Articles By Dr. Stephen Young, Jr.

Dr. Stephen Young, Jr. PhD. is the Vice President of DBS Tampa Bay, Inc. His original articles on the subject of Mental Health are published on a regular basis.

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.

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