{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:39:02Z","timestamp":1788979142218,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mood episodes in bipolar disorder (BD) follow a seasonal pattern in approximately 25% of patients. We aimed to examine the associations of specific seasonality patterns in BD with various clinical phenotypes and treatment\u2010related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients from the Mayo Clinic Bipolar Disorder Biobank with available seasonality data were included in the study. Among those reporting any seasonality, participants were further categorized into four seasonality groups: fall\/winter depression, spring\/summer (hypo)mania, biphasic (fall\/winter depression with spring\/summer (hypo)mania), and equinoctial seasonality (any mood episode occurring in spring or fall). Regression models were used, treating seasonality patterns as the predictor of clinical phenotypes (BD subtype, early onset, history of psychosis, suicide attempt, rapid cycling), lifetime medication exposure (number of unique antidepressants, antipsychotics, and any psychotropics) and treatment response to mood stabilizers (Alda A score).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1702 patients with BD (61.5% female, mean age\u2009=\u200941.43\u2009\u00b1\u200914.73\u2009years), 44.6% reported seasonal mood episodes. Individuals with any seasonality were more likely to have BD\u2010I (OR\u2009=\u20091.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.024), early onset (OR\u2009=\u20091.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026), exposure to higher lifetime number of antipsychotics (IRR\u2009=\u20091.20,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and any psychotropics (IRR\u2009=\u20091.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Fall\/winter depression was associated with a higher lifetime number of antidepressants (IRR\u2009=\u20091.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.021), any psychotropics (IRR\u2009=\u20091.14,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), worse response to lithium (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029) and all mood stabilizers (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u2009\u22120.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). Spring\/summer (hypo)mania showed negative associations with rapid cycling (OR\u2009=\u20090.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and lifetime number of antidepressants (IRR\u2009=\u20090.70,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). Equinoctial seasonality was linked to a history of psychosis (OR\u2009=\u20091.76,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Seasonality in BD is associated with distinct clinical features and treatment\u2010related outcomes. Specific seasonality patterns, particularly fall\/winter depression, may reflect a more complex and difficult\u2010to\u2010treat illness course. These findings highlight the need for research to better characterize seasonality subtypes beyond a binary \u201cseasonal\u201d vs. \u201cnon\u2010seasonal\u201d classification and to explore how these patterns influence the illness course and management of BD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.70063","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T09:02:12Z","timestamp":1766739732000},"page":"257-269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Seasonality Patterns in Bipolar Disorder: Associations With Clinical Phenotypes and Treatment\u2010Related Outcomes"],"prefix":"10.1111","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9873-6500","authenticated-orcid":false,"given":"Siralp","family":"Bostan","sequence":"first","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic  Rochester Minnesota USA"},{"name":"Ankara Provincial Health Directorate  Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8224-1307","authenticated-orcid":false,"given":"Lindsay M.","family":"Melhuish Beaupre","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mete","family":"Ercis","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; Psychology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-5923","authenticated-orcid":false,"given":"Brandon J.","family":"Coombes","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5894-3701","authenticated-orcid":false,"given":"Francisco","family":"Romo\u2010Nava","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Lindner Center of HOPE  Mason Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5578-4605","authenticated-orcid":false,"given":"Miguel L.","family":"Prieto","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Facultad de Medicina Universidad de los Andes  Santiago Chile"},{"name":"Mental Health Service Cl\u00ednica Universidad de los Andes  Santiago Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7663-913X","authenticated-orcid":false,"given":"Alfredo B.","family":"Cuellar Barboza","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Universidad Aut\u00f3noma de Nuevo Le\u00f3n  Monterrey Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8879-0865","authenticated-orcid":false,"given":"Susan L.","family":"McElroy","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience University of Cincinnati College of Medicine  Cincinnati Ohio USA"},{"name":"Lindner Center of HOPE  Mason Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6997-4215","authenticated-orcid":false,"given":"Mark A.","family":"Frye","sequence":"additional","affiliation":[{"name":"Department of Psychiatry &amp; 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