Treating Circadian Rhythm Disruption in Bipolar Disorder

Abstract

Purpose of Review

Disruptions in circadian rhythms are believed to underlie the illness course of bipolar disorder (BD). This review evaluates recent studies on the treatment of circadian dysfunction in BD.

Recent Findings

Targeted social rhythm therapy may be useful for bipolar depression though some studies suggest that a non-targeted psychosocial or pharmacological intervention may be just as efficacious. Lithium holds potential for addressing circadian dysfunction in BD. Blue-blocking therapy may be useful for mania and midday bright light therapy may relieve depression.

Conclusions

Psychosocial, pharmacological, and light-based approaches are promising avenues for treating circadian dysfunction in BD.

This is a preview of subscription content, access via your institution.

References

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

  1. 1.

    Murray G, Harvey A. Circadian rhythms and sleep in bipolar disorder. Bipolar Disord. 2010;12(5):459–72.

    PubMed  Google Scholar 

  2. 2.

    Soreca I. Circadian rhythms and sleep in bipolar disorder: implications for pathophysiology and treatment. Curr Opin Psychiatry. 2014;27(6):467–71.

    PubMed  Google Scholar 

  3. 3.

    Gold AK, Sylvia LG. The role of sleep in bipolar disorder. Nat Sci Sleep. 2016;8:207–14.

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Hastings M, O’Neill JS, Maywood ES. Circadian clocks: regulators of endocrine and metabolic rhythms. J Endocrinol. 2007;195(2):187–98.

    CAS  PubMed  Google Scholar 

  5. 5.

    Richardson GS. The human circadian system in normal and disordered sleep. J Clin Psychiatry. 2005;66:3–9 quiz 42-3.

    PubMed  Google Scholar 

  6. 6.

    Wehrens SM, Christou S, Isherwood C, Middleton B, Gibbs MA, Archer SN, et al. Meal timing regulates the human circadian system. Curr Biol. 2017;27(12):1768–75.e3.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Richards J, Gumz ML. Advances in understanding the peripheral circadian clocks. FASEB J. 2012;26(9):3602–13.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Harvey AG. Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatr. 2008;165(7):820–9.

    PubMed  Google Scholar 

  9. 9.

    Plante DT, Winkelman JW. Sleep disturbance in bipolar disorder: therapeutic implications. Am J Psychiatry. 2008;165(7):830–43.

    PubMed  Google Scholar 

  10. 10.

    •• Takaesu Y. Circadian Rhythm in Bipolar Disorder: A review of the literature. Psychiatry Clin Neurosci. 2018. This recent review discusses mechanisms underlying circadian rhythm disruption in BD, as well as interventions for treating circadian dysfunction.

  11. 11.

    Brown GM. Light, melatonin and the sleep-wake cycle. J Psychiatry Neurosci. 1994;19(5):345–53.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Mitchell HA, Weinshenker D. Good night and good luck: norepinephrine in sleep pharmacology. Biochem Pharmacol. 2010;79(6):801–9.

    CAS  PubMed  Google Scholar 

  13. 13.

    Kennedy SH, Tighe S, McVEY G, Brown GM. Melatonin and cortisol" switches" during mania, depression, and euthymia in a drug-free bipolar patient. J Nerv Ment Dis. 1989;177:300–3.

    CAS  PubMed  Google Scholar 

  14. 14.

    Lewy AJ. Biochemistry and regulation of mammalian melatonin production: Elsevier biomedical. New York; 1983.

  15. 15.

    Post RM, Stoddard FJ, Gillin JC, Buchsbaum MS, Runkle DC, Black KE, et al. Alterations in motor activity, sleep, and biochemistry in a cycling manic-depressive patient. Arch Gen Psychiatry. 1977;34(4):470–7.

    CAS  PubMed  Google Scholar 

  16. 16.

    Juckel G, Hegerl U, Mavrogiorgou P, Gallinat J, Mager T, Tigges P, et al. Clinical and biological findings in a case with 48-hour bipolar ultrarapid cycling before and during valproate treatment. J Clin Psychiatry. 2000;61(8):585–93.

    CAS  PubMed  Google Scholar 

  17. 17.

    Kurita M. Noradrenaline plays a critical role in the switch to a manic episode and treatment of a depressive episode. Neuropsychiatr Dis Treat. 2016;12:2373–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Dell'Osso B, Palazzo MC, Oldani L, Altamura AC. The noradrenergic action in antidepressant treatments: pharmacological and clinical aspects. CNS Neurosci Ther. 2011;17(6):723–32.

    CAS  PubMed  Google Scholar 

  19. 19.

    Robillard R, Naismith SL, Hickie IB. Recent advances in sleep-wake cycle and biological rhythms in bipolar disorder. Curr Psychiatry Rep. 2013;15(10):402.

    PubMed  Google Scholar 

  20. 20.

    Harvey AG, Schmidt DA, Scarnà A, Semler CN, Goodwin GM. Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatr. 2005;162(1):50–7.

    PubMed  Google Scholar 

  21. 21.

    Harvey AG, Lee J, Williams J, Hollon SD, Walker MP, Thompson MA, et al. Improving outcome of psychosocial treatments by enhancing memory and learning. Perspect Psychol Sci. 2014;9(2):161–79.

    PubMed  PubMed Central  Google Scholar 

  22. 22.

    •• Alloy LB, Ng TH, Titone MK, Boland EM. Circadian rhythm dysregulation in bipolar spectrum disorders. Curr Psychiatry Rep. 2017;19(4):21. This manuscript synthesizes the evidence base supporting circadian rhythm disruption as a relevant mechanism in BD.

    PubMed  Google Scholar 

  23. 23.

    Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: a comprehensive review. Chronobiol Int. 2012;29(9):1153–75.

    PubMed  Google Scholar 

  24. 24.

    Melo MC, Abreu RL, Neto VBL, de Bruin PF, de Bruin VM. Chronotype and circadian rhythm in bipolar disorder: a systematic review. Sleep Med Rev. 2017;34:46–58.

    PubMed  Google Scholar 

  25. 25.

    Moon JH, Cho CH, Son GH, Geum D, Chung S, Kim H, et al. Advanced circadian phase in mania and delayed circadian phase in mixed mania and depression returned to Normal after treatment of bipolar disorder. EBioMedicine. 2016;11:285–95.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Hickie IB, Naismith SL, Robillard R, Scott EM, Hermens DF. Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression. BMC Med. 2013;11:79.

    PubMed  PubMed Central  Google Scholar 

  27. 27.

    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(10):948–52.

    CAS  PubMed  Google Scholar 

  28. 28.

    Grandin LD, Alloy LB, Abramson LY. The social zeitgeber theory, circadian rhythms, and mood disorders: review and evaluation. Clin Psychol Rev. 2006;26(6):679–94.

    PubMed  Google Scholar 

  29. 29.

    Haynes PL, Gengler D, Kelly M. Social rhythm therapies for mood disorders: an update. Curr Psychiatry Rep. 2016;18(8):75.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Klerman GL, Weissman MM. Interpersonal psychotherapy of depression: a brief, focused, specific strategy. Jason Aronson, Incorporated; 1994.

  31. 31.

    Frank E. Interpersonal and social rhythm therapy: a means of improving depression and preventing relapse in bipolar disorder. J Clin Psychol. 2007;63(5):463–73.

    PubMed  Google Scholar 

  32. 32.

    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).

  33. 33.

    Frank E, Hlastala S, Ritenour A, Houck P, Tu XM, Monk TH, et al. Inducing lifestyle regularity in recovering bipolar disorder patients: results from the maintenance therapies in bipolar disorder protocol. Biol Psychiatry. 1997;41(12):1165–73.

    CAS  PubMed  Google Scholar 

  34. 34.

    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 Psychiatry. 2005;62(9):996–1004.

    PubMed  Google Scholar 

  35. 35.

    Frank E, Soreca I, Swartz HA, Fagiolini AM, Mallinger AG, Thase ME, et al. The role of interpersonal and social rhythm therapy in improving occupational functioning in patients with bipolar I disorder. Am J Psychiatry. 2008;165(12):1559–65.

    PubMed  PubMed Central  Google Scholar 

  36. 36.

    Sachs GS, Thase ME, Otto MW, Bauer M, Miklowitz D, Wisniewski SR, et al. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2003;53(11):1028–42.

    PubMed  Google Scholar 

  37. 37.

    Miklowitz DJ, Otto MW, Frank E, Reilly-Harrington NA, Wisniewski SR, Kogan JN, et al. Psychosocial treatments for bipolar depression: a 1-year randomized trial from the systematic treatment enhancement program. Arch Gen Psychiatry. 2007;64(4):419–26.

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Swartz HA, Frank E, O'Toole K, Newman N, Kiderman H, Carlson S, et al. Implementing interpersonal and social rhythm therapy for mood disorders across a continuum of care. Psychiatr Serv. 2011;62(11):1377–80.

    PubMed  PubMed Central  Google Scholar 

  39. 39.

    Hoberg AA, Ponto J, Nelson PJ, Frye MA. Group interpersonal and social rhythm therapy for bipolar depression. Perspect Psychiatr Care. 2013;49(4):226–34.

    PubMed  PubMed Central  Google Scholar 

  40. 40.

    Monk TK, 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.

  41. 41.

    Bouwkamp CG, de Kruiff ME, van Troost TM, Snippe D, Blom MJ, de Winter RF, et al. Interpersonal and social rhythm group therapy for patients with bipolar disorder. Int J Group Psychother. 2013;63(1):97–115.

    PubMed  Google Scholar 

  42. 42.

    Swartz HA, Frank E, Frankel DR, Novick D, Houck P. Psychotherapy as monotherapy for the treatment of bipolar II depression: a proof of concept study. Bipolar Disord. 2009;11(1):89–94.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    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.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. 44.

    •• Swartz HA, Rucci P, Thase ME, Wallace M, Carretta E, Celedonia KL, et al. Psychotherapy Alone and Combined With Medication as Treatments for Bipolar II Depression: A Randomized Controlled Trial. J Clin Psychiatry. 2018;79(2). This RCT evaluates IPSRT adjunctive to pharmacotherapy for patients with bipolar II depression.

  45. 45.

    Hlastala SA, Kotler JS, McClellan JM, McCauley EA. Interpersonal and social rhythm therapy for adolescents with bipolar disorder: treatment development and results from an open trial. Depress Anxiety. 2010;27(5):457–64.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Goldstein TR, Fersch-Podrat R, Axelson DA, Gilbert A, Hlastala SA, Birmaher B, et al. Early intervention for adolescents at high risk for the development of bipolar disorder: Pilot study of Interpersonal and Social Rhythm Therapy (IPSRT). Psychotherapy. 2014;51(1).

  47. 47.

    Goldstein TR, Merranko J, Krantz M, Garcia M, Franzen P, Levenson J, et al. Early intervention for adolescents at-risk for bipolar disorder: a pilot randomized trial of interpersonal and social rhythm therapy (IPSRT). J Affect Disord. 2018;235:348–56.

    PubMed  Google Scholar 

  48. 48.

    Inder ML, Crowe MT, Luty SE, Carter JD, Moor S, Frampton CM, et al. Randomized, controlled trial of interpersonal and social rhythm therapy for young people with bipolar disorder. Bipolar Disord. 2015;17(2):128–38.

    PubMed  Google Scholar 

  49. 49.

    Inder ML, Crowe MT, Moor S, Carter JD, Luty SE, Frampton CM, et al. Three-year follow-up after psychotherapy for young people with bipolar disorder. Bipolar disorders. 2017.

  50. 50.

    Miklowitz DJ, Price J, Holmes EA, Rendell J, Bell S, Budge K, et al. Facilitated integrated mood management for adults with bipolar disorder. Bipolar Disord. 2012;14(2):185–97.

    PubMed  PubMed Central  Google Scholar 

  51. 51.

    Bilderbeck AC, Atkinson LZ, McMahon HC, Voysey M, Simon J, Price J, et al. Psychoeducation and online mood tracking for patients with bipolar disorder: a randomised controlled trial. J Affect Disord. 2016;205:245–51.

    PubMed  Google Scholar 

  52. 52.

    Buijink A, Visser BJ, Marshall L. Medical apps for smartphones: lack of evidence undermines quality and safety. Evid Based Med. 2013;18(3):90–2.

    PubMed  Google Scholar 

  53. 53.

    Harvey AG, Soehner AM, Kaplan KA, Hein K, Lee J, Kanady J, et al. Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. J Consult Clin Psychol. 2015;83(3):564–77.

    PubMed  PubMed Central  Google Scholar 

  54. 54.

    Sylvia LG, Salcedo S, Bianchi MT, Urdahl A, Nierenberg AA, Deckersbach T. A novel home sleep monitoring device and brief sleep intervention for bipolar disorder: feasibility, tolerability, and preliminary effectiveness. Cognit Ther Res. 2014;38(1):55–61.

    PubMed  Google Scholar 

  55. 55.

    Faria AD, de Mattos Souza LD, de Azevedo CT, Pinheiro KA, Pinheiro RT, da Silva RA, et al. The influence of psychoeducation on regulating biological rhythm in a sample of patients with bipolar II disorder: a randomized clinical trial. Psychol Res Behav Manag. 2014;7:167–74.

    PubMed  PubMed Central  Google Scholar 

  56. 56.

    de Azevedo CT, Mondin TC, Reyes AN, Zeni CP, de Mattos Souza LD, da Silva RA, et al. Biological rhythm and bipolar disorder: twelve-month follow-up of a randomized clinical trial. J Nerv Ment Dis. 2015;203(10):792–7.

    Google Scholar 

  57. 57.

    Dinan TG. Lithium in bipolar mood disorder: evidence suggests that lithium should still be first choice for prophylactic treatment. British Medical Journal Publishing Group; 2002.

  58. 58.

    Moreira J, Geoffroy PA. Lithium and bipolar disorder: impacts from molecular to behavioural circadian rhythms. Chronobiol Int. 2016;33(4):351–73.

    CAS  PubMed  Google Scholar 

  59. 59.

    Geoffroy PA, Curis E, Courtin C, Moreira J, Morvillers T, Etain B, Laplanche JL, Bellivier F, Marie-Claire C Lithium response in bipolar disorders and core clock genes expression. World J Biol Psychiatry. 2017;1–14.

  60. 60.

    Geoffroy PA, Samalin L, Llorca PM, Curis E, Bellivier F. Influence of lithium on sleep and chronotypes in remitted patients with bipolar disorder. J Affect Disord. 2016;204:32–9.

    CAS  PubMed  Google Scholar 

  61. 61.

    De Berardis D, Marini S, Fornaro M, Srinivasan V, Iasevoli F, Tomasetti C, et al. The melatonergic system in mood and anxiety disorders and the role of agomelatine: implications for clinical practice. Int J Mol Sci. 2013;14(6):12458–83.

    PubMed  PubMed Central  Google Scholar 

  62. 62.

    De Berardis D, Fornaro M, Serroni N, Campanella D, Rapini G, Olivieri L, et al. Agomelatine beyond borders: current evidences of its efficacy in disorders other than major depression. Int J Mol Sci. 2015;16(1):1111–30.

    PubMed  PubMed Central  Google Scholar 

  63. 63.

    Calabrese JR, Guelfi JD, Perdrizet-Chevallier C, Group ABS. Agomelatine adjunctive therapy for acute bipolar depression: preliminary open data. Bipolar Disord. 2007;9(6):628–35.

    CAS  PubMed  Google Scholar 

  64. 64.

    Fornaro M, McCarthy MJ, De Berardis D, De Pasquale C, Tabaton M, Martino M, et al. Adjunctive agomelatine therapy in the treatment of acute bipolar II depression: a preliminary open label study. Neuropsychiatr Dis Treat. 2013;9:243.

    CAS  PubMed  PubMed Central  Google Scholar 

  65. 65.

    Yatham LN, Vieta E, Goodwin GM, Bourin M, De Bodinat C, Laredo J, et al. Agomelatine or placebo as adjunctive therapy to a mood stabiliser in bipolar I depression: randomised double-blind placebo-controlled trial. Br J Psychiatry. 2016;208(1):78–86.

    PubMed  Google Scholar 

  66. 66.

    Norris ER, Burke K, Correll JR, Zemanek KJ, Lerman J, Primelo RA, et al. A double-blind, randomized, placebo-controlled trial of adjunctive ramelteon for the treatment of insomnia and mood stability in patients with euthymic bipolar disorder. J Affect Disord. 2013;144(1–2):141–7.

    CAS  PubMed  Google Scholar 

  67. 67.

    Mahableshwarkar AR, Calabrese JR, Macek TA, Budur K, Adefuye A, Dong X, et al. Efficacy and safety of sublingual ramelteon as an adjunctive therapy in the maintenance treatment of bipolar I disorder in adults: a phase 3, randomized controlled trial. J Affect Disord. 2017;221:275–82.

    CAS  PubMed  Google Scholar 

  68. 68.

    Phelps J. A powerful non-pharmacologic treatment for mania–virtually. Bipolar Disord. 2016;18(4):379–82.

    PubMed  Google Scholar 

  69. 69.

    Phelps J. Amber lenses for virtual darkness: confirmed as a mood stabilizer. Med Hypotheses. 2017;98:1.

    PubMed  Google Scholar 

  70. 70.

    Phelps J. Dark therapy for bipolar disorder using amber lenses for blue light blockade. Med Hypotheses. 2008;70(2):224–9.

    PubMed  Google Scholar 

  71. 71.

    •• Henriksen TE, Skrede S, Fasmer OB, Schoeyen H, Leskauskaite I, Bjørke-Bertheussen J, et al. Blue-blocking glasses as additive treatment for mania: a randomized placebo-controlled trial. Bipolar Disord. 2016;18(3):221–32. This paper describes results from a promising recent study of virtual darkness therapy in BD.

    PubMed  PubMed Central  Google Scholar 

  72. 72.

    •• Sit DK, McGowan J, Wiltrout C, Diler RS, Dills J, Luther J, et al. Adjunctive bright light therapy for bipolar depression: a randomized double-blind placebo-controlled trial. Am J Psychiatr. 2017;175(2):131–9. This paper describes results from a promising recent study of bright light therapy in BD.

    PubMed  Google Scholar 

  73. 73.

    Hashimoto S, Kohsaka M, Nakamura K, Honma H, Honma S, Honma K. Midday exposure to bright light changes the circadian organization of plasma melatonin rhythm in humans. Neurosci Lett. 1997;221(2–3):89–92.

    CAS  PubMed  Google Scholar 

  74. 74.

    Sit D, Wisner KL, Hanusa BH, Stull S, Terman M. Light therapy for bipolar disorder: a case series in women. Bipolar Disord. 2007;9(8):918–27.

    PubMed  Google Scholar 

  75. 75.

    Keltner NL, Folks DG. Alternatives to lithium in the treatment of bipolar disorder. Perspect Psychiatr Care. 1991;27(2):36–7.

    CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Alexandra K. Gold.

Ethics declarations

Conflict of Interest

Alexandra K. Gold receives research support from the National Institute of Mental Health (F31MH116557).

Gustavo Kinrys has received research support from Astra-Zeneca, Bristol-Myers Squibb Company, Cephalon, Elan Pharmaceuticals, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sanofi/Synthelabo, Sepracor Inc., Pfizer Inc., UCB Pharma, and Wyeth-Ayerst Laboratories, Agency for Healthcare Research and Quality (AHRQ) Grant R01 HS019371–01, and Takeda Pharmaceuticals. He has been an advisor or consultant for Astra-Zeneca, Cephalon, Eli Lilly & Company, Forest Pharmaceuticals Inc., GlaxoSmithkline, Janssen Pharmaceutica, Pfizer Inc., Sepracor Inc., UCB Pharma, and Wyeth-Ayerst Laboratories. Dr. Kinrys has been a speaker for Astra-Zeneca, Forest Pharmaceuticals Inc., GlaxoSmithkline, Sepracor Inc., and Wyeth-Ayerst Laboratories.

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

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Bipolar Disorders

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gold, A.K., Kinrys, G. Treating Circadian Rhythm Disruption in Bipolar Disorder. Curr Psychiatry Rep 21, 14 (2019). https://doi.org/10.1007/s11920-019-1001-8

Download citation

Keywords

  • Bipolar disorder
  • Circadian rhythms
  • Social rhythm therapy
  • Light therapy