The Elusive "Switch Process" in Bipolar Disorder and Photoperiodism: A Hypothesis Centering on NADPH Oxidase-Generated Reactive Oxygen Species Within the Bed Nucleus of the Stria Terminalis.

First, although a relevant study drawing on 51 papers, many retrospective and hospital-based, found that manic episodes develop to a lesser extent in autumn than in spring/summer ( 22 ), one carefully executed prospective clinical study involving BD I and II patients discovered a highly significant peak in manic symptoms in the weeks surrounding the autumn equinox, a pattern that was most pronounced in BDII individuals ( 23 ).

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