Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 14, 2018
ARTICLE COMMENTARY

Towards an Evolutionary View of Bipolar Disorders



Antonio E. Nardi*
Institute of Psychiatry – Federal University of Rio de Janeiro. National Academy of Medicine, Rio de Janeiro, Brazil


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Identifiers and Pagination:

Year: 2018
Volume: 14
First Page: 233
Last Page: 235
Publisher Id: CPEMH-14-233
DOI: 10.2174/1745017901814010233

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Electronic publication date: 29/09/2018
Collection year: 2018

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© 2018 Antonio E. Nardi.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Institute of Psychiatry – Federal University of Rio de Janeiro. National Academy of Medicine, Rio de Janeiro, Brazil; Tel: +5521-2523-6839; E-mail: antonioenardi@gmail.com




During the last decades, there has been a strong emphasis on the concern how environmental features, for example nutritional or toxicological conditions, can influence brain metabolism and biochemistry and human behaviour [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 2Dias GP, Cavegn N, Nix A, et al. The role of dietary polyphenols on adult hippocampal neurogenesis: Molecular mechanisms and behavioural effects on depression and anxiety. Oxid Med Cell Longev 2012; 2012: 541971.[http://dx.doi.org/10.1155/2012/541971] [PMID: 22829957] ]. We all recognize that the environment may impact our health, a special attention has been given to mechanisms related to mental health and mental disorder [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] ]. Nowadays, it is clear that environmental exposures and neuroendocrine responses influence the brain function and affect mental health [3McEwen BS. The brain on stress: Toward an integrative approach to brain, body, and behavior. Perspect Psychol Sci 2013; 8(6): 673-5.[http://dx.doi.org/10.1177/1745691613506907] [PMID: 25221612] ].

The interactions between gene and environment are of special interest for the development of neurogenesis and neurobiochemical systems that work into the Hypothalamic-Pituitary-Adrenal (HPA) axis and how they can result in emotional responses [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 2Dias GP, Cavegn N, Nix A, et al. The role of dietary polyphenols on adult hippocampal neurogenesis: Molecular mechanisms and behavioural effects on depression and anxiety. Oxid Med Cell Longev 2012; 2012: 541971.[http://dx.doi.org/10.1155/2012/541971] [PMID: 22829957] ]. The environment is a strong activator of the HPA axis, the complex feedback-regulated neuroendocrine system controlling cortisol secretion and physiological stress responses in mammals [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 4Herman JP, Cullinan WE. Neurocircuitry of stress: Central control of the hypothalamo-pituitary-adrenocortical axis. Trends Neurosci 1997; 20(2): 78-84.[http://dx.doi.org/10.1016/S0166-2236(96)10069-2] [PMID: 9023876] ]. Some data highlights the cumulative burden of social stress and HPA axis activation facilitating the onset of mental disorders [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 5Champagne FA. Early environments, glucocorticoid receptors, and behavioral epigenetics. Behav Neurosci 2013; 127(5): 628-36.[http://dx.doi.org/10.1037/a0034186] [PMID: 24128352] ]. Severe and chronic stress may clearly lead to changes in the prefrontal and in limbic systems with lifelong adjustments in region-specific gene expression, neural plasticity, neuroendocrine function and behavioural response to stressors [4Herman JP, Cullinan WE. Neurocircuitry of stress: Central control of the hypothalamo-pituitary-adrenocortical axis. Trends Neurosci 1997; 20(2): 78-84.[http://dx.doi.org/10.1016/S0166-2236(96)10069-2] [PMID: 9023876] , 5Champagne FA. Early environments, glucocorticoid receptors, and behavioral epigenetics. Behav Neurosci 2013; 127(5): 628-36.[http://dx.doi.org/10.1037/a0034186] [PMID: 24128352] ].

One of the established impact on mental health is of the modern city life [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 6Dye C. Health and urban living. Science 2008; 319(5864): 766-9.[http://dx.doi.org/10.1126/science.1150198] [PMID: 18258905] ]. Almost all urban subjects tend to be healthier than rural population, as they have superior educational, economic and healthcare conveniences that large cities may offer [6Dye C. Health and urban living. Science 2008; 319(5864): 766-9.[http://dx.doi.org/10.1126/science.1150198] [PMID: 18258905] ]. But interestingly, the opposite seems to be true for mental health—psychiatric disorders are more frequent in urban areas [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 7Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010; 121(2): 84-93.[http://dx.doi.org/10.1111/j.1600-0447.2009.01438.x] [PMID: 19624573] ]. Evidence suggests a dose-dependent relationship between psychosis onset, severity and its prognosis when the subject is exposed to urban environments [8Pedersen CB, Mortensen PB. Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry 2001; 58(11): 1039-46.[http://dx.doi.org/10.1001/archpsyc.58.11.1039] [PMID: 11695950] ].

The urban specific features of demand and adaptation are highly complex and have an enormous variability, and they are useful as an agent for a set of environmental influences in the city. Carta et al. [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ] presented us with some interesting hypotheses about how cities’ noise and light pollution might influence our mental health and increase the risk for bipolar disorder. They [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ] suggested that we may be facing an evolutionary decoupling of habits and adaptive demands. From an evolutionary perspective, the authors [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ] assumed that having an excess of energy during a sleepless night episode may have had an adaptive effect. They pointed out that we were accustomed to resting at night and awakening due to light (or noise) may be undoubtedly associated with a stress reaction that urges a consumption of mental and physical resources [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ]. It can be supposed and scientifically tested that if the city demands that biological rhythms be broken, people with a basic predisposition to living with biologic rhythms different from what was considered normal in a previous moment of human life may be in an adaptive state [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ].

For their point of view [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ], people who are driven to novelty-seeking may be, for example, explorers with hyper-rhythmic temperaments, which are also consistent with studies on migrants by will and not as refugees, as observed in studies conducted by Carta et al. [10Carta MG, Perra A, Atzeni M, et al. An evolutionary approach to mania studying Sardinian immigrants to Argentina. Rev Bras Psiquiatr 2017; 39(2): 147-53.[http://dx.doi.org/10.1590/1516-4446-2016-2005] [PMID: 28300934] ]. The psychopathological changes and demands nowadays in big cities would be the disordered side of those who find it difficult to adapt to the demands of non-stop activities. But the new lifestyle might also influence those who adapt and show behaviors, reactions and responses that might resemble bipolar disorder, but may be just an adaptative behavior [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ]. This may also justify some overdiagnosis of bipolar disorder II in some psychiatric centers. Supporting their hypotheses and a general worry of many psychiatrists, some surveys have found that mood disorders and bipolar disorder continue to increase in Western societies [11Carta MG, D’Oca S, Atzeni M, et al. Quality of life of sardinian immigrants in buenos aires and of people living in italy and sardinia: Does the kind of care have a role for people with depression? Clin Pract Epidemiol Ment Health 2016; 12: 158-66.[http://dx.doi.org/10.2174/1745017901612010158] [PMID: 28217143] ]. For Carta et al. [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ], a possible explanation for this paradox may be that those who have so-called “predisposition to mood disorders” but do not become ill will live better and reproduce in the new world of constant activity.

Sleep patterns are increasingly jeopardized by recent changes in the challenging human modern life [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ]. Individuals with poor quality of sleep might be more vulnerable to the impact of road traffic noise on mental health even if it is difficult to understand the precise mechanism. Carta et al. [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ] directed our attention to the idea that it is still undetermined whether those affected by road traffic noise were already poor sleepers or poor sleep was the first manifestation of impairment due to road traffic, thus being the first step in mental disorder onset [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ].

Artificial light changes daily rhythms by allowing the presence, during hours of natural darkness, of activities normally performed during daylight hours, such as food intake or social meetings [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ]. This has a great impact on the immune-endocrine circadian timing mechanisms and the other endogenous rhythms that have evolved to ensure that human behavior are more efficient when synchronized with variations in light and with other environmental circumstances such as weather and seasons [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] , 12Wyse CA, Biello SM, Gill JM. The bright-nights and dim-days of the urban photoperiod: Implications for circadian rhythmicity, metabolism and obesity. Ann Med 2014; 46(5): 253-63.[http://dx.doi.org/10.3109/07853890.2014.913422] [PMID: 24901354] ]. Some studies suggested that sleep-wake cycle interruptions and artificial light pollution might be triggering features for bipolar disorder [13Bedrosian TA, Nelson RJ. Timing of light exposure affects mood and brain circuits. Transl Psychiatry 2017; 7(1): e1017.[http://dx.doi.org/10.1038/tp.2016.262] [PMID: 28140399] ].

Although melatonin steroid-induced mechanisms are very complex, in general, they decrease estradiol and increase progesterone levels [14Chuffa LG, Seiva FR, Fávaro WJ, et al. Melatonin and ethanol intake exert opposite effects on circulating estradiol and progesterone and differentially regulate sex steroid receptors in the ovaries, oviducts, and uteri of adult rats. Reprod Toxicol 2013; 39: 40-9.[http://dx.doi.org/10.1016/j.reprotox.2013.04.001] [PMID: 23591044] ], so the block of melatonin at night, due to light pollution, unbalances the estradiol / progesterone ratio in favor of estradiol which may be relevant in bipolar disorder [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] , 9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ]. Carta et al. [9Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149] ] advanced the hypothesis that the blockade of night-time production of melatonin due to light pollution may play an important role in the genesis of bipolar disorder also as a consequence of the effect that melatonin exerts on the stability of steroid hormones.

Another challenge for future research tests will be the development of animal models that could be compared to the complexity of environmental challenges in the modern world [1Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717] ]. And we must always consider that modern life and its demanding are changing every day, mainly increasing its stress factors. A long-term study of risk and resilience relationship to mental disorders onset could also present us the perspective of preventive measures to psychiatric disorders and promote a better life for people daily challenged by the rapid modern world demands.

REFERENCES

[1] Tost H, Champagne FA, Meyer-Lindenberg A. Environmental influence in the brain, human welfare and mental health. Nat Neurosci 2015; 18(10): 1421-31.[http://dx.doi.org/10.1038/nn.4108] [PMID: 26404717]
[2] Dias GP, Cavegn N, Nix A, et al. The role of dietary polyphenols on adult hippocampal neurogenesis: Molecular mechanisms and behavioural effects on depression and anxiety. Oxid Med Cell Longev 2012; 2012: 541971.[http://dx.doi.org/10.1155/2012/541971] [PMID: 22829957]
[3] McEwen BS. The brain on stress: Toward an integrative approach to brain, body, and behavior. Perspect Psychol Sci 2013; 8(6): 673-5.[http://dx.doi.org/10.1177/1745691613506907] [PMID: 25221612]
[4] Herman JP, Cullinan WE. Neurocircuitry of stress: Central control of the hypothalamo-pituitary-adrenocortical axis. Trends Neurosci 1997; 20(2): 78-84.[http://dx.doi.org/10.1016/S0166-2236(96)10069-2] [PMID: 9023876]
[5] Champagne FA. Early environments, glucocorticoid receptors, and behavioral epigenetics. Behav Neurosci 2013; 127(5): 628-36.[http://dx.doi.org/10.1037/a0034186] [PMID: 24128352]
[6] Dye C. Health and urban living. Science 2008; 319(5864): 766-9.[http://dx.doi.org/10.1126/science.1150198] [PMID: 18258905]
[7] Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010; 121(2): 84-93.[http://dx.doi.org/10.1111/j.1600-0447.2009.01438.x] [PMID: 19624573]
[8] Pedersen CB, Mortensen PB. Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry 2001; 58(11): 1039-46.[http://dx.doi.org/10.1001/archpsyc.58.11.1039] [PMID: 11695950]
[9] Carta MG, Preti A, Akiskal HS. Coping with the new era: Noise and light pollution, hyperactivity and steroid hormones. Towards an evolutionary view of Bipolar Disorders. Clin Pract Epidemiol Ment Health 2018; 14: 33-6.[http://dx.doi.org/10.2174/1745017901814010033] [PMID: 29541149]
[10] Carta MG, Perra A, Atzeni M, et al. An evolutionary approach to mania studying Sardinian immigrants to Argentina. Rev Bras Psiquiatr 2017; 39(2): 147-53.[http://dx.doi.org/10.1590/1516-4446-2016-2005] [PMID: 28300934]
[11] Carta MG, D’Oca S, Atzeni M, et al. Quality of life of sardinian immigrants in buenos aires and of people living in italy and sardinia: Does the kind of care have a role for people with depression? Clin Pract Epidemiol Ment Health 2016; 12: 158-66.[http://dx.doi.org/10.2174/1745017901612010158] [PMID: 28217143]
[12] Wyse CA, Biello SM, Gill JM. The bright-nights and dim-days of the urban photoperiod: Implications for circadian rhythmicity, metabolism and obesity. Ann Med 2014; 46(5): 253-63.[http://dx.doi.org/10.3109/07853890.2014.913422] [PMID: 24901354]
[13] Bedrosian TA, Nelson RJ. Timing of light exposure affects mood and brain circuits. Transl Psychiatry 2017; 7(1): e1017.[http://dx.doi.org/10.1038/tp.2016.262] [PMID: 28140399]
[14] Chuffa LG, Seiva FR, Fávaro WJ, et al. Melatonin and ethanol intake exert opposite effects on circulating estradiol and progesterone and differentially regulate sex steroid receptors in the ovaries, oviducts, and uteri of adult rats. Reprod Toxicol 2013; 39: 40-9.[http://dx.doi.org/10.1016/j.reprotox.2013.04.001] [PMID: 23591044]

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