Stabilizing Bipolar Disorder With Changing Seasons

Expert Alberto Augsten, PharmD, MS, BCPP, discussed the clinical implications of seasonal change—particularly the spring transition—for patients with bipolar disorder.¹ Augsten emphasized that while seasonality affects all psychiatric populations, individuals with bipolar disorder face distinct risks tied to fluctuations in light exposure, activity level, and daily routine.

Augsten noted that geographic location modulates seasonal impact, with patients in regions experiencing more extreme seasonal shifts bearing greater vulnerability. As daylight increases in spring, patients prone to hypomanic or manic episodes may be especially susceptible.² Of particular concern were college-aged patients, in whom spring break–associated behaviors—including alcohol use, illicit substance use, and stimulant misuse for academic purposes—can precipitate acute manic or psychotic episodes requiring inpatient hospitalization. Augsten observed that these patients often expressed confusion, articulating sentiments such as: "My friends were doing the same thing I did, why didn't they get hospitalized?"

Augsten underscored that sleep disruption serves as a key early warning sign across mood states. Decreased sleep need in particular—characterized by patient statements such as "I slept 3 hours last night. I'm ready to go. I'm on 2 hours tonight and ready to go"—may represent one of the earliest heralds of a manic episode. He recommended that patients be educated to recognize their individualized prodromal symptoms and communicate changes promptly to their treatment team.

From a pharmacologic standpoint, Augsten addressed nonadherence as a significant clinical challenge, particularly during hypomanic and manic states. He highlighted the role of long-acting injectable formulations in ensuring medication delivery and noted the availability of agents with more favorable metabolic profiles for patients concerned about weight gain. Augsten identified routine and consistency as the cornerstone of effective management for bipolar disorder.

Dr Augsten is the founder of Augsten Consulting and is a consultant and expert witness specializing in psychopharmacology and clinical toxicology. He is also founder and director of the Long-Acting Therapy (LAT) Clinic at Memorial Regional Hospital in Florida.

References

1. Skowron C. Spring mania: a different kind of spring fever. Psychology Today. March 2, 2024. Accessed March 27, 2026. https://www.psychologytoday.com/us/blog/a-different-kind-of-therapy/202403/spring-mania-a-different-kind-of-spring-fever

2. Cho CH, Lee HJ. Why do mania and suicide occur most often in the spring? Psychiatry Investig. 2018;15(3):232-234.