Evening chronotype as a discrete clinical subphenotype in bipolar disorder
Abstract
Objective Our aim was to investigate evening chronotype, a proxy marker of circadian system dysfunction, as a clinical subphenotype in bipolar disorder (BD).Methods In this cross-sectional study, 773 BD participants and 146 control subjects were evaluated using the Structured Clinical Interview for DSM-IV and a set of questionnaires. Chronotype was determined using item-5 from the reduced Morningness-Eveningness Questionnaire. Univariate analyses and regression models were used to compare evening and non-evening chronotype in BD and chronotype association with clinical variables.Results Overall, 205 (27%) of BD patients reported an evening chronotype. Evening chronotype was higher in a matched sub-sample of BD patients (n = 150) than in controls (24% and 5% respectively, OR=5.4, p<0.01). Compared to those with non-evening chronotypes, BD patients with an evening chronotype were younger, had an earlier age of onset of BD, and had more prior depressive and manic episodes, higher rates of rapid cycling, past suicide attempts, more comorbid anxiety and substance use disorders. Multivariate regression showed age, prior suicide attempts, and co-occurring substance use disorder were associated with evening chronotype (OR range of 0.97 to1.59). Hypertension, migraine, asthma, and obstructive sleep apnea were significantly associated with evening chronotype (OR range of 1.56 to 2.0).Limitation Limitations include a cross-sectional study design that precludes establishing causality. Analyses did not control for medication use. Younger participant age may prevent evaluation of associations with late-life illnesses.Conclusions Evening chronotype may be a discrete clinical subphenotype in BD and circadian dysfunction a shared pathophysiological mechanism between psychopathology and medical morbidity.
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Higher eveningness chronotypes have lower success with lithium treatment and are more likely to present with challenging features like suicidality.
“higher eveningness chronotypes have lower success with such treatments, and are more likely to present with challenging features like suicidality [33].”
From Essential Information About Chronobiology and Chronotherapy for the Optimal Care of People With Bipolar Disorders: An Expert Consensus (2026) · cites this paper as [33]
Higher morningness chronotypes tend to respond better to lithium.
“higher morningness chronotypes tend to respond better to lithium”
From Essential Information About Chronobiology and Chronotherapy for the Optimal Care of People With Bipolar Disorders: An Expert Consensus (2026) · cites this paper as [33]
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Meta-analysis of sleep deprivation in the acute treatment of bipolar depression
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“…knowing a patient's chronotype can inform prognosis and treatment, as higher morningness chronotypes tend to respond better to lithium, whereas higher eveningness chronotypes have lower success with such treatments, and are more likely to present with challenging features like suicidality [33].”
- Authors
- Romo-Nava, F., Blom, T. J., Cuellar-Barboza, A. B., Winham, S. J., Colby, C. L., Nunez, N. A., Biernacka, J. M., Frye, M. A., & McElroy, S. L.
- Affiliations
- Lindner Center of HOPE (US)
- Mayo Clinic (US)
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2020-04
- Volume
- 266
- Pages
- 556-562
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3001524963
- Cited by
- 63
- References
- 79
- Citations by year
- 2026: 10 · 2025: 10 · 2024: 11 · 2023: 7 · 2022: 9 · 2021: 10 · 2020: 6
- FWCI
- 5.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cephalon
- Shire
- Sunovion
- MSN
- 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
- evening chronotype, bipolar disorder, rapid cycling, suicide attempts, substance use disorders, anxiety comorbidity, comorbidities, age of onset
- MeSH terms
- Bipolar Disorder, Circadian Rhythm, Cross-Sectional Studies, Humans, Surveys and Questionnaires, Sleep
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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