Articles By Dr. Stephen Young, Jr.
Social Rhythm Disruption ~ Dr. Stephen Young, Jr. PhD.
Social Rhythm Disruption
Few things are more stressful than major life-changing events, like moving, losing a job, or ending
a relationship. Individuals with bipolar disorder have many examples of how disruptive changes brought
about the onset of an episode or their diagnosis. This stress doesn’t have to be negative. Eustress, or good
stress, seemingly positive outcomes and occasions, can act as a trigger as well.
The concept of Social Rhythm Disruption (SRD) explains this paradox. Put simply, SRD is the
effect of a life event on an individual’s normal routine. Researchers and doctors emphasized the impact on
circadian rhythms and sleep loss, but some think there may be a “social rhythm sensitivity” itself. (Boland
et al., 2012). Early studies found that SRD was linked to mania.
Interestingly, in the context of one study, they found the onset of mania to be more strongly
connected to SRD, rather than cycling. In addition, when SRD was present, it acted as a causal factor
unconnected to the number of previous manic episodes. (Frank et al., 2000) A more recent cross-cultural
study states that “people with bipolar disorder are even more susceptible to social rhythm disruption
following life events than healthy non-disordered individuals.” (Magraff et al., 2016) Numerous studies
agree that SRD events bring about a faster onset and a worsening of bipolar symptoms. (Boland et al.,
2012).
The first takeaway is the importance of routine. People with bipolar disorder need to walk the
fine line between self-isolation and over-extension. The second is that Social Rhythm Therapy and Inter-
Personal Social Rhythm Therapy (IPSRT) now exist as avenues that seek to address the issue of SRD.
Third, the significance of SRD illustrates the importance of environmental factors for bipolar disorder.
While appropriate medication is essential for the treatment of bipolar disorder, the study of SRD shows
that the person with bipolar disorder must take special care in controlling what they can, and encountering
what they cannot control.
Sources
Frank E., Anderson B. P., Hlastala, S. A., Luther, J. F., Sherril, J. T., Houck, P. R., & Kupfer, D. J.
(2000, September). Social rhythm disruption and stressful life events in the onset of bipolar and unipolar
episodes. Psychological Medicine, 30(5), 1005–1016. https://doi.org/10.1017/s0033291799002706
Margraf J, Lavallee K, Zhang X, Schneider S (2016) Social Rhythm and Mental Health: A Cross-
Cultural Comparison. PLoS ONE 11(3): e0150312. https://doi.org/10.1371/journal.pone.0150312
Boland EM, Bender RE, Alloy LB, Conner BT, Labelle DR, Abramson LY. Life events and social
rhythms in bipolar spectrum disorders: an examination of social rhythm sensitivity. J Affect Disord. 2012
Aug;139(3):264-72. doi: 10.1016/j.jad.2012.01.038. Epub 2012 Feb 29. PMID: 22381951; PMCID:
PMC3368102.
The above article is printed here as an academic resource for educational purposes and casual reference. Always check with your doctor or licensed mental health professional with any questions regarding behavioral health diagnosis and treatments for yourself or loved one. Depression Bipolar Support Tampa Bay, Inc. does not endorse, approve, recommend, or certify any information, specific treatment, medication, service, or professional presented.
Thyroid & Mental Health~ Dr. Stephen Young, Jr. PhD.
Thyroid & Mental Health
The thyroid gland is a small, butterfly-shaped gland located at the base of the neck that
regulates metabolism and influences many other functions such as blood pressure, heart rate, and how
other hormones interact with the body. Hypothyroidism, the state in which the thyroid gland doesn’t
produce enough thyroid hormone, and hyperthyroidism, the condition in which it produces too much,
are two common disorders of the thyroid. Thyroid health is important for mental health, because
psychiatric literature notes that thyroid disorders can result in anxiety, depression, mania and psychosis.
(Adiba)
Depression, especially treatment resistant depression, has often shown a link to
hypothyroidism. Undiagnosed, untreated, and undertreated individuals with hypothyroidism are
particularly vulnerable to depression (Nuguru). Females with hypothyroidism show the clearest
correlation to clinical depression. (Bode) Alternatively, in a chicken-and-the-egg scenario, patients with
depression may frequently develop thyroid abnormalities. (Hage) Certain mood disorder medications
can even induce hypothyroidism, which may have long-lasting effects.
Depression and hypothyroidism are not the only link between mental health and the thyroid.
Mania, delusions, and hallucinations have been found present in patients with excess thyroid hormones.
Doctors have diagnosed individuals with organic, thyroid-related illnesses as bipolar and found that both
thyroid and psychiatric treatment is required to adequately care for them. These cases of
hyperthyroidism or thyrotoxicosis can arise two ways. First, from an organic disease, as stated earlier.
Second, from thyroid supplementation to treat hypothyroidism.
Phenomena like this are one of the reasons DBS Tampa Bay emphasizes the importance of
diagnosis by a physician. Medical doctors should seek to investigate or eliminate the possibility that
thyroid disorders play into a patient’s mental health, especially if any prescribed medication is known to
interact with thyroid function. As far as the question of broader research goes, there is hope that in the
future studies can find genetic linkages between thyroid function and other mood disorders such as
bipolar disorder. (Menon)
Sources
Afifa Adiba, M.D. Association of Thyrotoxicosis With Mania
https://doi.org/10.1176/appi.ajp-rj.2019.140504
Bocchetta A, Tamburini G, Cavolina P, Serra A, Loviselli A, Piga M. Affective psychosis, Hashimoto's
thyroiditis, and brain perfusion abnormalities: case report. Clin Pract Epidemiol Ment Health. 2007
Dec 20;3:31. doi: 10.1186/1745-0179-3-31. PMID: 18096026; PMCID: PMC2235848
Bode H, Ivens B, Bschor T, Schwarzer G, Henssler J, Baethge C. Association of Hypothyroidism and
Clinical Depression: A Systematic Review and Meta-analysis. JAMA
Psychiatry. 2021;78(12):1375–1383. doi:10.1001/jamapsychiatry.2021.2506
Hage MP, Azar ST. The Link between Thyroid Function and Depression. J Thyroid Res.
2012;2012:590648. doi: 10.1155/2012/590648. Epub 2011 Dec 14. PMID: 22220285; PMCID:
PMC3246784.
Menon B. Hypothyroidism and bipolar affective disorder: is there a connection? Indian J Psychol Med.
2014 Apr;36(2):125-8. doi: 10.4103/0253-7176.130966. PMID: 24860210; PMCID: PMC4031577.
Nuguru S P, Rachakonda S, Sripathi S, et al. (August 20, 2022) Hypothyroidism and Depression: A
Narrative Review. Cureus 14(8): e28201. doi:10.7759/cureus.28201
Verma R, Sachdeva A, Singh Y, Balhara YP. Acute mania after thyroxin supplementation in
hypothyroid state. Indian J Endocrinol Metab. 2013 Sep;17(5):922-3. doi: 10.4103/2230-8210.117220.
PMID: 24083180; PMCID: PMC3784882.
The above article is printed here as an academic resource for educational purposes and casual reference. Always check with your doctor or licensed mental health professional with any questions regarding behavioral health diagnosis and treatments for yourself or loved one. Depression Bipolar Support Tampa Bay, Inc. does not endorse, approve, recommend, or certify any information, specific treatment, medication, service, or professional presented.
Assortative Mating and Bipolar Disorder ~ Dr. Stephen Young, Jr. PhD.
Assortative Mating and Bipolar Disorder
Assortative mating is the phenomena in which similar individuals mate with each other.
This can be done on the basis of economic status, phenotype (appearance), or similar
backgrounds. Partner selection is often directed by mutual similarities that may not even be
explicitly recognized by the mates in question.
When it comes to bipolar disorder and other forms of affective disorder, studies suggest
that assortative mating may play a key role in generational prevalence of the mental health issues
in question. Improved access to genetic databases and better record-keeping have paved the way
for the study of assortative mating in several countries throughout the world. One meta-analytical
study from 2001 (Matthews, Reuss) found that the prevalence of assortative mating in bipolar
disorder was significantly higher than in unipolar depression.
A more recent study determined that there was “more illness and assortative mating for a
mood disorder in both the spouse and patient’s parents from the US compared to Europe.” (Post,
et. al, 2020) The same study found that in the across two generations of those with a mood
disorder in the US, more bipolar disorder, unipolar depression and substance abuse were found in
the offspring when assortative mating played a role. Another group of researchers found that
individuals who had children with a partner with bipolar disease were more likely to fulfill the
criteria for a mental illness, as well as having sub-normal social functioning and processing
skills. (Greve, et al., 2020)
This vein of research has multiple ramifications. Like often attracts like, although the
other causal factors in assortative mating (economic status, culture, phenotype) might present a
chicken-and-the-egg type paradox. Put simply, someone with, for instance, multiple
hospitalizations could be less likely to rely on a high-economic status as a driver in mate
selection. Furthermore, the evidence of the outcomes and correlations of assortative mating
strongly support the role of genetics in heritability and the prevalence of bipolar disorder overall.
It is strongly unlikely that a single gene is the determinant. Evidence supports that
multiple “rare, disease-causing mutations in brain genes” are responsible. (Kerner, 2015) Since
disease is hypothesized to be negatively selected (avoided) in evolution, some suggest that
multiple gene groups that may be responsible for bipolar disorder have associations with
creativity, openness to new experiences, and novelty-seeking. Mysteriously, however, inherited
bipolar disorder seems to follow the model as if it did depend on one or a small number of genes.
As genetic testing and indexing grows more commonplace, and if the role of environment is not
disregarded, many more questions may arrive at answers. Above all, researchers agree that early
intervention in at-risk children is key.
Sources
Kerner
https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2015.00105/full
Matthews, Reuss
https://pubmed.ncbi.nlm.nih.gov/11458299/
Post
https://link.springer.com/article/10.1007/s00406-018-0934-y
Greve
https://academic.oup.com/schizophreniabulletin/article/46/Supplement_1/S155/5839221
The above article is printed here as an academic resource for educational purposes and casual reference. Always check with your doctor or licensed mental health professional with any questions regarding behavioral health diagnosis and treatments for yourself or loved one. Depression Bipolar Support Tampa Bay, Inc. does not endorse, approve, recommend, or certify any information, specific treatment, medication, service, or professional presented.
DBS Tampa Bay Newsletter
Welcome to our online Newsletter page. Coming soon will be our new digital version of the DBS Tampa Bay, Inc. Newsletter! Past editions of our Newsletters which were published by our organization will be available also from the archives.