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Glutamatergic Neurometabolite Levels in Bipolar Disorder: A Systematic Review and Meta-analysis of Proton Magnetic Resonance Spectroscopy Studies

Published:October 22, 2022DOI:https://doi.org/10.1016/j.bpsc.2022.09.017

      ABSTRACT

      Background

      The glutamatergic system is thought to play an important role in the pathophysiology of bipolar disorder (BD). While there has been an increase in proton magnetic resonance spectroscopy (1H-MRS) studies examining this neurotransmission system, the results are inconsistent. Possible reasons for the inconsistency include clinical features such as mood state and childhood versus adulthood age were not addressed in previous meta-analyses.

      Methods

      This systematic review and meta-analysis of 1H-MRS studies on BD included 40 studies, with 1,135 patients with BD and 964 healthy controls (HCs).

      Results

      Glutamate plus glutamine (Glx) and glutamine levels in the anterior cingulate cortex (ACC) of patients with BD were significantly elevated compared with those of HCs (standardized mean difference = 0.42; 0.48, respectively). Subgroup analyses showed that adult patients had significantly higher levels of Glx than adult HCs, but not in pediatric patients. For mood states, ACC Glx levels were higher in patients with bipolar depression than that in HCs.

      Conclusions

      Our results imply that glutamatergic dysfunction in the ACC may be implicated in the pathophysiology of BD, which is most evident in adult BD and depressed BD.

      Keywords

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