Bipolar Disorder may be related to cellular, not blood Vitamin D

• Bipolar category listing has 16 items along with related searches
• Depression category listing has 260 items along with related searches
• ADHD and Vitamin D Deficiency

See also Vitamin D Life

• Bipolar Spectrum Disorder decreased with 2,000 IU of vitamin D - June 2015
• Hypothesis: Some Mental Illness could be treated or prevented with vitamin D
• Fewer white spots in MRI brain scans if had more vitamin D – Jan 2014
• Mental health problems cut in half when have adequate level of vitamin D – Jan 2013
  lack of blood flow in brain regions appears to be associated with low vitamin D
• DBP-L is 8 times higher with Bipolar Disorder, but might be invisible to most tests – April 2017
• ADHD and Vitamin D Deficiency

16 articles in the Bipolar category

Bipolar Manic Attacks triggered by lower vitamin D (might supplementation decrease them?)

Does Decreased Vitamin D Level Trigger Bipolar Manic Attacks?
Behav Sci (Basel). 2023 Sep 18;13(9):779. doi: 10.3390/bs13090779.
Okan İmre 1, Mustafa Karaağaç 2, Cuneyt Caglayan 3

Vitamin D levels much lower during mania phase

Background: Bipolar disorder is a chronic psychiatric disorder with depression and manic episodes. It is one of the leading causes of disease-related disability worldwide. Despite the presence of various alternative drug options for bipolar disorder, some patients do not adequately benefit from the treatment. Therefore, possible underlying mechanisms need to be clarified. Recently, studies on the relationship between bipolar disorder and vitamin D (Vit D) have attracted attention. Although many studies have found an association between depression and Vit D deficiency, little is known about the relationship between manic episodes and Vit D. The aim of this study was to compare Vit D and related metabolites of bipolar manic episodes prior to treatment, bipolar remission after treatment, and healthy control groups.

Methods: This case-control study consisted of 34 bipolar manic episode patients and 34 healthy controls. Disease activity was evaluated with the Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Firstly, serum 25-hydroxy vitamin D (25-OHD), calcium (Ca) and phosphorus (P) levels of patients in the bipolar manic episode were measured and compared with healthy control. Secondly, serum 25-OHD, Ca and P levels in the euthymic periods of the same patients were measured and compared with healthy control.

Results: Bipolar manic episode Vit D levels were lower when compared to healthy controls; while there was no difference in terms of Ca and P levels. There was no significant difference between the bipolar euthymic period patients and the healthy control group in terms of 25-OHD, Ca and P levels.

Conclusion: Our results demonstrated low serum Vit D concentrations in the acute manic episode of bipolar disorder. Decreased Vit D level may play a role in the onset of the manic episode, or malnutrition and insufficient sunlight during the manic episode may have caused Vit D deficiency. Future studies are needed to exclude potential confounding factors and to compare all mood episodes.
 Download the PDF from Vitamin D Life

Vitamin D might help bipolar - Jan 2021

The role of vitamin D in bipolar disorder: Epidemiology and influence on disease activity
Journal of Affective Disorders Vol 278, 1 Jan 2021, Pages 209-217 https://doi.org/10.1016/j.jad.2020.09.039 FREE TEXT

Background
Although many studies found an association between psychiatric disorders, especially major depressive disorder, and vitamin D deficiency, little is still known about the association between vitamin D and bipolar disorder (BD). Therefore, the present review aims at providing an overview of the available literature exploring the role of vitamin D in BD patients in different phases of the disease.

Methods
From a bibliographic research in PubMed until April 2020, we collected ten original studies that fulfilled our inclusion criteria.

Results
No significant differences in vitamin D levels between BD patients and other psychiatric disorders were found by most of the studies. In the majority of the studies, the average values of vitamin D in BD population were sub-threshold for vitamin D deficiency. Moreover, although an association between vitamin D levels and clinical symptomatology was observed in BD patients, it cannot be considered a specific marker of this disorder but a common characteristic shared with other psychiatric disorders, including schizophrenia and major depressive disorder. Finally, vitamin D supplementation was associated with a reduction in both depressive and manic symptoms.

Limitations
Few studies with small and heterogeneous populations. Methodological heterogeneity in terms of vitamin D measurement and threshold.

Conclusions
The results showed that vitamin D status does not differ between BD and other psychiatric conditions. However, given the correlation between vitamin D levels and depressive or manic symptoms, we could hypothesize that an adequate vitamin D status could positively affect the mood balance thanks to its immunomodulatory activity.

Bipolar more likely to start a month after low level of UVB - June 2023

Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder

• "Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. "
• "Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production."

 Download the PDF from Vitamin D Life
Note: UVB ==> Vitamin D to brain etc without going thu the gut, liver, kidney, etc.

Bipolar strongly assocoated with poor VDR (blood level vit D is a poor indicator) - March 2022

Abnormal pattern of vitamin D receptor-associated genes and lncRNAs in patients with bipolar disorder
BMC Psychiatry volume 22, Article number: 178 (2022) https://doi.org/10.1186/s12888-022-03811-8 FREE PDF
Reyhane Eghtedarian, Soudeh Ghafouri-Fard, Hamid Bouraghi, Bashdar Mahmud Hussen, Shahram Arsang-Jang & Mohammad Taheri

Background
Bipolar disorder (BD) is a multifactorial condition. Several signaling pathways affect development of this disorder. With the purpose of exploring the role of vitamin D receptor (VDR) signaling in this disorder, we measured expression of selected mRNA coding genes and long non-coding RNAs (lncRNAs) in this pathway in patients versus normal subjects.

Methods
We measured expression of VDR-associated lncRNAs and mRNAs (SNHG6, MALAT1, Linc00511, Linc00346, VDR and CYP27B1) in the peripheral blood of BD patients vs. healthy individuals.

Results
Expression of SNHG6 was significantly higher in cases vs. controls (Posterior beta = 1.29, P value < 0.0001. Subgroup analysis by sex revealed significant results in both subgroups (P value < 0.0001 and P value = 0.023 for males and females, respectively). Expression of CYP27B1 was up-regulated in cases vs. controls (Posterior beta = 0.415, P < 0.0001). Such pattern was also detected among males (P < 0.0001), but not females (P = 0.419). Similarly, MALAT1 and Linc00346 were up-regulated in total cases vs. controls (Posterior beta = 0.694, P < 0.0001 and Posterior beta = 0.4, P = 0.012, respectively) and in male cases compared with male controls (Posterior beta = 0.712, P < 0.0001 and Posterior beta = 0.41, P value = 0.038, respectively). Expression of VDR was up-regulated in total cases compared with controls (Posterior beta = 0.683, P value = 0.001). Finally, expression of Linc00511 was not different between groups. MALAT1, SNHG6, CYP27B1, VDR and Linc00346 had AUC values of 0.95, 0.94, 0.91, 0.85 and 0.83 in differentiation of male patients from controls, respectively.

Conclusion
The current study suggests VDR-associated genes as possible markers for BD.

More sunlight and higher temperature ==> more bipolar (opposite of Vitamin D association) - Dec 2021

The influence of weather on the course of bipolar disorder: A systematic review
The European J of Psychiatry Vol 35, Issue 4, Dec 2021, Pages 261-273 https://doi.org/10.1016/j.ejpsy.2021.03.002
J.M.Montesa C.Serrano b A.Pascual-Sanchez c

Background and objectives
Several studies have addressed the relationship between bipolar disorder and meteorological variables, but no previous review focusing on the influence of a wide range of meteorological variables on bipolar disorder has been published. The aim of this study is to conduct a systematic review about the influence of weather on the clinical course of bipolar disorder patients.

Methods
Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the main electronic medical databases were searched in February 2020, and studies were screened based on the eligibility criteria. 24 studies were selected for qualitative synthesis. Most of them were observational retrospective studies based in medical records.

Results
The most studied meteorological variables were temperature and sunlight, and the most studied clinical outcomes were hospital admissions. Significant correlations were found between temperature and sunlight and clinical outcomes, although the findings were heterogeneous. Higher temperatures may trigger bipolar disorder relapses that require hospital admission, and higher expositions to sunlight may increase the risk of manic episodes.

Conclusion
Meteorological variables seem to have an influence in the course of bipolar disorder, especially temperature and sunlight, although further studies are needed to clarify this possible relationship.

Bipolar review of Nutraceuticals (no vitamin D) - Sept 2022

A Systematic Review of Nutraceuticals for the Treatment of Bipolar Disorder
https://doi.org/10.1177/0706743720961734 FREE PDF
Studies revealed promising, albeit conflicting, evidence for omega-3 fatty acids and N-acetylcysteine. Isolated positive results were reported for coenzyme Q10.

National Trends in the Outpatient Diagnosis and Treatment of Bipolar Disorder in Youth

September 2007, Vol 64, No. 9
Carmen Moreno, MD; Gonzalo Laje, MD; Carlos Blanco, MD, PhD; Huiping Jiang, PhD; Andrew B. Schmidt, CSW; Mark Olfson, MD, MPH
Arch Gen Psychiatry. 2007;64(9):1032-1039. doi:10.1001/archpsyc.64.9.1032.

Context Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people.

Objectives To present national trends in outpatient visits with a diagnosis of bipolar disorder and to compare the treatment provided to youth and adults during those visits.

Design We compare rates of growth between 1994-1995 and 2002-2003 in visits with a bipolar disorder diagnosis by individuals aged 0 to 19 years vs those aged 20 years or older. For the period of 1999 to 2003, we also compare demographic, clinical, and treatment characteristics of youth and adult bipolar disorder visits.

Setting Outpatient visits to physicians in office-based practice.

Participants Patient visits from the National Ambulatory Medical Care Survey (1999-2003) with a bipolar disorder diagnosis (n = 962).

Main Outcome Measures Visits with a diagnosis of bipolar disorder by youth (aged 0-19 years) and by adults (aged ≥ 20 years).

Results The estimated annual number of youth office-based visits with a diagnosis of bipolar disorder increased from 25 (1994-1995) to 1003 (2002-2003) visits per 100 000 population, and adult visits with a diagnosis of bipolar disorder increased from 905 to 1679 visits per 100 000 population during this period. In 1999 to 2003, most youth bipolar disorder visits were by males (66.5%), whereas most adult bipolar disorder visits were by females (67.6%); youth were more likely than adults to receive a comorbid diagnosis of attention-deficit/hyperactivity disorder (32.2% vs 3.0%, respectively; P < .001); and most youth (90.6%) and adults (86.4%) received a psychotropic medication during bipolar disorder visits, with comparable rates of mood stabilizers, antipsychotics, and antidepressants prescribed for both age groups.

Conclusions There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.

PDF is attached at the bottom of this page

Bi-polar as a % of all youth admissions: 0.01% (1994-1995), 0.44% (2002-2003)

The Story Behind the Rise in Bipolar Diagnoses

• Chart was based on visits to regular doctors, not mental health specialists
• It is is a study of doctors’ diagnostic behaviors, not of actual bipolar disorder prevalence rates.
• NAMCS records visits rather than individual patients, and the number of duplicated data for individual patients is unknown.
• Blader et al. (2007) showed that– Population-adjusted rates of hospital discharges of children (in-patients) with a primary diagnosis of BD
  1.3 per 10,000 U.S. children 1996, 7.3 in 2004. = 4.6 X in 8 years = 5.7 X in a decade

Bipolar seems to have increased even more among black youth (low vitamin D)

From Bipolar Disorder In Children–A Diagnosis in the Doghouse April 2012

Black teens consuming media 13 hours/day, white teens 8.5 hours__ - generally indoors, and getting even less access to the sun

The impact of periventricular white matter lesions in patients with bipolar disorder type I - Jan 2014

CNS Spectr. 2014 Jan 10:1-12.
Serafini G1, Pompili M1, Innamorati M1, Girardi N2, Strusi L3, Amore M4, Sher L5, Gonda X6, Rihmer Z6, Girardi P1.

Introduction White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated.
METHODS:Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17.
RESULTS:Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients.
CONCLUSIONS:Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.

PMID: 24411553

Less sun more Bipolar Disorder - Oct 2014

Relationship between sunlight and the age of onset of bipolar disorder: An international multisite study
Journal of Affective Disorders, Volume 167, 1 October 2014, Pages 104–111
Michael Bauera, , , Tasha Glennb, Martin Aldac, Ole A. Andreassend, Elias Angelopoulose, Raffaella Ardauf, Christopher Baethgeg, Rita Bauera, Frank Bellivierh, i, Robert H. Belmakerj, Michael Berkk, l, m, Thomas D. Bjellad, Letizia Bossinin, Yuly Bersudskyj, Eric Yat Wo Cheungo, Jörn Conella, Maria Del Zompop, Seetal Doddk, q, Bruno Etainr, i, Andrea Fagiolinin, Mark A. Fryes, Kostas N. Fountoulakist, Jade Garneau-Fournieru, Ana González-Pintov, Hirohiko Harimaw, Stefanie Hasselx, Chantal Henryr, i, Apostolos Iacovidest, Erkki T. Isometsäy, z, Flávio Kapczinskiaa,

Background
The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode.

Methods
Data from 4037 patients with bipolar I disorder were collected at 36 collection sites in 23 countries at latitudes spanning 3.2 north (N) to 63.4 N and 38.2 south (S) of the equator. The age of onset of the first episode, onset location, family history of mood disorders, and polarity of first episode were obtained retrospectively, from patient records and/or direct interview. Solar insolation data were obtained for the onset locations.

Results: There was a large, significant inverse relationship between maximum monthly increase in solar insolation and age of onset, controlling for the country median age and the birth cohort. The effect was reduced by half if there was no family history. The maximum monthly increase in solar insolation occurred in springtime. The effect was one-third smaller for initial episodes of mania than depression. The largest maximum monthly increase in solar insolation occurred in northern latitudes such as Oslo, Norway, and warm and dry areas such as Los Angeles, California.

Limitations: Recall bias for onset and family history data.

Conclusions: A large springtime increase in sunlight may have an important influence on the onset of bipolar disorder, especially in those with a family history of mood disorders.

Nutritional and Safety Outcomes from an Open-Label Micronutrient Intervention for Pediatric Bipolar Spectrum Disorders Oct 2013

Abstract says the study tried some unspecified amount of vitamin D, which did help.
 Download the PDF from Vitamin D Life

See also web

• Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators Am J Psychiatry. 2013 Mar
  Metabolic syndrome and bipolar are strongly associated (2X) (as both associated with low vitamin D - not mentioned in article)
• The high prevalence of obstructive sleep apnea among patients with bipolar disorders J Affect Disord. 2013 Oct
  Both are strongly associated with low vitamin D - not mentioned in article. Full text on-line
• Bipolar trends in the US March 2011

has the following chart: 7X increase of bipolar of all ages in a decade (4.3X in 6 years) US

• Bipolar Disorder Symptoms International Mental Health Research Org. has the following graphic

• Woman describing her bipolar life - 4 minute video Oct 2017
• "While ADHD is chronic or ongoing, bipolar disorder is usually episodic, with periods of normal mood interspersed with depression, mania, or hypomania."
• Bipolar Mercola April 2018, Vitamin D not mentioned
• The role of vitamin D in bipolar disorder: Epidemiology and influence on disease activity - Sept 2020
  • doi: 10.1016/j.jad.2020.09.039 - behind paywall
  • "vitamin D status does not differ between BD and other psychiatric conditions"

Mood disorders helped by Vitamin D, Omega-3, etc -Jan 2017

Clinical use of nutraceuticals in the adjunctive treatment of depression in mood disorders.
Australas Psychiatry. 2017 Jan 1:1039856216689533. doi: 10.1177/1039856216689533. [Epub ahead of print]
Sarris J1. Pfessor of Integrative Mental Health, NICM, Western Sydney University, Campbelltown, NSW, and; Principal Research Fellow, The University of Melbourne, Department of Psychiatry, The Melbourne Clinic, Professorial Unit, Melbourne, VIC, Australia.

OBJECTIVES:
The aim of this paper is to detail a summary of the current evidence in this area, to better inform clinical practice. Our recent systematic reviews and meta-analyses of nutrient pharmacotherapies in the treatment unipolar depression revealed primarily positive results for replicated studies testing

• S-adenosyl methionine (SAMe),
• methylfolate,
• omega-3 (EPA or ethyl-EPA), and
• Vitamin D;

with supportive isolated studies found for creatine and an amino acid combination. Mixed results were found for zinc, folic acid, Vitamin C, and tryptophan; and non-significant study results for inositol. In bipolar depression, omega-3 and N-acetyl cysteine (NAC) were found to have supportive evidence, with an isolated study using a chelated mineral formula also displaying efficacy. No major adverse effects were noted in the studies (aside from occasional minor digestive disturbances with omega-3 and NAC).

CONCLUSIONS:
Several clinical considerations are needed when psychiatrists are considering prescribing nutrients, including knowledge of drug interactions, supplement safety and quality issues, individual psychological and biochemical individualities, in addition to cost factors.

PMID: 28135835 DOI: 10.1177/1039856216689533

US has the highest lifetime prevelance of bipolar (note: this will tend to ignore youth)

Bipolar treated by bright light (similar to SAD?) -RCT Oct 2017

Bright light therapy at midday helped patients with bipolar depression

• "Patients were randomly assigned to either a 7,000 lux bright white light or a 50 lux placebo light. The light therapy patients were instructed to place the light box about one foot from their face for 15-minute sessions to start. Every week, they increased their exposure to the light therapy by 15-minute increments until they reached a dose of 60 minutes per day or experienced a significant change in their mood" doi/10.1176/appi.ajp.2017.16101200.

• Seasonal Affective Disorder treatments include vitamin D and bright light – review Dec 2015
• Hypothesis – A SAD risk factor is low vitamin D – Nov 2014
• Light Therapy Lamp review - for Seasonal Affective Disorder - May 2015

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