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Seasonality and bipolar disorder: A systematic review, from admission rates to seasonality of symptoms

Lookup NU author(s): Emeritus Professor Jan Scott


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Introduction: Bipolar disorder (BD) is a severe mental disorder affecting 1-4% of the population worldwide. It is characterized by periods of (hypo)manic and depressive episodes. Seasonal patterns (SP) may be observed in admission rates, mood relapses and symptom fluctuations.Methods: We conducted a systematic review of seasonality in BD, classifying studies based on seasonal admission rates to seasonality of symptoms assessments.Results: Fifty-one papers were identified of which 32 addressed hospitalization rates by season, 6 addressed categorical diagnoses, and 13 explored symptom dimensions. Seasonal peaks for different BD mood episodes are observed worldwide and widely replicated. Manic episodes peak during spring/ summer and, to a lesser extent, in autumn, depressive episodes peak in early winter and, to a lesser extent, summer, and mixed episodes peak in early spring or mid/idle summer. There was a high frequency of SP for manic episodes (15%) and depressive episodes (25%), the latter being associated with a more complex clinical profile (BD II subtype, comorbid eating disorders, more relapses and rapid cycling). Finally, there was evidence for greater seasonal fluctuations in mood and behavior in individuals with BD than in those with unipolar depression or healthy' controls. Limitations: Sample size, gender distribution, methodological qualify and sophistication of the analytical approaches employed varied considerably.Conclusions: There is evidence of seasonality in BD, with emerging evidence that climatic conditions may trigger BD symptoms or episodes. A better understanding of the underlying mechanisms would facilitate the development of personalized chronobiological therapeutic and preventive strategies. (C) 2014 Elsevier EN. All rights reserved.

Publication metadata

Author(s): Geoffroy PA, Bellivier F, Scott J, Etain B

Publication type: Review

Publication status: Published

Journal: Journal of Affective Disorders

Year: 2014

Volume: 168

Pages: 210-223

Print publication date: 15/10/2014

Online publication date: 10/07/2014

Acceptance date: 02/07/2014

ISSN (print): 0165-0327

ISSN (electronic): 1573-2517



DOI: 10.1016/j.jad.2014.07.002