Background
Bipolar disorder (BD) and unipolar depression (UD) can be difficult to
distinguish clinically, particularly during episodes of depression. In this study we
test for differences between BD, UD, and healthy control (HC) adults regarding within-
and between-session changes in BOLD response during implicit emotional processing.
Methods
During fMRI, HC adults (N=19) and depressed adults with UD
(N=19) and BD (N=16) performed an implicit emotion-processing task. Each
participant was scanned twice, separated by 6-months, resulting in 108 scans. BOLD
response and linear change in BOLD response were examined within and between
sessions.
Results
We observed within-session linear decreases in BOLD signal (irrespective of
group, condition, or session) in the left amygdala, a right-sided temporo-parietal
region, and a right-sided fronto-insular region. Furthermore, we observed group
differences in within-session BOLD signal change (p<0.05, FWE corrected) in a
left-sided striatal-insular-thalamic region. Individuals with BD demonstrated a linear
decrease in BOLD signal compared to HC (p<0.008, FWE corrected) across this
region and compared to UD in the posterior insula portion of the region
(p<0.008, FWE corrected). Finally, we observed main effects of emotional valence
in bilateral visuo-spatial processing regions as well as in the left and right
amygdala.
Conclusions
Individuals with BD demonstrated linear attenuation of BOLD response to
emotional stimuli within left-sided striatal-insular-thalamic regions. Individuals with
BD may either have experienced abnormal habituation in this region or disengaged quickly
from processing the emotional stimuli, despite comparable task performance. This pattern
may represent an underlying pathophysiological process associated with BD that differs
from UD.