Evidence map›Paper›PMID 36661342›Full record

ReviewBipolar disorders2023

Does circadian dysrhythmia drive the switch into high- or low-activation states in bipolar I disorder?

Ian B Hickie, Kathleen R Merikangas, Joanne S Carpenter, Frank Iorfino, Elizabeth M Scott, Jan Scott, Jacob J Crouse

Open access · hybridAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Bipolar disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
2.4field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 11 citations in OpenAlex.

  1. Article
  2. The effect of sleep-wake behaviors on the onset of mania in youth: A computational model.European psychiatry : the journal of the Association of European Psychiatrists · 2026
    Article
  3. Article
  4. Differentiating Between Major Depressive Disorder and Bipolar Disorder.Advances in experimental medicine and biology · 2026
    Review
  5. Mental health and sleep correlates of self-reported outdoor daylight exposure in over 13,000 adults with depression.European psychiatry : the journal of the Association of European Psychiatrists · 2025
    Article
  6. Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 6 countries.

Ian B HickieYouth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia.ORCID 0000-0001-8832-9895
Kathleen R MerikangasGenetic Epidemiology Research Branch, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland, USA.ORCID 0000-0002-4667-2414
Joanne S CarpenterYouth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia.ORCID 0000-0002-9766-6700
Frank IorfinoYouth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia.ORCID 0000-0003-1109-0972
Elizabeth M ScottYouth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia.ORCID 0000-0003-3907-0324
Jan ScottInstitute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-7203-8601
Jacob J CrouseYouth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia.ORCID 0000-0002-3805-2936
University of Technology Sydney · AUNational Institute of Mental Health · USUniversité Paris Cité · FR

Funding

Motor Activity Research Consortium for Health (mMarch)ZIAMH002954 · NIMH · NATIONAL INSTITUTE OF MENTAL HEALTH · PI MERIKANGAS, KATHLEEN R · 2016 to 2025
$10.1M
6 · The paper itself

Abstract

objectivesEmerging evidence suggests a role of circadian dysrhythmia in the switch between "activation" states (i.e., objective motor activity and subjective energy) in bipolar I disorder.

methodsWe examined the evidence with respect to four relevant questions: (1) Are natural or environmental exposures that can disrupt circadian rhythms also related to the switch into high-/low-activation states? (2) Are circadian dysrhythmias (e.g., altered rest/activity rhythms) associated with the switch into activation states in bipolar disorder? (3) Do interventions that affect the circadian system also affect activation states? (4) Are associations between circadian dysrhythmias and activation states influenced by other "third" factors?

resultsFactors that naturally or experimentally alter circadian rhythms (e.g., light exposure) have been shown to relate to activation states; however future studies need to measure circadian rhythms contemporaneously with these natural/experimental factors. Actigraphic measures of circadian dysrhythmias are associated prospectively with the switch into high- or low-activation states, and more studies are needed to establish the most relevant prognostic actigraphy metrics in bipolar disorder. Interventions that can affect the circadian system (e.g., light therapy, lithium) can also reduce the switch into high-/low-activation states. Whether circadian rhythms mediate these clinical effects is an unknown but valuable question. The influence of age, sex, and other confounders on these associations needs to be better characterised.

conclusionBased on the reviewed evidence, our view is that circadian dysrhythmia is a plausible driver of transitions into high- and low-activation states and deserves prioritisation in research in bipolar disorders.

Indexed as

Bipolar DisorderCircadian RhythmHumansLithiumPhototherapyRestSleepLithiumbipolar disorderscircadian rhythmsmood disorders

Identifiers

PMID36661342
PMCPMC10947388
OpenAlexW4317568115

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.