Cerebral blood flow in bipolar disorder

Brain function is highly reliant on cerebral blood flow (CBF). Despite the availability of multiple methods of evaluating CBF, this approach is currently underutilized in bipolar disorder research. While CBF offers its own unique advantages, it is also relevant to other functional and structural imaging modalities. Measures of CBF may offer important insights into the etiopathology of bipolar disorder given its connection to cerebral metabolism, cardiovascular risk, and microvascular function, all domains relevant to bipolar disorder. This chapter outlines how CBF is measured and summarizes literature to date regarding CBF difference across mood states, CBF in relation to other psychiatric populations, and the association of CBF with psychiatric treatments and treatment response. Finally, we propose an integrative supply-demand model outlining why anomalous perfusion may be observed in bipolar disorder and the possibility of engaging CBF as a novel treatment target. Future, prospective studies are needed to examine CBF as it relates to course of illness, vascular pathology, and treatment in bipolar disorder across the lifespan.