Circadian rhythm in bipolar disorder: A review of the literature

Psychiatry Clin Neurosci. 2018 Sep;72(9):673-682. doi: 10.1111/pcn.12688. Epub 2018 Jul 4.


Sleep disturbances and circadian rhythm dysfunction have been widely demonstrated in patients with bipolar disorder (BD). Irregularity of the sleep-wake rhythm, eveningness chronotype, abnormality of melatonin secretion, vulnerability of clock genes, and the irregularity of social time cues have also been well-documented in BD. Circadian rhythm dysfunction is prominent in BD compared with that in major depressive disorders, implying that circadian rhythm dysfunction is a trait marker of BD. In the clinical course of BD, the circadian rhythm dysfunctions may act as predictors for the first onset of BD and the relapse of mood episodes. Treatments focusing on sleep disturbances and circadian rhythm dysfunction in combination with pharmacological, psychosocial, and chronobiological treatments are believed to be useful for relapse prevention. Further studies are therefore warranted to clarify the relation between circadian rhythm dysfunction and the pathophysiology of BD to develop treatment strategies for achieving recovery in BD patients.

Keywords: bipolar disorder; chronotype; circadian rhythm; clock gene; melatonin.

Publication types

  • Review

MeSH terms

  • Bipolar Disorder* / complications
  • Bipolar Disorder* / drug therapy
  • Bipolar Disorder* / physiopathology
  • Bipolar Disorder* / therapy
  • Chronobiology Disorders* / complications
  • Chronobiology Disorders* / drug therapy
  • Chronobiology Disorders* / physiopathology
  • Chronobiology Disorders* / therapy
  • Depressive Disorder, Major / drug therapy
  • Depressive Disorder, Major / physiopathology
  • Depressive Disorder, Major / therapy
  • Endophenotypes
  • Humans
  • Sleep Wake Disorders* / complications
  • Sleep Wake Disorders* / drug therapy
  • Sleep Wake Disorders* / physiopathology
  • Sleep Wake Disorders* / therapy