Neural activity to intense positive versus negative stimuli can help differentiate bipolar disorder from unipolar major depressive disorder in depressed adolescents: a pilot fMRI study

Psychiatry Res. 2013 Dec 30;214(3):277-84. doi: 10.1016/j.pscychresns.2013.06.013. Epub 2013 Sep 27.


Failure to distinguish bipolar depression (BDd) from the unipolar depression of major depressive disorder (UDd) in adolescents has significant clinical consequences. We aimed to identify differential patterns of functional neural activity in BDd versus UDd and employed two (fearful and happy) facial expression/ gender labeling functional magnetic resonance imaging (fMRI) experiments to study emotion processing in 10 BDd (8 females, mean age=15.1 ± 1.1) compared to age- and gender-matched 10 UDd and 10 healthy control (HC) adolescents who were age- and gender-matched to the BDd group. BDd adolescents, relative to UDd, showed significantly lower activity to both intense happy (e.g., insula and temporal cortex) and intense fearful faces (e.g., frontal precentral cortex). Although the neural regions recruited in each group were not the same, both BDd and UDd adolescents, relative to HC, showed significantly lower neural activity to intense happy and mild happy faces, but elevated neural activity to mild fearful faces. Our results indicated that patterns of neural activity to intense positive and negative emotional stimuli can help differentiate BDd from UDd in adolescents.

Keywords: Adolescents; Bipolar depression; Emotion processing; Functional magnetic resonance imaging (fMRI); Major depressive disorder.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Bipolar Disorder / complications
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / pathology
  • Bipolar Disorder / physiopathology*
  • Brain Mapping
  • Cerebral Cortex / pathology*
  • Cerebral Cortex / physiopathology*
  • Child
  • Cross-Sectional Studies
  • Depression / complications
  • Depressive Disorder, Major / complications
  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / pathology
  • Depressive Disorder, Major / physiopathology*
  • Diagnosis, Differential
  • Emotions*
  • Facial Expression
  • Fear / psychology
  • Female
  • Happiness
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Pilot Projects