Lifestyle interventions for bipolar disorders: A systematic review and meta-analysis

Mario Simjanoski; Swara Patel; Raquel De Boni; Vicent Balanzá-Martínez; Benicio N Frey; Luciano Minuzzi; Flavio Kapczinski; Taiane de Azevedo Cardoso

doi:10.1016/j.neubiorev.2023.105257

Lifestyle interventions for bipolar disorders: A systematic review and meta-analysis

Neurosci Biobehav Rev. 2023 Sep:152:105257. doi: 10.1016/j.neubiorev.2023.105257. Epub 2023 May 30.

Authors

Mario Simjanoski¹, Swara Patel², Raquel De Boni³, Vicent Balanzá-Martínez⁴, Benicio N Frey⁵, Luciano Minuzzi⁶, Flavio Kapczinski⁷, Taiane de Azevedo Cardoso⁸

Affiliations

¹ Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada. Electronic address: simjanom@mcmaster.ca.
² Life Sciences Program, School of Interdisciplinary Science, McMaster University, 1280 Main St. West, Hamilton, ON, Canada.
³ Institute of Scientific and Technological Communication and Information in Health (ICICT), Oswaldo Cruz Foundation (FIOCRUZ), 4365 Manguinhos, Rio de Janeiro, Brazil.
⁴ Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Av. de Blasco Ibáñez, 13, Valencia, Spain.
⁵ Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Women's Health Concerns Clinic and Mood Disorders Program, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, Canada.
⁶ Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Av. de Blasco Ibáñez, 13, Valencia, Spain.
⁷ Neuroscience Graduate Program, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre, Brazil.
⁸ Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main St. West, Hamilton, ON, Canada; Life Sciences Program, School of Interdisciplinary Science, McMaster University, 1280 Main St. West, Hamilton, ON, Canada.

PMID: 37263531
DOI: 10.1016/j.neubiorev.2023.105257

Abstract

This review and meta-analysis aimed to describe the existing literature on interventions for bipolar disorder (BD) targeting the 6 pillars of Lifestyle Psychiatry: diet, physical activity (PA), substance use (SU), sleep, stress management, and social relationships (SR). Randomized Controlled Trials that examined the efficacy of lifestyle interventions targeting improvement in depressive/(hypo)manic symptom severity, lifestyle patterns, functioning, quality of life, and/or circadian rhythms were included. The systematic review included 18 studies, while the meta-analysis included studies targeting the same lifestyle domains and outcomes. Sleep (n = 10), PA (n = 9), and diet (n = 8) were the most targeted domains, while SU, SM and SR were least targeted (n = 4 each). Combined diet and PA interventions led to significant improvements in depressive symptoms (SMD: -0.46; 95%CI: -0.88, -0.04; p = 0.03), and functioning (SMD: -0.47; 95%CI: -0.89, -0.05; p = 0.03). Sleep interventions also led to significant improvements in depressive symptoms (SMD: -0.80; 95%CI: -1.21, -0.39; p < 0.01). Future research should focus on developing more multidimensional lifestyle interventions for a potentially greater impact on clinical and functional outcomes of BD.

Keywords: Bipolar disorder; Diet; Exercise; Lifestyle interventions; Lifestyle medicine; Lifestyle psychiatry; Meta-analysis; RCT; Sleep; Social relationships; Stress; Substance use; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Bipolar Disorder* / therapy
Exercise
Humans
Life Style
Psychotherapy
Quality of Life