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Discriminating unipolar and bipolar depression by means of fMRI and pattern classification: a pilot study

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Abstract

Bipolar disorders rank among the most debilitating psychiatric diseases. Bipolar depression is often misdiagnosed as unipolar depression, leading to suboptimal therapy and poor outcomes. Discriminating unipolar and bipolar depression at earlier stages of illness could therefore help to facilitate efficient and specific treatment. In the present study, the neurobiological underpinnings of emotion processing were investigated in a sample of unipolar and bipolar depressed patients matched for age, gender, and depression severity by means of fMRI. A pattern-classification approach was employed to discriminate the two samples. The pattern classification yielded up to 90 % accuracy rates discriminating the two groups. According to the feature weights of the multivariate maps, medial prefrontal and orbitofrontal regions contributed to classifications specific to unipolar depression, whereas stronger feature weights in dorsolateral prefrontal areas contribute to classifications as bipolar. Strong feature weights were observed in the amygdala for the negative faces condition, which were specific to unipolar depression, whereas higher amygdala features weights during the positive faces condition were observed, specific to bipolar subjects. Standard univariate fMRI analysis supports an interpretation, where this might be related to a higher responsiveness, by yielding a significant emotion × group interaction within the bilateral amygdala. We conclude that pattern-classification techniques could be a promising tool to classify acutely depressed subjects as unipolar or bipolar. However, since the present approach deals with small sample sizes, it should be considered as a proof-of-concept study. Hence, results have to be confirmed in larger samples preferably of unmedicated subjects.

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Acknowledgments

The study was supported by grants of Innovative Medizinische Forschung of the Medical Faculty, University of Münster (IMF AR510403 to VA, IMF DA120309 to UD and IMF DA211012 to UD) and Rolf-Dierichs-Stiftung (ZUW80037 to UD). These funding sources had no influence on the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All authors state that they have no conflicts of interest to declare, financial or otherwise.

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Authors and Affiliations

  1. Department of Psychiatry, University of Münster, Albert-Schweitzer-Campus 1 A9, 48149, Münster, Germany

    Dominik Grotegerd, Thomas Suslow, Jochen Bauer, Patricia Ohrmann, Volker Arolt, Anja Stuhrmann & Udo Dannlowski

  2. Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany

    Thomas Suslow

  3. Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Campus 1 A1, 48149, Münster, Germany

    Walter Heindel & Harald Kugel

  4. Department of Psychiatry, University of Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Germany

    Udo Dannlowski

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  1. Dominik Grotegerd
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Correspondence to Udo Dannlowski.

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Grotegerd, D., Suslow, T., Bauer, J. et al. Discriminating unipolar and bipolar depression by means of fMRI and pattern classification: a pilot study. Eur Arch Psychiatry Clin Neurosci 263, 119–131 (2013). https://doi.org/10.1007/s00406-012-0329-4

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