across the bipolar spectrum.
A key takeaway was the lack of gray matter in the bipolar brain scans compared with the neurotypical brains. Furthermore, the frontal and temporal regions, the parts of the brain most responsible for the control of inhibition and motivation, were greatly affected. Finally, researchers said that they learned a great deal about the potential effects of different psychiatric medications, specifically by identifying the effect of many popular medications on the brain's gray matter.
The acquisition and potential application of this knowledge regarding gray matter could possibly be monumental. The brain is made up of approximately 40% gray matter. Gray matter is composed mostly of neurons. It is distinct from white matter, which is the brain's infrastructure. The lack of medications to preserve gray matter has massive implications for the treatment of bipolar disorder.
This breakthrough study came from an international collective called ENIGMA (Enhancing Neuro Imaging Genetics Through Metal Analysis). It spanned 76 different research sites over 26 research groups. Centered at the University of Southern California, this was an exceptional study that took substantial international cooperation.
Researchers used MRI scans in 2017 to determine that people with bipolar disorder showed an irregularity with processing visuals during a manic, mixed, or depressed state. The study used 40 people with bipolar disorder and 33 controls. The subjects were shown a flashing checkerboard pattern while hooked up to the scanning machine.
When the bipolar subjects were recorded to be stable, they responded much like the control groups. However, when the bipolar subjects were in a mixed, manic, or depressed state, several brain regions related to sensory processing were less active. The researchers determined this by measuring the brain's blood flow because blood flow typically indicates brain activity.
It may seem like a minor study, but it could have major implications because it may show that people with bipolar disorder are affected neurologically on a much deeper and more fundamental level. The emotional and behavioral dysregulation that is trademark bipolar may be the tip of the iceberg neurologically. If explored further, there is a potential for far reaching implications for the treatment of bipolar disorder because bipolar episodes may have engrossing impacts throughout the brain.
Distinguishing Bipolar Disorder From Depression
In 2018 a research team used advanced MRI methods to analyze the amygdala (a part of the brain central to your ability to feel some emotions in yourself as well as to perceive some emotions in other people) response to a patient’s processing of facial expressions such as happiness, anger, fear, sadness, and disgust.
The study's key finding was that the amygdala of someone with depression responded differently than someone with bipolar disorder. In subjects who have bipolar, the amygdala's left side was less engaged, connected, and active with the rest of the brain than in people with depression. The researchers estimated that they had an 80% accuracy rate in distinguishing between bipolar and depression.
Senior researcher Dr. Mayuresh Korgaonkar commented that his study implies that the techniques could distinguish between bipolar and depression. This could be heavily influential in clinically diagnosing both disorders. Bipolar depression and depression often appear almost identical, but people with bipolar disorder will frequently require a different treatment course, which may include different medications. It would be a huge gain for doctors and patients alike to easily and accurately distinguish between bipolar and depression.
Bipolar brain scans are an ever-advancing, growing, and developing frontier. For now, they are used for research purposes, and they have heavily limited diagnostic use. However, there is a great deal of potential for general research on therapies and medications and the potential for diagnostic gains.
Bipolar brain scans have come a long way with the development of modern medicine, science, and research practices, tools, and techniques. There is plenty to be learned, and more is always on the way. Hopefully, this article has helped to summarize and clarify a few key learnings.