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 studies examining this neurotransmission system, the results are inconsistent.
Possible reasons for the inconsistency, including 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 proton magnetic resonance spectroscopy
studies of BD included 40 studies, with 1135 patients with BD and 964 healthy control
(HC) subjects.
Results
Glutamate plus glutamine and glutamine levels in the anterior cingulate cortex of
patients with BD were significantly elevated compared with those of HC subjects (standardized
mean difference = 0.42, 0.48, respectively). Subgroup analyses showed that adult BD
patients had significantly higher levels of glutamate plus glutamine than adult HC
subjects, but this was not the case in pediatric patients. For mood states, anterior
cingulate cortex glutamate plus glutamine levels were higher in patients with bipolar
depression than those in HC subjects.
Conclusions
Our results imply that glutamatergic dysfunction in the anterior cingulate cortex
may be implicated in the pathophysiology of BD, which is most evident in adult BD
patients and patients with bipolar depression.
Keywords
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Article info
Publication history
Published online: October 22, 2022
Accepted:
September 28,
2022
Received in revised form:
September 27,
2022
Received:
November 18,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc on behalf of Society of Biological Psychiatry.
