Bipolar disorder affects close to 6 million Americans each year and is recognized as one of the leading causes of disability worldwide.
The grant supports the formation of the Bipolar Disorder Imaging and Treatment Research Center (BITREC) at the UC College of Medicine and was awarded by the National Institute of Mental Health (NIMH) of the National Institutes of Health.
The causes of bipolar disorder are unclear, researchers say, so that determining the best treatment quickly for a given individual remains difficult and is largely based on educated trial-and-error of various medications that have been shown to improve symptoms in studies of large groups of affected individuals.
BITREC investigators, led by Stephen Strakowski, MD, professor and interim chairman of the department of psychiatry and director of the Center for Imaging Research, will use functional magnetic resonance imaging (fMRI) and magnetic resonance spectroscopy (MRS)—a technique used to measure the locations and amounts of specific brain chemicals based on their magnetic properties— to study what bipolar disorder looks like in the brain, particularly in response to different treatments.
“Bipolar disorder is a condition that’s very dynamic,” says Strakowski. “Symptoms are progressive and frequently changing. To us, this suggests there are changes developing in the brain that impact how treatments will work during different times in the illness.”
Strakowski says there are key areas in the brain where changes are occurring. These areas include the prefrontal cortical and subcortical brain regions that form the anterior limbic network, the system primarily responsible for emotional and social behaviors.
He and his BITREC team plan to further study these areas by visualizing them in healthy people and in people with bipolar disorder during several different early phases of illness. They will then view the brain’s physiological response to two mechanistically different, but widely used FDA-approved medications prescribed to treat bipolar disorder. More than 400 people will be recruited for this study.
“We think that by viewing what’s happening in people very early before bipolar disorder has progressed too far, we can really refine our understanding of this disease,” says Strakowski. “We hope to understand how different people respond to different treatments, with the ultimate goal of being able to predict what might work best for each individual.”
Bipolar disorder is a serious mental illness that causes dramatic shifts in a person’s mood, energy and ability to function. It can strike at any age, but most commonly develops in adolescence or early adulthood. The disorder is characterized by alternating episodes of mania and depression, often with periods of normal mood in between. Some symptoms of a manic episode include increased energy, activity and restlessness, excessively “high” or overly euphoric mood, and extreme irritability. In contrast, a depressive episode is characterized by a lasting sad, anxious, or empty mood, feelings of hopelessness or pessimism, and decreased energy.
An NIMH–supported study estimates that 1 percent of adolescents between 14 and 18 meet the criteria for bipolar disorder, or a similar, milder illness known as cyclothymia, suggesting it may be as common among youths as it is among adults.
BITREC studies will be conducted in UC’s Center for Imaging Research. Partners on the grant include Cincinnati Children’s Hospital Medical Center, Indiana University and the University of Iowa.
Co-investigators from UC include Caleb Adler, MD, Melissa DelBello, MD, Jim Eliassen, PhD, Paul Keck, MD, Richard Komoroski, MD, and Susan McElroy, MD, all of the department of psychiatry, and William Ball, MD, and Jing-Huei Lee, PhD, both from biomedical engineering.
Psychiatry faculty at UC are affiliated with the Neuroscience Institute—a collaborative of nine academic departments at the UC College of Medicine, the University Hospital and independent physician practice groups. The institute is dedicated to patient care, research, education and the development of new medical technologies.