Functional Imaging Changes in Bipolar Disorder After Psychotherapy or Drug Therapy

An activation likelihood estimation meta-analysis found that both psychotherapies and drug therapies have their own distinct brain effects among patients with bipolar disorder (BD). These findings were published in Psychological Medicine.

Investigators from Anhui Medical University in China searched publication databases from inception through June 2021 for studies of psychotherapy or drug therapy interventions among patients with BD that had functional magnetic resonance imaging (fMRI) data. A total of 21 studies met the inclusion criteria and were considered in this analysis.

The studies evaluated psychotherapy (n=7) or drug therapy (n=12) interventions and fMRIs were conducted during emotional (n=12) or cognitive (n=9) tasks.

Overall, among 527 patients, the interventions associated with 127 increased activation points and 21 decreased activation points. After clustering, there were 10 increased activation clusters and 1 decreased activation cluster. After translating the clusters to brain regions, the increased clusters affected the right anterior cingulate cortex (ACC), bilateral medial frontal gyrus (MeFG), bilateral inferior frontal gyrus (IFG), left amygdala, left lingual gyrus, left angular gyrus, left insula, and right claustrum whereas the right posterior cingulate cortex (PCC) was decreased.

After receiving psychotherapy, the IFG and the superior temporal gyrus (STG) were activated. Drug therapy activated the ACC, MeFG, IFG, amygdala, lingual gyrus, angular gyrus, insula, and claustrum areas and decreased activation in the PCC.

Stratified by tasks performed during fMRI, emotional tasks associated with activation of the ACC and IGF and decreased activation of the PCC whereas the cognitive tasks were associated with activation of the STG and decreased activation of the precuneus and MeFG.

The major limitation of this analysis was the inclusion of only 2 broad categories of interventions.

Study authors concluded, “Different brain regions activated by psychotherapy and drug therapy may be related to distinct therapeutic mechanisms. In addition, the analysis results of emotional tasks and cognitive tasks were inconsistent, which may be due to the different types of tasks assessed. It is suggested that medication may have a bottom-up effect, whereas psychotherapy may have a top-down effect. This meta-analysis may contribute to the clinical differential diagnosis of BD and would be helpful to improve its treatment effect as well as identify more accurate neuroimaging biomarkers for its treatment.”