Can a Brain Scan Detect Bipolar Disorder?

Although brain scans aren’t used to diagnose bipolar disorder, they can help rule out other conditions.

According to the Depression and Bipolar Support Alliance, these conditions may cause symptoms resembling those of bipolar disorder, like brain injury, tumor, or stroke. People who get brain scans related to bipolar disorder typically do so for research purposes, rather than for diagnosing the disorder.

Brain scans can show which structures are involved in different disease processes. They can also show whether certain functions or differences are involved in a mental health condition. Experts think there may be an association between structural differences in the brain and bipolar disorder.

But a 2018 imaging study had inconsistent results. The researchers found thinner cortical gray matter in the frontal, parietal, and temporal areas of both hemispheres of the brain. Cortical thickness was also affected, but this may be from certain medications, like lithium.

The amygdala, which helps process emotions, may also respond differently depending on whether a person has bipolar disorder or depression. In those living with bipolar disorder, a small 2019 study suggests the left side of the amygdala is less active and less connected with other areas of the brain, as opposed to those living with depression.

About 60 percent of people who have bipolar disorder are initially misdiagnosed with depression. Experts hope that imaging scans may eventually be helpful in telling the two conditions apart. But more research is needed first.

Imaging scans can tell us a lot about the brain. But, right now, brain scans are not used to diagnose bipolar disorder.

To diagnose this condition, a psychologist or other mental health professional may do a physical exam or order lab tests. These can help rule out any other medical condition causing your symptoms. They will also ask you questions to learn more about the symptoms you’re experiencing.

The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” is used to evaluate whether someone meets the criteria for a mental health condition.

There are different types of bipolar disorder. The DSM-5 helps a clinician tell the difference between them and make the appropriate diagnosis.

• Bipolar I disorder. You must have had at least one manic episode lasting at least 7 days to receive a diagnosis of bipolar 1 disorder, according to the National Institute of Mental Health (NIMH). The symptoms of a manic episode may be so severe that you require hospital care. Depressive episodes also occur, usually lasting at least 2 weeks.
• Bipolar II disorder. The NIMH defines this type of bipolar disorder as a pattern of depressive episodes and hypomanic episodes, but not fully manic episodes.
• Cyclothymic disorder. This type of bipolar disorder is also known as cyclothymia. The NIMH says it’s defined by periods of hypomanic symptoms alternating with periods of depressive symptoms lasting at least 2 years, or 1 year in children and teens. These symptoms do not fully meet the criteria for a hypomanic episode or depressive episode.

Depending on the type of bipolar disorder and severity of mania or depression, symptoms can vary.

According to the American Psychiatric Association, symptoms of mania can include:

• less need for sleep
• increased or faster speech
• uncontrollable racing thoughts
• increased activity or risky behavior

Hypomanic symptoms are less severe manic symptoms. They do not cause the disturbances in functioning that manic symptoms do.

Symptoms of a major depressive episode include:

• intense sadness or despair
• loss of interest in activities previously enjoyed
• feelings of worthlessness or guilt
• fatigue
• changes in sleep or appetite
• trouble concentrating
• thoughts of death or suicide

Bipolar disorder is a lifelong illness. While it cannot be cured, it can be treated and managed. Medication and psychotherapy are common elements of treatment.

According to the NIMH, treatment often includes:

• Mood stabilizers. These types of medications are most frequently used to help manage bipolar disorder.
• Second-generation antipsychotics. These types of medications are also called atypical antipsychotics.
• Cognitive behavioral therapy (CBT). This therapy is also known as psychoeducation, and can include interpersonal and social rhythm therapy or family therapy.

What works for one person may not work for another. You may need to try different medications to find the one that works best for you. Talk with your therapist and healthcare professional about how your medication is working, if there are any problems, and if you are finding the therapy helpful.

Other treatments people may find helpful include:

• Electroconvulsive therapy. This is an effective treatment for severe depressive and manic episodes, especially if medication or therapy is not helpful.
• Transcranial magnetic stimulation. This treatment uses magnetic waves to stimulate the brain, but it’s still being studied for bipolar disorder.

Always talk with your healthcare professional about any vitamins, medications, and supplements you’re taking. Even “natural” products may interact with medications and can have unwanted side effects.

While brain scans aren’t typically used in diagnosing bipolar disorder, researchers are using them to explore the condition. This can help with future diagnostic processes, and potentially with treatment.

Currently, mental health professionals diagnose bipolar disorder through a clinical interview. From there, you can work together to develop a treatment plan. With appropriate treatment, bipolar disorder can be effectively managed.