Advanced Circadian Phase in Mania and Delayed Circadian Phase in Mixed Mania and Depression Returned to Normal after Treatment of Bipolar Disorder
Open accessAbstract
Disturbances in circadian rhythms have been suggested as a possible cause of bipolar disorder (BD). Included in this study were 31 mood episodes of 26 BD patients, and 18 controls. Circadian rhythms of BD were evaluated at admission, at 2-week intervals during hospitalization, and at discharge. All participants wore wrist actigraphs during the studies. Saliva and buccal cells were obtained at 8:00, 11:00, 15:00, 19:00, and 23:00 for two consecutive days. Collected saliva and buccal cells were used for analysis of the cortisol and gene circadian rhythm, respectively. Circadian rhythms had different phases during acute mood episodes of BD compared to recovered states. In 23 acute manic episodes, circadian phases were ~7hour advanced (equivalent to ~17hour delayed). Phases of 21 out of these 23 cases returned to normal by ~7hour delay along with treatment, but two out of 23 cases returned to normal by ~17hour advance. In three cases of mixed manic episodes, the phases were ~6-7hour delayed. For five cases of depressive episodes, circadian rhythms phases were ~4-5hour delayed. After treatment, circadian phases resembled those of healthy controls. Circadian misalignment due to circadian rhythm phase shifts might be a pathophysiological mechanism of BD.
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State-dependent differences in the timing of wake-onset in this patient are consistent with recent findings in patients who were not specifically identified as rapid-cycling patients.
“In this regard, it is worth noting that state-dependent differences in the timing of wake-onset in this patient are consistent with recent findings in patients who were not specifically identified as rapid-cycling patients24,25.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [25]
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- Authors
- Moon, J.-H., Cho, C.-H., Son, G. H., Geum, D., Chung, S., Kim, H., Kang, S.-G., Park, Y.-M., Yoon, H.-K., Kim, L., Jee, H.-J., An, H., Kripke, D. F., & Lee, H.-J.
- Affiliations
- Korea University (KR)
- Ewha Womans University (KR)
- Gachon University (KR)
- Inje University (KR)
- University of California San Diego (US)
- Corresponding author
- Lee, Heon-Jeong
- ORCID
- Venue
- EBioMedicine
- Publisher
- Elsevier BV
- Published
- 2016-09
- Volume
- 11
- Pages
- 285-295
- ISSN
- 2352-3964 (ISSN-L)
- PMC
- PMC5049992
- OpenAlex
- W2510503065
- Cited by
- 163
- References
- 39
- Citations by year
- 2026: 15 · 2025: 16 · 2024: 17 · 2023: 16 · 2022: 23 · 2021: 18 · 2020: 18 · 2019: 16 · 2018: 17 · 2017: 5 · 2016: 2
- FWCI
- 11.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- EBioMedicine (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Ministry of Science, ICT and Future Planning
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- bipolar disorder, circadian rhythm, circadian phase shift, mania, depressive episodes, cortisol, actigraphy, mood episodes, circadian misalignment, treatment response
- MeSH terms
- Adult, Affect, Bipolar Disorder, Circadian Rhythm, Depression, Female, Humans, Hydrocortisone, Male, Saliva, Biomarkers, Exercise, Case-Control Studies, Age of Onset, Young Adult
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