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Indeed, despite years of work, neuroscientists still do not know what causes bipolar disorder, or exactly which parts of the brain are involved. That lack of knowledge has severely hampered the search for safer and more effective ways to treat the disease. The principal drugs for bipolar disorder, lithium and Depakote, have been around for decades.
Both were discovered by accident, when researchers trying to do something else noticed that the drugs eased the symptoms of patients with bipolar disorder. And though the drugs can be reasonably effective in some people, doctors have no idea how they work or which patients are most likely to benefit. In order to find better pharmaceuticals, researchers need to be able to target the exact mechanisms or structures involved in bipolar disorder.
Pinpointing the mechanisms could also lead to more accurate evaluation of the disorder. Often, diagnosis in psychiatry is done by a kind of trial and error, in which a psychiatrist makes an educated guess based on the behavior or self-reported symptoms of a patient, prescribes a medication, and sees whether or not it helps. If it doesn't, the psychiatrist considers a different diagnosis and a different medication, until something begins to work.
"What psychiatrists need is some test that will give them the answer: this patient has the disease or doesn't," says Port. He and other researchers hope MRI scanners will offer the definitive diagnosis. And for those in the mental-health profession, that would change everything. "I'm dedicating the rest of my career to coming up with an imaging test that will help psychiatrists diagnose" bipolar disorder and other illnesses, Port says.
Tomorrow: A deeper look at the technologies of MRI spectroscopy and DTI.
Paul Raeburn's most recent book is Acquainted with the Night, a memoir of raising children with depression and bipolar disorder.
Home page image courtesy of John Port.
An MRI imager that is 100 million times more powerful could create 3-D images of viruses.
Kelvin Lim is using a new brain-imaging method to understand schizophrenia.
MIT researchers work to build implants to replace stroke-damaged brain areas.
Guest (Julie Thomas)
Diagnosing Bi-polar Disorder with MRI
I was diagnosed with Bi-polar Disorder three years ago when my life was completely in turmoil. I went through 1.5 years of prescription trials to find the "right" medication for me. I have been completely off all of my medications for a year. My psychiatrist told me he does not feel I have Bi-polar. (I was actually diagnosed by another psychiatrist)I would love the mystery to be solved. I do have depressive episodes and know that I deffinently did have wild mood swings at that time but at this point I really do not know if I have Bi-polar or not. If you want a Guinea Pig I will volunteer. Please, give me any input you can.
Re: Diagnosing Bi-polar Disorder with MRI
I would insist on a full physical, full blood work, blood sugar, Ctscan, liver and kidney function, including ALA PBG urin, fecal and blood and all your enzyme panels before making any diagnosis of bipolar disorder. It is far more common to have a reaction to alcohol or medication that causes these symptoms and you have to rule out physical causes before diagnosing a mental health condition.
Guest (Jennifer)
I was diagnosed with manic depresion 15 years ago. Now called bipolar I have suffered so much over the last few years. Just comming out of a 3 year depresion I have been hospitalized 4 times in the past few years. All the groups i have attended all the people tht i have met, one of the biggest toppics has always been how horrible it is for us who suffer with this disease to waste so many years switching from this drug to that drug and switching diagnoses. How wonderful it would be for us to know what was wrong right away and be treated for it. My prayers are with you Dr. Port.
Guest (Barbara)
I was diagnosed with bipolar in September 2002. Since then I've been on a wide variety of drugs. This past September (2005), after nearly of year of deep depression, we finally found a "cocktail" that worked with a little tweaking of what I was already on (removing one thing, adding another). Then in December one of the meds I'd been on for a year decided that it wanted to mess with my system and started causing side effects. I've been fully off that med for a week now and am feeling the effects of it terribly. I am hoping that it passes without having to add something else, but only time will tell that. In the meantime it is watch and listen and pay attention. I would love if there were a way to determine exactly what is going on in the brain and what medication is the right one to treat it with.
I would be a very willing guinea pig in your research. Feel free to contact me at your discretion. mrs_jaros@comcast.net
Guest (Veronica Narutowicz)
I am also in search of the right medication, and would like to be included in research that would bring us closer to successfully managing my illness. I was wondering if you received a response about being a part of their research.
Guest (Cathi)
Dear Dr. Port,
I live in an area where research of this type should be available. I am close to Cleveland Clinic and University Hospitals but have no idea who to contact. It has been my contention that I should be treated by a neurologist, not a psychiatrist, for my BP. This is brain chemistry. Thank God you are researching from that perspective. If you or anyone is aware of somewhere in Northeastern Ohio where I can be a test subject, please e-mail me at cagreen2u@neo.rr.com. Thank you.
Guest (Traci ~ Michigan)
I have a 19 year old son who suffers from BP. It would be awesome to pinpoint his brain chemistry imbalance with MRI.He is heavily medicate and when he goes off he medshe ends up in a Psych unit. (THis Happens often~ he doesn't like the way the meds make him feel). Will medicaid pay for an MRI? Where would I go to see a good Psychiastrist that works with the neurologist in Michigan?
Guest (R)
I was diagnosed with bipolar at the McLean Hospital a few years ago. While I was there I had an MRI scan. After the scan I noticed that I felt remarkably better and that most of my symptoms had temporarily disappeared. Now doctors are learning that the MRI scan itself can ease symptoms -- much like electroshock therapy! An amazing development. (By the way, I started a monotherapy of Lamictal a few years ago and it has put me in complete remission for two years now. Lamictal has saved my life.)
Guest (Betty)
My son is diagnosed pediatric bipolar. We had a "spec scan" done a couple of years ago at the Aman Clinic. It mapped blood flow in his brain. We actually did this to help figure out the onset of learning disabilities--this was prior to his diagnosis as pediatric bipolar. It showed his brain as more or less "neurotypical" when he was engaged, but his brain at rest had increased blood flow all over the place. We are trying to get the meds right, which is hard since his is pubescent. He just got off of Depakote--he gained 50 pounds, and trying to cut back on lithium (his hands shake so badly he cant hold a pencil). Now we're on to lamictal, and I hope to god it will help chill him out. Thanks for your comments.
Guest (jes)
my brother had been suffering from manic depression right now and he is not yet been fully diagonised as one with bipolar .they doubt it as bipolar with schizoprenic features .i just hope people like us will soon find a cloud with silver lining as ur research finds an answer.
If they ever find a way then the majority of the pop will be diagnosed with wome mental illness
everybody is crazy.
I have been on testoterone therapy all my life and have had alot of problems.I went into psychosis twice and have been treated for bi polar since the first time. would the mri scan help me in chosing the right meds.And to what degree I have the disorder.realize that testosterone therapy creates mood problems.I would also like to participate in any study on this matter.I can be contacted at mrb1@cableone.net
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Guest (O Viera)
Finding Bipolar Disorder with MRI
This is an excellent article. It helps me to increase my understanding of the role of the brain in mental illness. It is enlightening and is a hope for a more acurate diagnosis of mental illness.
Reply