Fall Mania


I had been gearing up to write my usual set of posts about seasonal affective disorder, and then this afternoon I met with a young woman who has had a clear and consistent pattern of getting hypomanic in the fall.

We talk a lot about winter and fall depression. And, for many people, as the days get shorter and darker they find they are less energetic, want to sleep longer, perhaps even eat more. But there are also people who experience energized states (hypomania or mania) in the Fall.

Doctors Goodwin and Jamison, in their classic book, [amazon_link id=”0195135792″ target=”_blank” container=”” container_class=”” ]Manic-Depressive Ilness[/amazon_link], note that, “Changes in light conditions are most rapid in spring and fall, and it may be that patients with recurrent affective disorders are more susceptible to rapid changes in the photoperiod.”

In other words, although the sun is brightest in the summer and dimmest in the winter, for people with bipolar what may trigger episodes is more the change in the amount of daylight, and the changes happen fastest in the spring and fall. This fits with an evolving model of bipolar that suggests that a major part of what leads to mood instability is unstable circadian (daily) rhythms

Most of the evidence for people with bipolar having a greater seasonality than the general population comes from clinical studies (studies of patients in a clinic) but there was one recent community study. In this study, Shin, et al. observed that:

Individuals with bipolar disorder experience greater seasonality than those with depression or healthy controls. Even the non-seasonal bipolar group had as much seasonal fluctuation as the seasonal depression group, which has important implications for the management of bipolar illness.”

While it is true that mania occurs more often in the spring, there is evidence that some people experience the reverse pattern. A research group at Harvard identified two seasonal patterns in bipolar. Type A consisted of  fall-winter depression with or without spring-summer mania or hypomania. Type B involved a spring-summer depression with or without fall-winter mania or hypomania.

Take home lesson – if you are bipolar, in the spring and fall it is especially important to focus on maintaining daily routines.