Functional and Neurochemical Brain Changes Bipolar Depression

Inclusion Criteria - Depressed bipolar patients (N=100; 15-20 patients/year): 1. Patients will meet DSM-IV criteria for type I bipolar disorder, depressed, as determined by structured interview and best-estimate diagnostic procedures.138 2. Patient has experienced a maximum of three documented affective episodes. 3. Patient has been off medications for one week prior to study enrollment. 4. Patient has a Hamilton Depression Rating Scale (HDRS) total score ≥20 5. Patient is between the ages of 12 and 35 years. Exclusion criteria: All subjects will be excluded from participation for the following reasons: 1. Any chemical use disorder within 3 months. 2. Any history of significant suicidality that would place the patient at risk to participate in this protocol. 3. Current score ≥3 on item 3 of the HDRS-17 (Suicide Item) 4. Any medical or neurological disorder that could influence fMRI results. 5. A history of mental retardation or an estimated IQ total score \<85. 6. An MRI scan is contraindicated in the subject for any reason. 7. The patient lives \>100 miles from the University of Cincinnati or cannot attend follow-up visits. 8. Meets DSM-IV criteria for a bipolar mixed episode