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Roguski A, Ritter P, Smith DJ. Sensitivity to light in bipolar disorder: implications for research and clinical practice. Br J Psychiatry 2024; 224:143-146. [PMID: 38174418 PMCID: PMC7615859 DOI: 10.1192/bjp.2023.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Circadian dysfunction is a core feature of bipolar disorder and may be due, at least in part, to abnormalities of non-visual photoreception. We critically review the evidence for light hypersensitivity in bipolar disorder and discuss how this may shape future research and clinical innovation, with a focus on a possible novel mechanism of action for lithium.
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Affiliation(s)
- Amber Roguski
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Philipp Ritter
- Clinic for Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technical University of Dresden, Dresden, Germany
| | - Daniel J. Smith
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
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Needham N, Campbell IH, Grossi H, Kamenska I, Rigby BP, Simpson SA, McIntosh E, Bahuguna P, Meadowcroft B, Creasy F, Mitchell-Grigorjeva M, Norrie J, Thompson G, Gibbs MC, McLellan A, Fisher C, Moses T, Burgess K, Brown R, Thrippleton MJ, Campbell H, Smith DJ. Pilot study of a ketogenic diet in bipolar disorder. BJPsych Open 2023; 9:e176. [PMID: 37814952 PMCID: PMC10594182 DOI: 10.1192/bjo.2023.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/11/2023] [Accepted: 08/22/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Recent evidence from case reports suggests that a ketogenic diet may be effective for bipolar disorder. However, no clinical trials have been conducted to date. AIMS To assess the recruitment and feasibility of a ketogenic diet intervention in bipolar disorder. METHOD Euthymic individuals with bipolar disorder were recruited to a 6-8 week trial of a modified ketogenic diet, and a range of clinical, economic and functional outcome measures were assessed. Study registration number: ISRCTN61613198. RESULTS Of 27 recruited participants, 26 commenced and 20 completed the modified ketogenic diet for 6-8 weeks. The outcomes data-set was 95% complete for daily ketone measures, 95% complete for daily glucose measures and 95% complete for daily ecological momentary assessment of symptoms during the intervention period. Mean daily blood ketone readings were 1.3 mmol/L (s.d. = 0.77, median = 1.1) during the intervention period, and 91% of all readings indicated ketosis, suggesting a high degree of adherence to the diet. Over 91% of daily blood glucose readings were within normal range, with 9% indicating mild hypoglycaemia. Eleven minor adverse events were recorded, including fatigue, constipation, drowsiness and hunger. One serious adverse event was reported (euglycemic ketoacidosis in a participant taking SGLT2-inhibitor medication). CONCLUSIONS The recruitment and retention of euthymic individuals with bipolar disorder to a 6-8 week ketogenic diet intervention was feasible, with high completion rates for outcome measures. The majority of participants reached and maintained ketosis, and adverse events were generally mild and modifiable. A future randomised controlled trial is now warranted.
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Affiliation(s)
- Nicole Needham
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | | | - Helen Grossi
- Department of Nutrition and Dietetics, Royal Hospital for Children and Young People, NHS Lothian, UK
| | | | | | | | - Emma McIntosh
- Health Economics and Health Technology Assessment, University of Glasgow, UK
| | - Pankaj Bahuguna
- Health Economics and Health Technology Assessment, University of Glasgow, UK
| | | | | | | | - John Norrie
- Usher Institute, University of Edinburgh, UK
| | - Gerard Thompson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | | | - Ailsa McLellan
- Department of Paediatric Neurology, Royal Hospital for Children and Young People, NHS Lothian, UK
| | - Cheryl Fisher
- Department of Nutrition and Dietetics, Royal Hospital for Children and Young People, NHS Lothian, UK
| | - Tessa Moses
- Centre for Engineering Biology, University of Edinburgh, UK
| | - Karl Burgess
- Centre for Engineering Biology, University of Edinburgh, UK
| | | | | | | | - Daniel J. Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
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