Bipolar (BPAD) and unipolar (MDD) depression are difficult to distinguish yet diverge in treatment. Functional near-infrared spectroscopy (fNIRS) during a verbal fluency task (VFT) probes prefrontal function, but three-group comparisons under leakage-free machine learning are scarce. This single-center cross-sectional study recorded 52-channel fNIRS during a phonemic VFT in 173 adults (64 healthy controls [HC], 61 MDD, 48 BPAD). Oxygenated-hemoglobin activation (VFT > Counting) was compared across eight Brodmann-based regions and four laterality indices with false-discovery-rate (FDR) correction. Three classification tasks used leakage-free nested cross-validation with permutation testing and Shapley additive explanation (SHAP) attribution. Both patient groups showed less prefrontal activation than HC (HC vs. BPAD Cohen’s d = 0.58, p = 0.003; HC vs. MDD Cohen’s d = 0.49, p = 0.010), most focally in the left inferior frontal gyrus/Broca’s area (HC vs. BPAD FDR p = 0.005, Cohen’s d = 0.60), persisting after age adjustment. BPAD showed a region-specific laterality reversal: a leftward dorsolateral prefrontal bias (laterality index + 0.22, p = 0.021) and loss of leftward Broca asymmetry seen in HC (+ 0.18, p = 0.032), though between-group laterality was not FDR-significant. Region-level features discriminated patients from HC (AUC 0.654, 95
Individuals with bipolar disorder experience high rates of cardiometabolic and other chronic medical comorbidities, yet there is limited bipolar-specific evidence on whether antidepressant class is associated with differential long-term medical risk. Using longitudinal electronic health record (EHR) data from a tertiary academic health system, we examined whether antidepressant class (selective serotonin reuptake inhibitors [SSRIs], serotonin–norepinephrine reuptake inhibitors [SNRIs], tricyclic antidepressants [TCAs], monoamine oxidase inhibitors [MAOIs], and atypical antidepressants) was associated with incident medical comorbidity among patients with bipolar disorder. This retrospective cohort included 50,706 antidepressant treatment instances among 15,613 unique patients with bipolar disorder. Comorbidities were derived from harmonized Charlson and Elixhauser indices. Baseline comorbidity status, after January 1, 2019, was taken from the most recent encounter prior to antidepressant initiation; follow-up was the first encounter after antidepressant discontinuation. Incident comorbidity was defined as absence at baseline and presence at follow-up within an instance. Generalized linear mixed-effects models with patient-level random intercepts, adjusted for age, sex, baseline comorbidity count, and log-transformed observation duration, with inverse probability of treatment weighting (IPTW), estimated odds of incident comorbidity by antidepressant class, with pairwise comparisons using a contrast matrix of log-odds differences with propagated standard errors. SSRIs were most commonly prescribed (50.6
Comparative-effectiveness evidence on lithium and valproate maintenance treatment in bipolar disorder comes largely from Nordic and United Kingdom registers, with little evidence from Middle Eastern health systems. To our knowledge, this is the first study from the United Arab Emirates, the Gulf Cooperation Council, or the wider Arab world to compare lithium and valproate initiation on psychiatric service use with an active-comparator new-user design. We compared 12-month psychiatric service use after lithium versus valproate initiation. We conducted a retrospective active-comparator new-user cohort study using electronic health records of a tertiary psychiatric hospital in the United Arab Emirates from 1 January 2018 to 22 December 2025. Eligible adults had an International Classification of Diseases, Tenth Revision, F31 diagnosis and initiated lithium or valproate as recorded new users. The primary outcome was the first inpatient admission or emergency department contact within 12 months. Adjustment used overlap propensity score weighting across 14 baseline-covariate terms. Emergency department chief complaints were classified to define relapse-indicative outcomes, and dispensing records described adherence. The cohort included 316 new users: 101 lithium and 215 valproate initiators. The overlap-weighted 12-month risk was 54.3
This correspondence is a commentary to the recently published report from the OSAN trial by Fiedorowicz et al. but with applicability to the broader research involving blue-blocking glasses and patients in a manic episode. Clinical studies on dark therapy are still rare, and we read with great interest the report from the OSAN trial published in Journal of Affective Disorders the 1st of April 2026. The sample was significantly higher in manic symptoms, more medicated and less adherent to the intervention than in preceding studies on effects of dark therapy for mania. Efforts to comply with the gold standard of blinding of raters may have come with the cost of underestimating the symptom level. Extended intervention period (2 weeks) may have caused the extensive loss to follow up (35/42 (83
Bipolar disorder is frequently characterized by reduced physical activity, increased sedentary behavior, and cognitive impairment, although the latter varies considerably across individuals. While physically active lifestyles are associated with better cognitive functioning in the general population, it remains unclear whether a similar relationship exists in bipolar disorder. This study explores physical activity patterns in bipolar disorder and assesses the association between cognitive status groups and self-reported and objectively measured physical activity. Cross-sectional data were available from 79 participants with bipolar disorder in full or partial remission. Physical activity patterns were assessed using retrospectively self-reported physical activity, Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), and accelerometer-measured physical activity over a 10-day period. Cognitive function was assessed with a self-administered Internet-based test platform. Participants were divided into 2 groups based on cognitive performance z-scores. Participants were classified as cognitively normal (0-1 test score at least 1 SD below the normative mean or cognitively impaired ( ≥ 2 test scores at least 1 SD below the normative mean). The recommended levels of 150 minutes accelerometer-measured physical activity of moderate-to-vigorous intensity in bouts of at least 10 minutes were reached by 43
