The action of lithium in bipolar disorder (BD) is incompletely defined but the inositol depletion hypothesis1 states that lithium inhibits IMPase to deplete myo-inositol, confirmed in vivo using proton magnetic resonance spectroscopy (1H-MRS) following acute treatment2,3 Chronic treatment may upregulate IMPase, with trend-level increases in grey matter myo-inositol reported.4 This 1H-MRS study compares frontal white matter myo-inositol/creatine levels (8cm3 voxel) in BD subjects (lithium-treated versus BD controls taking other medication), supplemented by measuring brain lithium signal intensity using 3D 7Li-MRI. Myo-Ino/Cr levels were significantly lower in the lithium-treated group, but their levels did not correlate with 7Li-MRI signal intensity.
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