Is SARS-CoV-2 a Risk Factor of Bipolar Disorder?—A Narrative Review

Abstract

For 2.5 years we have been facing the coronavirus disease (COVID-19) and its health, social and economic effects. One of its known consequences is the development of neuropsychiatric diseases such as anxiety and depression. However, reports of manic episodes related to COVID-19 have emerged. Mania is an integral part of the debilitating illness—bipolar disorder (BD). Due to its devastating effects, it is therefore important to establish whether SARS-CoV-2 infection is a causative agent of this severe mental disorder. In this narrative review, we discuss the similarities between the disorders caused by SARS-CoV-2 and those found in patients with BD, and we also try to answer the question of whether SARS-CoV-2 infection may be a risk factor for the development of this affective disorder. Our observation shows that disorders in COVID-19 showing the greatest similarity to those in BD are cytokine disorders, tryptophan metabolism, sleep disorders and structural changes in the central nervous system (CNS). These changes, especially intensified in severe infections, may be a trigger for the development of BD in particularly vulnerable people, e.g., with family history, or cause an acute episode in patients with a pre-existing BD.

First Manic Episode Following SARS-CoV-2 Infection

“…Although mania has sometimes been reported in the context of COVID-19 infection, the pathophysiology is far from elucidated. Hypotheses are being developed that take into account factors such as inflammation, changes in genetics and epigenetics, metabolism, hormones, neurotransmission, immunology, and oxidative stress [ 15 ]. Even though the virus has been shown to invade the central nervous system, a clear clinical correlation between positive CSF PCR testing and neuropsychiatric symptoms has not been identified [ 16 ].…”

A rare clinical presentation after COVID-19: Manic episode with psychotic features

“…However, immune system disturbances are also considered to be the major determinant of neuroinflammatory processes that feature in both the etiology and the course of bipolar disorder ( Kirlioglu et al, 2019 ). COVID-19 has been found to be related to cytokine dysregulations, tryptophan metabolism alterations, sleep disorders, and structural changes in the CNS that are similar to BD ( Lorkiewicz and Waszkiewicz, 2022 ). It is suggested that all these changes may trigger or unmask the development of BD ( Lorkiewicz and Waszkiewicz, 2022 , Del Casale et al, 2022 ).…”

“…COVID-19 has been found to be related to cytokine dysregulations, tryptophan metabolism alterations, sleep disorders, and structural changes in the CNS that are similar to BD ( Lorkiewicz and Waszkiewicz, 2022 ). It is suggested that all these changes may trigger or unmask the development of BD ( Lorkiewicz and Waszkiewicz, 2022 , Del Casale et al, 2022 ). In addition, our patient had a severe illness which may be related to the emergence of neuropsychiatric manifestations, which are considered to worsen the prognosis.…”

COVID-19 as a polymorphic inflammatory spectrum of diseases: a review with focus on the brain

“…There is speculative comparison of COVID-19 symptoms to bipolar disorders, citing the commonality of cytokine disorder, sleep disorders, and tryptophan metabolism in both (Lorkiewicz & Waszkiewicz, 2022). ADHD poses increased risk for COVID-19 but may reduce risk of severe outcomes.…”