Can brain-imaging studies provide a 'mood stabilizer signature?'.

Brain-imaging investigations have attempted to characterize the neurobiological basis of bipolar disorder. Preliminary studies have also focused on in vivo brain correlates of treatment response with antidepressants, mood stabilizers and other psychotropic medications. A MEDLINE literature search was conducted dating back to 1966. Selected in vivo brain-imaging studies that examined neurobiological correlates of treatment response in mood disorder patients were identified. Discrete anatomical abnormalities in subregions of the prefrontal cortex, medial temporal lobe and cerebellum have been identified in bipolar patients. Functional imaging studies suggested abnormalities in particular brain circuits encompassing these same brain regions and the striatum. However, functional imaging correlates of treatment response with lithium or other mood stabilizers have not yet been characterized. Neurochemical studies suggested a reduction in N-acetyl aspartate levels in prefrontal cortex and abnormalities in membrane phospholipids in frontal and temporal lobes. Preliminary findings suggest that lithium may increase the gray matter content and N-acetyl aspartate levels in various cortical regions, which could reflect its putative neurotrophic effects. Few in vivo receptor-imaging studies have examined brain correlates of treatment response in bipolar patients. The available studies suggest anatomical, neurochemical and functional brain abnormalities in bipolar patients. However, in vivo brain correlates of treatment response with mood stabilizers in bipolar patients have not yet been well characterized.