Distinct neural signatures of reward processing underlying bipolar disorder and major depressive disorder: a systematic review and meta-analysis

TY - JOUR

T1 - Distinct neural signatures of reward processing underlying bipolar disorder and major depressive disorder

T2 - a systematic review and meta-analysis

AU - Wang, Yuxi

AU - Peng, Yujia

AU - Steele, J. Douglas

AU - Tolomeo, Serenella

N1 - © 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

PY - 2026/3/19

Y1 - 2026/3/19

N2 - The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) delays appropriate treatment. Identifying distinct biomarkers is essential for improving diagnostic accuracy. Neuroimaging studies highlight disorder-specific neural signatures of reward processing in BD and MDD, particularly during reward anticipation and consumption. This meta-analysis investigates differential neural activation patterns in BD and MDD relative to healthy controls. A systematic search of PUBMED, Web of Science, Brainmap.org, EMBASE, MEDLINE, PsycINFO, PsycARTICLES, and Scopus identified twenty-three fMRI studies including a total of 1,264 participants. During reward anticipation, BD exhibits hyperactivity in the left inferior frontal gyrus and insula, with reduced activity in the right inferior frontal gyrus and insula. No consistent amplification or attenuation was observed during reward delivery. In contrast, MDD only shows blunted responses in the bilateral caudate during reward delivery. These findings reveal distinct neural signatures of reward processing in BD and MDD, offering potential neurobiological biomarkers for differentiation. This may contribute to precision psychiatry by enhancing diagnostic accuracy and informing targeted interventions.

AB - The misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD) delays appropriate treatment. Identifying distinct biomarkers is essential for improving diagnostic accuracy. Neuroimaging studies highlight disorder-specific neural signatures of reward processing in BD and MDD, particularly during reward anticipation and consumption. This meta-analysis investigates differential neural activation patterns in BD and MDD relative to healthy controls. A systematic search of PUBMED, Web of Science, Brainmap.org, EMBASE, MEDLINE, PsycINFO, PsycARTICLES, and Scopus identified twenty-three fMRI studies including a total of 1,264 participants. During reward anticipation, BD exhibits hyperactivity in the left inferior frontal gyrus and insula, with reduced activity in the right inferior frontal gyrus and insula. No consistent amplification or attenuation was observed during reward delivery. In contrast, MDD only shows blunted responses in the bilateral caudate during reward delivery. These findings reveal distinct neural signatures of reward processing in BD and MDD, offering potential neurobiological biomarkers for differentiation. This may contribute to precision psychiatry by enhancing diagnostic accuracy and informing targeted interventions.

KW - Reward anticipation

KW - Reward outcome

KW - Bipolar disorder

KW - Major depressive disorder

KW - Meta-analysis

U2 - 10.1016/j.pscychresns.2026.112196

DO - 10.1016/j.pscychresns.2026.112196

M3 - Article

SN - 0925-4927

VL - 359

JO - Psychiatry Research: Neuroimaging

JF - Psychiatry Research: Neuroimaging

M1 - 112196

ER -