Bipolar Disorder & the Full Moon
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Q:  Bipolar Disorder & the Full Moon

I was just wondering if the full moon really does affect someone with bipolar disorder in some way? I know that it affects some people whether they have emotional/mental issues or not.

I heard from a friend who used to work in the local psychiatric hospital that when the moon was full, the bipolar and schizophrenic (sp?) people would get "out of sorts" in the evenings and they would need extra help on staff.

I am also concerned because I have an ex-husband who was diagnosed with it after I left him, (which explained a lot!) and I am concerned about my two young children who go on visitation with him when the full moon is in cycle. (I don't think he takes the medication that was prescribed long ago.) Also, he is on morphine for a back operation that he had and I want to know if that would make him a risk to my kids when they are there?

Dear Lori -- 
Funny you should ask, as just last night I was meeting with a friend who's a psychiatrist and very good mood disorders researcher; and when I did a little search to see what's been written on the subject, the first paper to pop up was one of his!
Raison As you'll see from the abstract (I haven't read the article itself), his team's conclusion was that there may be a connection all right, or at least maybe there used to be one.  

The moon and madness reconsidered.  J Affect Disord. 1999 Apr;53(1):99-106.

Belief that the full moon is associated with psychiatric disturbance persists despite 50 years research showing no association. This article traces the historical roots of belief in the power of the moon to cause disorders the mind, especially insanity and epilepsy. Putative mechanisms of lunar action are critiqued. It is proposed that modern findings showing lack of lunar effect can be reconciled with pre-modern beliefs in the moon's power through a mechanism of sleep deprivation. Prior to the advent of modern lighting the moon was a significant source of nocturnal illumination that affected sleep-wake cycle, tending to cause sleep deprivation around the time of full moon. This partial sleep deprivation would have been sufficient to induce mania/hypomania in susceptible bipolar patients and seizures in patients with seizure disorders. The advent of modern lighting attenuated this lunar effect, especially in modern urban areas, where most 20th century studies of lunar effects on the mind have been conducted. The hypothesis presented in this article is open to empirical validation or falsification. Potential tests for the sleep-deprivation hypothesis of lunar action are discussed.

At the same time, without having done the kind of search for information that Dr. Raison and colleagues did, I must admit I've wondered about the relationship you're commenting on here also.  But my guesswork lead off in the direction of the way women's menstrual cycles can synchronize with the lunar cycle, which I had heard many times but had never researched (to see if this assumption is correct) until you asked here.  And as I surf around looking for some good solid data confirming that relationship, I'm not finding much. Rather than spend the evening chasing that one, I'll just leave it as a logical connection, if the moon relationship to menses is true, since we know for sure that women can have a worsening of bipolar symptoms right before menses, a sort of PMS that is actually a "perimenstrual worsening" of their underlying condition (about this relationship there is no debate; and it shows up clinically all the time as often the last symptoms to come under control when we are adding mood stabilizers are those right before menses). Although the word menses "comes from the Latin mensis (month), which in turn relates to the Greek mene (moon)" -- from the Wikipedia entry on this subject -- there may be no real connection there at all; I'd have to try to confirm that common assumption has really been investigated. Obviously it wouldn't help much with figuring out your ex-husband! 

As for morphine, we always worry about that leading to depression; and I've always worried about whether it might somehow induce cycling like alcohol does, but from what I've seen in patients and in the research literature, I don't think there's anywhere near as much reason for concern about morphine and other narcotic pain medications as there is for alcohol and stimulant-type stuff.  

Dr. Phelps

Published September, 2005


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