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Sex differences in bipolar disorder: a review of neuroimaging findings and new evidence


Corresponding author:
Sophia Frangou, M.D., Ph.D.
Department of Psychosis Studies
Section of Neurobiology of Psychosis
Institute of Psychiatry, PO66
King’s College London
De Crespigny Park
Fax: +442078480983


Jogia J, Dima D, Frangou S. Sex differences in bipolar disorder: a review of neuroimaging findings and new evidence.
Bipolar Disord 2012: 14: 461–471. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S.

Objectives:  The sex of an individual is known to modulate the clinical presentation of bipolar disorder (BD), but little is known as to whether there are significant sex-by-diagnosis interactions on the brain structural and functional correlates of BD.

Methods:  We conducted a literature review of magnetic resonance imaging (MRI) studies in BD, published between January 1990 and December 2010, reporting on the effects of sex and diagnosis. In the absence of any functional MRI (fMRI) studies, this review was supplemented by original data analyses focusing on sex-by-diagnosis interactions on patterns of brain activation obtained during tasks of working memory, incentive decision-making, and facial affect processing.

Results:  We found no support for a sex-by-diagnosis interaction in global gray or white matter volume. Evidence regarding regional volumetric measures is limited, but points to complex interactions between sex and diagnosis with developmental and temperamental factors within limbic and prefrontal regions. Sex-by-diagnosis interactions were noted in the pattern of activation within the basal ganglia during incentive decision-making and within ventral prefrontal regions during facial affect processing.

Conclusions:  Potential sex-by-diagnosis interactions influencing the brain structural and functional correlates of disease expression in BD have received limited attention. Our data suggest that the sex of an individual modulates structure and function within subcortical and cortical regions implicated in disease expression.