Emotion Regulation Differs Between Patients With Depressive and Bipolar Disorders

MedicalResearch.com Interview with:
Maaike M. M. Rive

Program for mood disorders
AMC/De Meren, Department of Psychiatry PA3.221
Amsterdam  The Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: For clinicians, it can be difficult to distinguish whether a depressed patient suffers from major depressive disorder (characterized by depressive episodes only) or bipolar disorder (characterized by both depressive and (hypo)manic episodes). Differentiation between the two disorders is important because e.g. the treatment approaches are different. Although we know that both types of mood disorders are characterized by emotion regulation disturbances, little is known about differences in emotion regulation between the two disorders.

Better insight in these differences would be helpful for differentiation between uni- and bipolar disorder. However, previous studies comparing these disorders often allowed medication use, and this may have influenced results. Furthermore, much is unknown about the effect of mood state on emotion regulation differences.

We therefore investigated emotion regulation by showing happy, sad and fearful pictures to patients and healthy controls. Participants were instructed to either passively view the pictures, or to distance themselves from their feelings, by thoughts like: ‘this is only a picture’, ‘this will never happen to me’, etc. Emotion regulation success was measured by the difference between subjective ratings of emotional intensity after passive viewing versus distancing. Brain activity was measured with fMRI.

The results of our study indicate that emotion regulation does indeed differ between medication-free major depressive or bipolar patients, and that specific differences depend on mood state. During remission, bipolar patients showed impaired emotion regulation across different types of emotions. In contrast, patients with major depressive disorder did not how such impairments during remission. During depression, patients differed regarding happy and sad emotion regulation: bipolar patients showed impaired sad, but unexpectedly normal happy emotion regulation, whereas in major depressive disorder, both sad and happy emotion regulation were compromised. These emotion regulation difficulties were associated with differences in brain activity in the dorsolateral prefrontal cortex (involved in effortful emotion regulation) and the rostral anterior cingulate cortex (connecting emotional and cognitive brain areas).

Medical Research: What should clinicians and patients take away from your report?

Response: Our findings suggest that major depressive and bipolar disorder are characterized by different underlying mechanisms of emotion regulation. This could provide opportunities for future diagnostic tests and/or so called biomarkers that can aid in the diagnosis of and differentiation between these two mood disorders. Currently, these results are not applicable for the individual patient yet, but our results can be used to guide future research to develop such diagnostic tools for major depressive and bipolar disorder.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: The next step would be to investigate whether the differences in brain activity related to emotion regulation can be used for individual diagnosis. More specific: it should be investigated whether our findings can be replicated in patients who never took any psychiatric medication, in patients who suffer from their first depressive episode and patients with different levels of depression severity. Furthermore, we have to ascertain to what extent medication use indeed interferes with these findings, to be able to use these insights in mood disorder clinics.


 JAMA Psychiatry. 2015 May 6. doi: 10.1001/jamapsychiatry.2015.0161. [Epub ahead of print]

State-Dependent Differences in Emotion Regulation Between Unmedicated Bipolar Disorder and Major Depressive Disorder.

Rive MM1, Mocking RJ1, Koeter MW1, van Wingen G1, de Wit SJ2, van den Heuvel OA3, Veltman DJ3, Ruhé HG4, Schene AH5.


MedicalResearch.com Interview with: Maaike M. M. Rive (2015). Emotion Regulation Differs Between Patients With Depressive and Bipolar Disorders MedicalResearch.com