Skip to main content

Advertisement

SpringerLink
Log in

Circadian Rhythm Dysregulation in Bipolar Spectrum Disorders

  • Sleep Disorders (P Gehrman, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We review recent evidence for circadian rhythm dysregulation in bipolar spectrum disorders (BSDs). We examine evidence for endogenous abnormalities in the biological clock and disruptions in the external entrainment of circadian rhythms in BSDs. We also address whether circadian dysregulation provides vulnerability to onset of BSD and evidence for a new integration of reward and circadian dysregulation in BSD.

Recent Findings

Relative circadian phase delay (e.g., later melatonin peak, evening chronotype) is associated with BSD, particularly in the depressive phase. More consistent evidence supports irregularity of social rhythms, sleep/wake and activity patterns, and disruptions of social rhythms by life events, as stable trait markers of BSD and potential vulnerabilities for BSD onset. Growing research supports an integrative reward/circadian model.

Summary

Both endogenous abnormalities in the biological clock pacemaking function and disruptions in the external entrainment of circadian rhythms by physical and social cues are involved in BSDs. Circadian dysregulation may provide vulnerability to BSD onset.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Alloy LB, Urošević S, Abramson LY, Jager-Hyman S, Nusslock R, et al. Progression along the bipolar spectrum: a longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders. J Abnorm Psychol. 2012b;121:16–27.

    Article  PubMed  Google Scholar 

  2. Birmaher B, Axelson D, Goldstein B, Strober M, Gill MK, et al. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the course and outcome of bipolar youth (COBY) study. Am J Psychiatry. 2009;166:795–804.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Akiskal HS, Djenderedjian AH, Rosenthal RH, Khani MK. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am J Psychiatry. 1977;134:1227–33.

    Article  CAS  PubMed  Google Scholar 

  4. Kochman FJ, Hantouche EG, Ferrari P, Lancrenon S, Bayart D, Akiskal HS. Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J. Affec. Disord. 2005;85:181–9.

    Article  CAS  Google Scholar 

  5. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RMA, et al. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2007;64:543–52.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boland EM, Alloy LB. Sleep disturbance and cognitive deficits in bipolar disorder: toward an integrated examination of disorder maintenance and functional impairment. Clin Psychol Rev. 2013;33:33–44.

    Article  PubMed  Google Scholar 

  7. Miller S, Dell’Osso B, Ketter TA. The prevalence and burden of bipolar depression. J. Affec. Disord. 2014;169:S3–11.

    Article  Google Scholar 

  8. Reppert SM, Wever DR. Molecular analysis of mammalian circadian rhythms. Ann Rev Physiol. 2001;63:647–76.

    Article  CAS  Google Scholar 

  9. Roenneberg T, Merrow M. Entrainment of the human circadian clock. Cold Spring Harb Symp Quant Biol. 2007;72:293–9.

    Article  CAS  PubMed  Google Scholar 

  10. Grandin LD, Alloy LB, Abramson LY. The social zeitgeber theory, circadian rhythms, and mood disorders: review and evaluation. Clin Psychol Rev. 2006;26:679–94.

    Article  PubMed  Google Scholar 

  11. Lewy AJ, Sack RL. The dim light melatonin onset as a marker for circadian phase position. Chronobiol Int. 1989;6:93–102.

    Article  CAS  PubMed  Google Scholar 

  12. Abreu T, Braganca M. The bipolarity of light and dark: a review on bipolar disorder and circadian cycles. J. Affec. Disord. 2015;185:219–29.

    Article  CAS  Google Scholar 

  13. McClung CA. Circadian genes, rhythms and the biology of mood disorders. Pharmacol & Ther. 2007;114:222–32.

    Article  CAS  Google Scholar 

  14. •• Murray G, Harvey A. Circadian rhythms and sleep in bipolar disorder. Bipolar Disord. 2010;12:459–72. This theoretical review of biological rhythm pathways to bipolar disorder emphasizes the importance of person-environment feedback loops to circadian adaptation.

    Article  PubMed  Google Scholar 

  15. Ehlers CL, Frank E, Kupfer DJ. Social zeitgebers and biological rhythms: a unified approach to understanding the etiology of depression. Arch Gen Psychiatry. 1988;45:948–52.

    Article  CAS  PubMed  Google Scholar 

  16. Stetler C, Dickerson SS, Miller GE. Uncoupling of social zeitgebers and diurnal cortisol secretion in clinical depression. Psychoneuroendocrinol. 2004;29:1250–9.

    Article  CAS  Google Scholar 

  17. Goel N. Late-night presentation of an auditory stimulus phase delays human circadian rhythms. Am J Physiol – Reg Integrat Compar Physiol. 2005;289:R209–16.

    Article  CAS  Google Scholar 

  18. Lewy AJ. Circadian misalignment in mood disturbances. Curr Psychiat Rep. 2009;11:459–65.

    Article  Google Scholar 

  19. •• Nováková M, Praško J, Látalová K, Sládek M, Sumová A. The circadian system of patients with bipolar disorder differs in episodes of mania and depression. Bipolar Disord. 2015;17:303–14. This recent study demonstrates differences in the circadian system in different mood states of bipolar disorder.

    Article  PubMed  CAS  Google Scholar 

  20. Robillard R, Naismith SL, Rogers NL, Scott EM, Ip TKC, Hermens DF, et al. Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: comparison of unipolar and bipolar phenotypes. Eur Psychiat. 2013;28:412–6.

    Article  CAS  Google Scholar 

  21. • Dallaspezia S, Benedetti F. Melatonin, circadian rhythms, and the clock genes in bipolar disorder. Curr Psychiatry Rep. 2009;11:488–93. This article reviews circadian rhythm disruption and chronotherapeutic strategies in bipolar disorder.

    Article  PubMed  Google Scholar 

  22. Nurnberger Jr JI, Adkins S, Lahiri DK, Mayeda A, Hu K, Lewy A, et al. Melatonin suppression by light in euthymic bipolar and unipolar patients. Arch Gen Psychiat. 2000;57:572–9.

    Article  CAS  PubMed  Google Scholar 

  23. Kennedy SH, Kutcher SP, Ralevski E, Brown GM. Nocturnal melatonin and 24-hour 6-sulphatoxymelatonin levels in various phases of bipolar affective disorder. Psychiat. Res. 1996;63:219–22.

    Article  CAS  Google Scholar 

  24. Nurnberger Jr JI, Berrettini W, Tamarkin L, Hamovit J, Norton J, Gershon E. Supersensitivity to melatonin suppression by light in young people at high risk for affective disorder. A preliminary report. Neuropsychopharmacol. Off. Publ. Am. Coll. Neuropsychopharmacol. 1988;1:217–23.

    Article  Google Scholar 

  25. Lewy AJ, Nurnberger Jr JI, Wehr TA, Pack D, Becker LE, Powell RL, et al. Supersensitivity to light: possible trait marker for manic-depressive illness. Am J Psychiat. 1985;142:725–7.

    Article  CAS  PubMed  Google Scholar 

  26. Lewy AJ, Wehr TA, Goodwin FK, Newsome DA, Rosenthal NE. Manic-depressive patients may be supersensitive to light. Lancet Lond Engl. 1981;1:383–4.

    Article  CAS  Google Scholar 

  27. Lam RW, Berkowitz AL, Berga SL, Clark CM, Kripke DF, Gillin JC. Melatonin suppression in bipolar and unipolar mood disorders. Psychiat. Res. 1990;33:129–34.

    Article  CAS  Google Scholar 

  28. Whalley LJ, Perini T, Shering A, Bennie J. Melatonin response to bright light in recovered, drug-free, bipolar patients. Psychiat. Res. 1991;38:13–9.

    Article  CAS  Google Scholar 

  29. Shi J, Wittke-Thompson JK, Badner JA, Hattori E, Potash JB, Willour VL, et al. Clock genes may influence bipolar disorder susceptibility and dysfunctional circadian rhythm. Am J Med Genet. 2008;147B:1047–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Kripke DF, Nievergelt CM, Joo E, Shekhtman T, Kelsoe JR. Circadian polymorphisms associated with affective disorders. J Circad Rhythms. 2009;7:2.

    Article  CAS  Google Scholar 

  31. Benedetti F, Serretti A, Colombo C, Barbini B, Lorenzi C, Campori E, Smeraldi E. Influence of CLOCK gene polymorphism on circadian mood fluctuation and illness recurrence in bipolar depression. Am J Med Genet. 2003;123B:23–6.

    Article  PubMed  Google Scholar 

  32. Nievergelt CM, Kripke DF, Barrett TB, Burg E, Remick RA, Sadovnick AD, et al. Suggestive evidence for association of the circadian genes PERIOD3 and ARNTL with bipolar disorder. Am J Med Genet. 2006;141B:234–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Mansour HA, Monk TH, Nimgaonkar VL. Circadian genes and bipolar disorder. Ann Med. 2005a;37:196–205.

    Article  CAS  PubMed  Google Scholar 

  34. Lai YC, Kao CF, Lu ML, Chen HC, Chen PY, Chen CH, et al. Investigation of associations between NR1D1, RORA and RORB genes and bipolar disorder. PLoS One. 2015;10(3):e0121245.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. • Benedetti F, Riccaboni R, Dallaspezia S, Locatelli C, Smeraldi E, Colombo C. Effects of CLOCK gene variants and early stress on hopelessness and suicide in bipolar depression. Chronobiol Int. 2015;32(8):1156–61. This study nicely illustrates the interaction between genetic vulnerability and environmental stress on the course of BSDs.

    Article  PubMed  Google Scholar 

  36. Bernert RA, Hasler BP, Cromer KR, Joiner TE. Diurnal preferences and circadian phase: a meta-analysis. Sleep. 2006;29:A54–5.

    Google Scholar 

  37. • Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: a comprehensive review. Chronobiol Internat. 2012;29(9):1153–75. This is a comprehensive review of the psychological correlates of chronotype.

    Article  Google Scholar 

  38. • Melo MCA, Abreu RLC, Linhares Neto VB., de Bruin PFC, de Bruin VMS. Chronotype and circadian rhythm in bipolar disorder: A systematic review. Sleep Med. Rev. 2016;https://doi.org/10.1016/j.smrv.2016.06.007. This is the first comprehensive and systematic review of the role of morningness-eveningness in bipolar disorder.

  39. Ahn YM, Chang J, Joo YH, Kim SC, Lee KY, Kim YS. Chronotype distribution in bipolar I disorder and schizophrenia in a Korean sample. Bipolar Disord. 2008;10:271–5.

    Article  PubMed  Google Scholar 

  40. Baek JH, Kim JS, Kim MJ, Ryu S, Lee K, Ha K, et al. Lifetime characteristics of evening-preference and irregular bed-rise time are associated with lifetime seasonal variation of mood and behavior: comparison between individuals with bipolar disorder and healthy controls. Behav Sleep Med. 2016;14(2):155–68.

    Article  PubMed  Google Scholar 

  41. Boudebesse C, Lajnef M, Geoffroy PA, Bellivier I, Nieto S, Gard E, et al. Chronotypes of bipolar patients in remission: validation of the French version of the circadian type inventory in the FACE-BD sample. Chronobiol. Internat. 2013;30:1042–9.

    Article  CAS  Google Scholar 

  42. Giglio LMF, Magalhaes PVS, Andersen ML, Walz JC, Jakobson L, Kapczinski F. Circadian preference in bipolar disorder. Sleep Breath. 2010;14:153–5.

    Article  PubMed  Google Scholar 

  43. Kim KL, Weissman AB, Puzia ME, Cushman GK, Seymour KE, Wegbreit E, et al. Circadian phase preference in pediatric bipolar disorder. J Clin Med Res. 2014;3(1):255–66.

    Google Scholar 

  44. • Wood J, Birmaher B, Axelson D, Ehmann M, Kalas C, et al. Replicable differences in preferred circadian phase between bipolar disorder patients and control individuals. Psychiat Res. 2009;166:201–9. This longitudinal study examines the relationship between eveningness and bipolar disorder using a large, well-defined sample with systemically recruited controls and evaluation of potential confounding factors.

    Article  Google Scholar 

  45. Saunders EF, Novick DM, Fernandez-Mendoza J, Kamali M, Ryan KA, Langenecker SA, et al. Sleep quality during euthymia in bipolar disorder: the role of clinical features, personality traits, and stressful life events. Int J Bipolar Disord. 2013;1:16.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Chung JK, Lee KY, Kim SH, Kim E, Jeong SH, et al. Circadian rhythm characteristics in mood disorders: comparison among bipolar I disorder, bipolar II disorder, and recurrent major depressive disorder. Clin Psychopharm Neurosci. 2012;10:110–6.

    Article  Google Scholar 

  47. Mansour HA, Wood J, Chowdari KV, Dayal M, Thase ME, et al. Circadian phase variation in bipolar I disorder. Chronobiol Int. 2005b;22:571–84.

    Article  PubMed  Google Scholar 

  48. Ashman SB, Monk TH, Kupfer JD, Clark CH, Myers FS, Frank E, et al. Relationship between social rhythms and mood in patients with rapid cycling bipolar disorder. Psychiat. Res. 1999;86(1):1–8.

    Article  CAS  Google Scholar 

  49. Seleem MA, Merranko JA, Goldstein TR, Goldstein BI, Axelson DA, Brent DA, et al. The longitudinal course of sleep timing and circadian preferences in adults with bipolar disorder. Bipolar Disord. 2015;17:392–402.

    Article  PubMed  Google Scholar 

  50. Brambilla C, Gavinelli C, Delmonte D, Fulgosi MC, Barbini B, Colombo C, et al. Seasonality and sleep: a clinical study on euthymic mood disorder patients. Depression Res. Treat. 2012; http://dx.doi.org/10.1155/2012/978962.

  51. Ng TH, Chung KF, Lee CT, Yeung WF, Ho FY. Eveningness and its associated impairments in remitted bipolar disorder. Behav Sleep Med. 2016a;14(6):650–64.

    Article  PubMed  Google Scholar 

  52. Etain B, Jamain S, Milhiet V, Lajnef M, Boudebesse C, Dumaine A, et al. Association between circadian genes, bipolar disorders and chronotypes. Chronobiol. Internat. 2014;31(7):807–14.

    Article  CAS  Google Scholar 

  53. Kripke DF, Klimecki WT, Nievergelt CM, Rex KM, Murray SS, Shekhtman T, et al. Circadian polymorphisms in night owls, in bipolars, and in non-24-hour sleep cycles. Psychiat Investig. 2014;11:345–62.

    Article  CAS  Google Scholar 

  54. Lee KY, Song JY, Kim SH, Kim SC, Joo EJ, Ahn YM, et al. Association between CLOCK 3111T/C and preferred circadian phase in Korean patients with bipolar disorder. Prog Neuropsychopharmacol Biol Psychiat. 2010;4:1196–201.

    Article  CAS  Google Scholar 

  55. Bullock B, Corlass-Brown J, Murray G. Eveningness and seasonality are associated with the bipolar disorder vulnerability trait. J Psychopathol & Behav Assess. 2014;36:443–51.

    Article  Google Scholar 

  56. Zanini MA, Castro J, Cunha GR, Asevedo E, Pan PM, Bittencourt L, et al. Abnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder. Schiz Res. 2015;169(3):262–7.

    Article  Google Scholar 

  57. Monk TH, Flaherty JF, Frank E, Hoskinson K, Kupfer DJ. The social rhythm metric: an instrument to quantify the daily rhythms of life. J Nerv Ment Dis. 1990;178:120–6.

    Article  CAS  PubMed  Google Scholar 

  58. Giglio LMF, Magalhaes PV, Andreazza AC, Walz JC, Jakobson L, et al. Development and use of a biological rhythm interview. J Affec Disord. 2009;118:161–5.

    Article  Google Scholar 

  59. Jones SH, Hare DJ, Evershed K. Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder. Bipolar Disord. 2005;7:1–11.

    Google Scholar 

  60. • Shen GC, Alloy LB, Abramson LY, Sylvia LG. Social rhythm regularity and the onset of affective episodes in bipolar spectrum individuals. Bipolar Disord. 2008a;10:520–9. This longitudinal study demonstrates that social rhythm irregularity prospectively predicts recurrences of major depressive and hypomanic/manic episodes in individuals with BSD.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Pinho M, Sehmbi M, Cudney E, Kauer-Sant’anna M, Magalhaes PV, et al. The association between biological rhythms, depression, and functioning in bipolar disorder: a large multi-center study. Acta Psychiat Scand. 2015;133:102–8.

    Article  Google Scholar 

  62. Rosa AR, Comes M, Torrent C, Sole B, Reinares M, et al. Biological rhythm disturbance in remitted bipolar patients. Internat J Bipolar Disord. 2013;1:1–6.

    Article  Google Scholar 

  63. Sylvia LG, Alloy LB, Hafner JA, Gauger MC, Verdon K, Abramson LY. Life events and social rhythms in bipolar spectrum disroders: a prospective study. Behav Ther. 2009;40:131–41.

    Article  PubMed  Google Scholar 

  64. Malkoff-Schwartz S, Frank E, Anderson BP, Hlastala SA, Luther JF, et al. Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes. Psychol Med. 2000;30:1005–10.

    Article  CAS  PubMed  Google Scholar 

  65. Malkoff-Schwartz S, Frank E, Anderson BP, Sherrill JT, Siegel L, et al. Stressful life events and social rhythm disruption in the onset of manic and depressive bipolar episodes: a preliminary investigation. Arch Gen Psychiatry. 1998;55:702–7.

    Article  CAS  PubMed  Google Scholar 

  66. • Boland EM, Bender RE, Alloy LB, Conner BT, DR LB, Abramson LY. Life events and social rhythms in bipolar spectrum disorders: an examination of social rhythm sensitivity. J. Affec. Disord. 2012;139:264–72. This study finds that individuals with BSDs are more sensitive to social rhythm disruption than matched controls following similar magnitude and valence life events.

    Article  Google Scholar 

  67. Depue RA, Krauss S, Spoont MR, Arbisi P. General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population. J Abnorm Psychol. 1989;98:117–26.

    Article  CAS  PubMed  Google Scholar 

  68. Alloy LB, Abramson LY, Walshaw PD, Cogswell A, Grandin LD, et al. Behavioral approach system and behavioral inhibition system sensitivities: prospective prediction of bipolar mood episodes. Bipolar Disord. 2008;10:310–22.

    Article  PubMed  Google Scholar 

  69. Bullock B, Judd F, Murray G. Social rhythms and vulnerability to bipolar disorder. J. Affec. Disord. 2011;135:384–8.

    Article  Google Scholar 

  70. Shen GC, Sylvia LG, Alloy LB, Barrett F, Kohner M, et al. Lifestyle regularity and cyclothymic symptomatology. J Clin Psychol. 2008b;64:482–500.

    Article  PubMed  Google Scholar 

  71. Meyer TD, Maier S. Is there evidence for social rhythm instability in people at risk for affective disorders? Psychiatr Res. 2006;141:103–14.

    Article  Google Scholar 

  72. •• Alloy LB, Boland EM, Ng T, Whitehouse WG, Abramson LY. Low social rhythm regularity predicts first onset of bipolar spectrum disorders among at risk individuals with reward hypersensitivity. J Abnorm Psychol. 2015a;124:944–52. This is the first truly prospective study to demonstrate that social rhythm irregularity predicts first onset of BSD in at-risk adolescents with reward hypersensitivity.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Alloy LB, Bender RE, Whitehouse WG, Wagner CA, Liu RT, et al. High behavioral approach system (BAS) sensitivity, reward responsiveness, and goal-striving predict first onset of bipolar spectrum disorders: a prospective behavioral high-risk design. J Abnorm Psychol. 2012a;121:399–51.

    Google Scholar 

  74. •• Boland EM, Stange JS, LaBelle DR, Shapero BG, Weiss RB, et al. Affective disruption from social rhythm and behavioral approach system (BAS) sensitivities: a test of the integration of the social zeitgeber and reward theories of bipolar disorder. Clin. Psychol. Sci. 2016;4:418–32. This is the first study to demonstrate that social rhythm disruption mediates the effects of reward-relevant life events in predicting prospective bipolar mood symptoms in individuals at risk for BSDs.

    Article  PubMed  Google Scholar 

  75. Jones SH, Tai S, Evershed K, Knowles R, Bentall R. Early detection of bipolar disorder: a pilot familial high-risk study of parents with bipolar disorder and their adolescent children. Bipolar Disord. 2006;8:362–72.

    Article  PubMed  Google Scholar 

  76. • De Crescenzo F, Economou A, Sharpley AL, Gormez A, Quested DJ. Actigraphic features of bipolar disorder: A systematic review and meta-analysis. Sleep Med. Rev. 2017;doi:10.1016/j.smrv.2016.05.003. This is the most recent meta-analysis of studies using actigraphy to investigate differences in activity and sleep patterns in people with bipolar disorder versus healthy controls.

  77. Geoffroy PA, Scott J, Boudebesse C, Lajnef M, Henry C, Leboyer M, et al. Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatr Scand. 2015;131:89–99.

    Article  CAS  PubMed  Google Scholar 

  78. •• Ng TH, Chung KF, Ho FYY, Yeung WF, Yung KP, Lam TH. Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals: a systematic review and meta-analysis. Sleep Med Rev. 2015;20:46–58. This is a comprehensive meta-analysis of studies using actigraphy, polysomnography, questionnaires, and sleep diaries to examine sleep-wake and circadian rhythm disruption in individuals diagnosed with or at risk for bipolar disorder.

    Article  PubMed  Google Scholar 

  79. Faedda GL, Ohashi K, Hernandez M, McGreenery CE, Grant MC, Baroni A, et al. Actigraph measures discriminate pediatric bipolar disorder from attention-deficit/hyperactivity disorder and typically developing controls. J Child Psychol Psychiatry. 2016;57:706–16.

    Article  PubMed  Google Scholar 

  80. Rock P, Goodwin G, Harmer C, Wulff K. Daily rest-activity patterns in the bipolar phenotype: a controlled actigraphy study. Chronobiol Int. 2014;31:290–6.

    Article  PubMed  Google Scholar 

  81. Bullock B, Murray G. Reduced amplitude of the 24-hr activity rhythm: a biomarker of vulnerability to bipolar disorder? Clin Psychol Sci. 2014;2:86–96.

    Article  Google Scholar 

  82. Castro J, Zanini M, da Silva Brandao Goncalves SB, Coelho FMS, Bressan R, Bittencourt L, et al. Circadian rest–activity rhythm in individuals at risk for psychosis and bipolar disorder. Schizophr Res. 2015;168:50–5.

  83. Ng TH, Chung K-F, Ng T-K, Lee C-T, Chan M-S. Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder. Compr Psychiatry. 2016b;69:155–62.

    Article  PubMed  Google Scholar 

  84. Frank E, Swartz HA, Boland E. Interpersonal and social rhythm therapy: an intervention addressing rhythm dysregulation in bipolar disorder. Dialogues Clin Neurosci. 2007;9(3):325–32.

    PubMed  PubMed Central  Google Scholar 

  85. Frank E, Kupfer DJ, Thase ME, Mallinger AG, Swartz HA, Fagiolini AM, et al. Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch. Gen. Psychiat. 2005;62(9):996–1004.

    Article  PubMed  Google Scholar 

  86. Swartz HA, Frank E, Cheng Y. A randomized pilot study of psychotherapy and quetiapine for the acute treatment of bipolar II depression. Bipolar Disord. 2012;14(2):211–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. • Benedetti F, Riccaboni R, Locatelli C, Poletti S, Dallaspezia S, Colombo C. Rapid treatment response of suicidal symptoms to lithium, sleep deprivation, and light therapy (chronotherapeutics) in drug-resistant bipolar depression. J Clin Psychiat. 2014;75:133–40. Benedetti and his team have published extensively on the use of chronotherapeutics as adjunctive treatments for BSD. This article in particular highlights the effect of combined sleep deprivation and light therapy on suicidal symptoms, a particularly important treatment target in BSD.

    Article  CAS  Google Scholar 

  88. Colombo C, Lucca A, Benedetti F, Barbini B, Campori E, Smeraldi E. Total sleep deprivation combined with lithium and light therapy in the treatment of bipolar depression: replication of main effects and interaction. Psychiat. Res. 2000;95:43–53.

    Article  CAS  Google Scholar 

  89. Tseng PT, Chen YW, Tu KY, Chung W, Wang HY, Wu CK, Lin PY. Light therapy in the treatment of patients with bipolar depression: a meta-analytic study. Eur Neuropsychopharmacol. 2016;26:1037–47.

    Article  CAS  PubMed  Google Scholar 

  90. Suzuki M, Dallaspezia S, Locatelli C, Uchiyama M, Colombo C, Benedetti F. Discrepancy between subjective and objective severity as a predictor of response to chronotherapeutics in bipolar depression. J Affect Disord. 2016;204:48–53.

    Article  CAS  PubMed  Google Scholar 

  91. •• Crowe M, Beaglehole B, Inder M. Social rhythm interventions for bipolar disorder: a systematic review and rationale for practice. J Psychiat Ment Health Nurs. 2016;23(1):3–11. This article is a comprehensive review of IPSRT and light therapies for the treatment of BSD, discussing the scientific underpinnings of the treatments as well as their clinical applicability.

    Article  CAS  Google Scholar 

  92. •• Alloy LB, Nusslock R, Boland EM. The development and course of bipolar spectrum disorders: an integrated reward and circadian rhythm dysregulation model. Annual Rev Clin Psychol. 2015b;11:213–50. This article reviews evidence for the reward hypersensitivity and social/circadian dysregulation theories of BSD and provides evidence for an integrated Reward Circadian Dysregulation model.

    Article  Google Scholar 

  93. Hasler BP, Clark DB. Circadian misalignment, reward-related brain function, and adolescent alcohol involvement. Alcoholism: Clin Exper Res. 2013;37:558–65.

    Article  CAS  Google Scholar 

  94. Nusslock R, Abramson LY, Harmon-Jones E, Alloy LB, Coan JA. Psychosocial interventions for bipolar disorder: perspective from the behavioral approach system (BAS) dysregulation theory. Clin Psychol Sci Prac. 2009;16:449–69.

    Article  Google Scholar 

  95. Alloy LB, Abramson LY. The role of the behavioral approach system (BAS) in bipolar spectrum disorders. Curr Direc Psych Sci. 2010;19:189–94.

    Article  Google Scholar 

  96. Alloy LB, Olino T, Freed R, Nusslock R. Role of reward sensitivity and processing in major depressive and bipolar spectrum disorders. Behav Ther. 2016;47:600–21.

    Article  PubMed  PubMed Central  Google Scholar 

  97. Johnson SL, Edge MD, Holmes MK, Carver CS. The behavioral activation system and mania. Ann Rev Clin Psychol. 2012;8:243–67.

    Article  Google Scholar 

  98. Urošević S, Abramson LY, Harmon-Jones E, Alloy LB. Dysregulation of the behavioral approach system (BAS) in bipolar spectrum disorders: review of theory and evidence. Clin Psychol Rev. 2008;28:1188–205.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Sleipness EP, Sorg BA, Jansen HT. Diurnal differences in dopamine transporter and tyrosine hydroxylase levels in rat brain: dependence on the suprachiasmatic nucleus. Brain Res. 2007;1129:34–42.

    Article  CAS  PubMed  Google Scholar 

  100. Yujnovsky I, Hirayama J, Doi M, Borrelli E, Sassone-Corsi P. Signaling mediated by the dopamine D2 receptor potentiates circadian regulation by CLOCK: BMAL1. Proc Nat Acad Sci. 2006;103:6386–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  101. Albrecht U. The circadian clock, reward, and memory. Front Molec Neurosci. 2011;4:41.

    Article  Google Scholar 

  102. Forbes EE, Dahl RE, Almeida JRC, Ferrell RE, Nimgaonkar VL, et al. PER2 rs2304672 polymorphism moderates circadian-relevant reward circuitry activity in adolescents. Biol Psychiatry. 2012;71:451–7.

    Article  CAS  PubMed  Google Scholar 

  103. •• Murray G, Nicholas CL, Kleiman J, Dwyer R, Carrington MJ, et al. Nature’s clock and human mood: the circadian system modulates reward motivation. Emotion. 2009;9:705–16. Three studies demonstrate that reward sensitivity exhibits a circadian rhythm in humans.

    Article  PubMed  Google Scholar 

  104. Baltazar RM, Coolen LM, Webb IC. Diurnal rhythms in neural activation in the mesolimbic reward system: critical role of the medial prefrontal cortex. Europ J Neurosci. 2013;38:2319–27.

    Article  Google Scholar 

  105. Hasler BP, Mehl MR, Bootzin RR, Vazire S. Preliminary evidence of diurnal rhythms in everyday behaviors associated with positive affect. J Res Personal. 2008;42:1537–46.

    Article  Google Scholar 

  106. Hasler BP, Allen JJB, Sbarra DA, Bootzi RR, Bernert RA. Morningness-eveningness and depression: preliminary evidence for the role of the behavioral activation system and positive affect. Psychiatr. Res. 2010;176:166–73.

    Article  Google Scholar 

  107. Murray G, Allen NB, Trinder J. Mood and the circadian system: investigation of a circadian component in positive affect. Chronobiol Int. 2002;19:1151–69.

    Article  PubMed  Google Scholar 

  108. • Hasler BP, Forbes EE, Franzen PL. Time-of-day differences and short-term stability of the neural response to monetary reward: a pilot study. Psychiat Res: Neuroimag. 2014;224:22–7. This is the first study to demonstrate time of day differences in neural reward processing.

    Article  Google Scholar 

  109. Hasler BP, Sitnick SL, Shaw DS, Forbes EE. An altered neural response to reward may contribute to alcohol problems among late adolescents with an evening chronotype. Psychiat. Res: Neuroimag. 2013;214:357–64.

    Article  Google Scholar 

  110. Hasler BP, Dahl RE, Holm SM, Jakubcak JL, Ryan ND, et al. Weekend-weekday advances in sleep timing are associated with altered reward-related brain function in healthy adolescents. Biol Psychol. 2012;91:334–41.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Berridge KC, RobinsonTE. Parsing reward. Trends Neurosci. 2003;26:507–13.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Preparation of this article was supported by National Institute of Mental Health Grants MH77908 and MH102310 to Lauren B. Alloy. Tommy H. Ng was supported by the Sir Edward Youde Memorial Fellowship for Overseas Studies. Elaine M. Boland was supported by the Office of Academic Affiliations, Advanced Fellowship Program in Mental Illness Research and Treatment, Department of Veterans Affairs.

Author information

Authors and Affiliations

  1. Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Lauren B. Alloy, Tommy H. Ng & Madison K. Titone

  2. Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania School of Medicine, Philadelphia, PA, USA

    Elaine M. Boland

Authors
  1. Lauren B. Alloy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tommy H. Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Madison K. Titone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elaine M. Boland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lauren B. Alloy.

Ethics declarations

Conflict of Interest

Lauren B. Alloy, Tommy H. Ng, Madison K. Titone, and Elaine M. Boland declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Sleep Disorders

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alloy, L.B., Ng, T.H., Titone, M.K. et al. Circadian Rhythm Dysregulation in Bipolar Spectrum Disorders. Curr Psychiatry Rep 19, 21 (2017). https://doi.org/10.1007/s11920-017-0772-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-017-0772-z

Keywords

Search

Navigation