Q: Using MRI for BP Diagnosis and Treatment?
I have learned a lot about bipolar from your web site and appreciate your work
on education for patients. I have read about some interesting new
developments in the use of MRI to treat and diagnose bipolar disorder. I
would enjoy hearing your opinion. The first article reports on some
serendipitous results that researchers at McClean found in using a unique MRI
modality on depressed patients with bipolar disorder. How likely is the
development of a tabletop scanner that can “rebalance” those pesky frontal
lobes? I find the depressive phase of BP the most awful and disruptive,
any new approach sure would be welcome.
The second article details the use of MRI scans to diagnose BP. Can it be
used to shorten the average 10-year time to correct diagnosis?
Thanks again for sharing your expertise with the bipoworld community!
Hello Ms. H' --
Thanks for your encouragement of my writing; glad you find it of use. You raise
two very interesting areas of research.
First, on the MRI scanner as treatment. As you may know, there is a
technique called rTMS, repetitive Transcranial Magnetic Stimulation, that's been
under research for at least 10 years. It is perhaps close to getting FDA
approval as a medical device for treatment of depression (a third try at this is
underway). I was getting very serious about buying one of these devices, about
$20 - $25,000, worth, when the Mclean study you linked came out.
The rTMS device has to be used in a fairly specific way, a certain location
on the skull to stimulate just a certain portion of the frontal cortex, at a
certain rate: thus duration of stimulation, position, intensity have all been
studied, although that work is still going. All of a sudden, comes the Harvard
report (I like this story because apparently a radiology technician basically
got the idea for the study when he observed that people coming out of the
scanner seemd "happier" than when they went in, and it's not the kind of
experience (a little tube to lie in for 20-30 minutes) that you'd think would
have that kind of effect. What I like about the story is that the research doc's
listened to the tech person! So, they took her/him seriously and designed
a study to test this observation, and sure enough, they got a very strong
Your link leads to a
lengthier story about this study
that concludes, as you probably noted: "We are also planning a much larger
clinical study using this smaller device to further test this effect," adds
Rohan. Researchers believe one day such a device may be used during perhaps a
20-minute nap at a doctor's office."
The irony here is that the Mclean result was so strong that it has derailed,
for me at least, the move toward rTMS. The TMS magnet requires some skill to
use, and having too strong a pulse has caused a very, very small number of
seizures (7 in all the research done so far; none since the researchers started
using 20 hertz as a maximum strength). So if there was a simpler way, that would
be much better (TMS can cause some headaches as well but is otherwise apparently
otherwise completely safe, according to results thus far; of course, long term
repetitive use has not been studied -- for TMS or this newer McLean-based
approach). So, I've shelved my plans to buy the rTMS device as a result of this
The really puzzling part is that the rTMS work is based on stimulating the
brain in a very focused area, whereas the McLean approach stimulates the whole
brain, although at a much lower energy level. So, there is going to be some
serious work to be done figuring out which approach is better, as well as just
how they work in the first place, if the smaller device the McLean team is going
to test turns out to work like their big scanner did.
Finally, note that the scanner is not your average MRI rig; this was MRS,
magnetic resonance spectroscopy, and the settings are different. I'll
have to ask on of my radiology colleagues if the entire device is
different; certainly the software is, but that wouldn't really matter if the
magnet is the same or can be made to function the same. I certainly understand
the appeal of the simpler device for patient care. This is going to be
interesting (including the debate -- can you imagine? -- about who's eligible to
get this treatment; i.e. what happens if people want to use it to just cheer up
a bit on a bad day, for example?)
Secondly, there's the use of MRI diagnostically. To be brief: "not there
yet", nor even close as far as I know; and we could wonder whether it would be a
good thing if it could be done, as this is a very expensive way to get to a
diagnosis for a condition that is very common, and we're already spending
too much in medical care generally, (including on tech' tools like this) and too
little on mental health treatment.
Published July, 2004