![]() Cannon, Yann Chye, Andreas Dahl, Orwa Dandash, Udo Dannlowski, Katharina Dohm, Torbjørn Elvsåshagen, Lukas Fisch, Janice M. Akudjedu, Martin Alda, Dag Alnæs, Silvia Alonso-Lana, Francesco Benedetti, Michael Berk, Erlend Bøen, Caterina del Mar Bonnin, Fabian Breuer, Katharina Brosch, Rachel M. ![]() Regardless, the study provides new clues about the structural effects of BD on the brain over time. ![]() One possibility to explain why BD patients may have slower thinning of the cortex compared to HC is that lithium, a medication used to treat BD, is known to have neuroprotective effects and could bolster cortical thickness. Lead author Christoph Abé, PhD, Assistant Professor, Karolinska Institutet, Sweden, said: "The abnormal ventricle enlargements and importantly the associations between cortical thinning and manic symptoms indicate that bipolar disorder may in fact be a neuroprogressive disorder, which could explain the worsening of bipolar symptoms in some patients." In cortical areas outside the PFC, BD participants actually showed slower thinning than HC participants. "Researchers should focus on better understanding the progressive mechanisms at play in bipolar disorder to ultimately improve treatment options."Ĭompared to HC, people with BD showed a faster enlargement in the brain's ventricles, cavities within the brain that contain cerebrospinal fluid. "The fact that cortical thinning in patients related to manic episodes stresses the importance of treatment to prevent mood episodes and is important information for psychiatrists," said senior author Mikael Landén, MD, PhD, Professor and Chief Physician at the Institute of Neuroscience and Physiology, University of Gothenburg, Sweden. The changes were most evident in the prefrontal cortex (PFC), an area associated with executive control and emotion regulation. Those who did not have mania showed no cortical thinning or even cortical thickening. The most striking finding was that the cortex, the brain's outermost layer, thinned over time to a greater extent in people who experienced more manic episodes. Participants were assessed at two timepoints, ranging from six months to nine years apart. The researchers gathered magnetic resonance imaging (MRI) and detailed clinical data from 307 people with BD and from 925 healthy controls (HC) from 14 clinical sites worldwide. Here, by combining data from 14 sites, we get one of the clearest pictures we have of the neurotoxic impact of bipolar disorder, particularly manic episodes." "Longitudinal neuroimaging studies are extremely challenging to conduct. "The ENIGMA Bipolar Disorder Working Group report illustrates the power of large-scale multi-center collaboration," said John Krystal, MD, Editor of Biological Psychiatry. The study involved a large international multi-center team of more than 70 researchers from the ENIGMA Bipolar Disorder Working Group. Doses of bupropion >450 mg/d should be used with caution in depressed patients with bipolar affective disorder.The report appears in Biological Psychiatry, published by Elsevier. However, our case report as well as others support the theory that this decreased risk may be due to dosages not exceeding the recommended daily dose (450 mg/d). Bupropion is believed to be associated with a decreased risk compared with other antidepressant therapies. ![]() Scientific literature supports this theory.Ī switch into mania is a potential risk associated with antidepressant drug use in bipolar affective disorder. Since the patient did not switch into mania until the dosage exceeded 450 mg/d, we speculate that this adverse reaction is a dose-related phenomenon. Due to a lack of response, the bupropion dosage was titrated to a maximum of 600 mg/d. Since bupropion is the agent least likely to cause a manic switch in bipolar disorder, this agent seemed a logical choice to treat the patient's depression. After exceeding the maximum recommended daily dose (450 mg/d), he experienced a manic episode attributed to high-dose bupropion.ĭue to increased risk of seizures, current prescribing guidelines state that the total daily dose of bupropion is not to exceed 450 mg/d. ![]() Bupropion therapy was initiated and the dosage was titrated to 600 mg/d. To report a case in which bipolar depression was resistant to usual therapies, requiring dosages of bupropion >450 mg/d and to review the literature on mania associated with bupropion and propose a potential theory of a dose-related threshold associated with bupropion and mania.Ī 44-year-old white man with a 25-year history of bipolar affective disorder presented with depression resistant to usual therapies. ![]()
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