Brain Volume Changes at 6 Weeks After Starting Lithium Monotherapy for BD Depression

Patients with bipolar disorder in an acute depressive episode underwent magnetic resonance imaging at baseline and following 6 weeks of lithium monotherapy.

A study published in Psychiatry Research: Neuroimaging found that 6 weeks of lithium therapy was associated with positive brain adaptations among young adults with bipolar disorder (BD).

This study was conducted between 2010 and 2012 at the University of Sao Paulo in Brazil. Patients (N=23) with BD in an acute depressive episode underwent magnetic resonance imaging (MRI) at baseline and following 6 weeks of lithium monotherapy. Changes to brain structures were evaluated.

Patients were aged mean 28.5±5.6 years, 73.9% were women, and all had fewer than 3 mood episodes in their lifetime.

After 6 weeks of lithium, 86.2% responded to treatment and 62.0% were in remission and the mean Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS) scores were 7.6±5.9 and 2.8±3.6 points, respectively.

The brain regions with an extreme level of evidence that lithium treatment had an effect on region volume were third ventricle (-4.83%), cortex (0.62%), total gray matter (0.57%), and right lateral ventricle (-5.98%). The regions with very strong evidence were left lateral ventricle (-6.15%), brain stem (0.54%), and right hippocampus (0.88%). The regions with strong evidence of an effect were supratentorial region (0.28%), fourth ventricle (-2.11%), right thalamus proper (1.02%), right cerebellum white matter (0.79%), and right cerebellum cortex (0.52%).

This study was likely limited by the short study duration. Some previous studies have found that the changes in brain volume peak at 10-16 weeks after lithium treatment.

The study authors concluded, “In line with prior studies, following lithium treatment, patients displayed reductions in lateral, third, and fourth ventricular volume. Evidentiary certainty was strong (or better) for the volumetric increases in total gray matter, cortical, supratentorial, brain stem, right thalamic, and right cerebellar (cortical and white matter). Larger thalamic volumes are consistent with the results of the 2 largest MRI studies to date. Likewise, larger global gray matter volumes are consistent with meta and mega analyses.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Jones G, Suchting R, Zanetti MV, et al. Lithium affects cortical and subcortical volume in bipolar depressed patients. Psychiatry Res Neuroimaging. 2022;324:111494. doi:10.1016/j.psychresns.2022.111494

This article originally appeared on Psychiatry Advisor