Mood Disorders Program

We are creating a comprehensive clinical program for patients with mood disorders and building an investigative program in translational research into the biological basis of bipolar disorder (BD).

We are using clinical subtypes such as sleep disturbance to guide investigations into biology. Sleep disturbance, migraine headaches, and mood are all linked to inflammatory and stress hormone pathways. Inflammation is central to creating oxidative stress in the brain that may worsen course of illness in BD. We are studying inflammation at several levels, including the polyunsaturated omega-3 and omega-6 pathways, cytokines and general inflammation,functioning of micronutrients such as zinc in the brain, and interactions with the stress hormone pathways. We are probing genomic and gene expression markers as well. By understanding more about the relationship between different types of inflammatory systems, we will learn how we can use these markers to predict onset of episode or treatment response.

BD often has co-morbidity with other illnesses, and migraine headache is present in about 30%of people with BD. The neuropathology and pharmacotherapy of migraine and BD overlap. Both may involve polyunsaturated fatty acid metabolism pathways and inflammation. With a grant from the Stanley Medical Research Institute, we are studying the effect of a dietary intervention to reduce inflammation adapted from a study of treatment of migraine headaches on mood stability and relapse , sleep, stress and functioning in BD patients. By understanding how biological factors influence clinical phenotype and outcome in BD, we aim to define subgroups of patients who have a more homogeneous biology of illness for predicting and following treatment response. We will then be able to apply the principles of personalized medicine to patients in the clinics suffering from BD.

  • Penn State Longitudinal Study of Bipolar Disorder, in collaboration with the University of Michigan Heinz C. Prechter Bipolar Research Group
  • Bipolar Disorder and Inflammation: "Are inflammatory and HPA axis markers abnormality patients with bipolar disorder who are manic or depressed, and are they modulated by treatment?"
  • Dietary Intervention in Bipolar Disorder

  • Erika Saunders, MD
  • Aubrey Reider
  • Caitlin Millett, graduate student, Neural and Behavioral Sciences
  • Sarthak Sawarkar, graduate student, Anatomy
  • Sanjay Yadav, resident psychiatrist

Past lab members

  • Mostafa Sherazy, resident psychiatrist
  • Scott Seaman, medical student
  • Andrew Jen, medical student
  • Andrew Fouche, medical student
  • Jesse Blank, medical student

Collaborations

Recommended Information on Bipolar Disorder

  • Saunders, EFH; McInnis, MG; Greden, JF. Evidence for the Need of Long Term Treatment of Major Depression Primary Psychiatry 14(6):60-65 (2007).
  • Saunders, EH; Scott, LJ; McInnis, MG; Burmeister, M. Familiarity and Diagnostic Patterns of Subphenotypes in the National Institutes of Mental Health Bipolar Sample American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics 147B:18-26 (2008).
  • McEachin, RC; Keller, BJ; Saunders, EFH; McInnis, MG. Modeling Gene-By-Environment Interaction in Comorbid Depression with Alcohol Use Disorder via an Integrated Bioinformatics Approach Biodata Mining 1(1):2 (2008). PMCID: PMC2547861
  • Saunders, BD; Saunders, EFH; Gauger, PG. Lithium Therapy and Hyperparathyroidism: An Evidence-Based Assessment. World Journal of Surgery 33(11):2314 (2009).
  • Saunders, EFH; Zhang, P; Copeland, JN; McInnis, MG; Zoellner, S. Suggestive linkage at 9p22 in bipolar disorder weighted by alcohol abuse. American Journal of Medical Genetics: Part B Neuropsychiatric Genetics 150B(8):1133-8 (2009).
  • Saunders, EFH; Silk KR. Personality Trait Dimensions and the Pharmacologic Treatment of Borderline Personality Disorder. Journal of Clinical Psychopharmacology 29(5):461-7 (2009).
  • Langenecker, S.A., Saunders, E.F.H., Kade, A.M., Ransom, M.T., McInnis, M.G. Intermediate Cognitive Phenotypes in Bipolar Disorder. Journal of Affective Disorders 122(3):285-93 (2010).
  • Kamali, MM; Saunders, EFH; Prossin, AR; Brucksch, CB; Harrington, GJ; Langenecker, SA;McInnis, MG. Associations Between Suicide Attempts and Elevated Bedtime Salivary Cortisol Levels in Bipolar Disorder. Journal of Affective Disorders 2012 Feb;136(3):350-8. (2012). NIHMSID #463875
  • Saunders, EFH; Fitzgerald, KD; Zhang, P; McInnis, MG. Clinical Features of Bipolar Disorder Comorbid with Anxiety Disorders. Depression and Anxiety Disorders 2012 Aug;29(8):739-746. (2012). NIHMSID #463874
  • Vederman, AC; Weisenbach, SL; Rapport, LJ; Leon, HM; Haase, BD; Franti, LM; Schallmo, M; Saunders, EFH; Kamali, MM; Zubieta, J; Langenecker, SA; McInnis, MG. Modality-specific alterations in the perception of emotional stimuli in Bipolar Disorder compared to Healthy Controls and Major Depressive Disorder. Cortex 2012 Sep;48(8):1027-34. (2012). NIHMSID #463872
  • Marshall DF, Walker SJ, Ryan KA, Kamali M, Saunders EF, Weldon AL, Adams KM, McInnis MG, Langenecker SA. Greater executive and visual memory dysfunction in comorbid bipolar disorder and substance use disorder. Psychiatry Res. 2012 Dec 30;200(2-3):252-7. NIHMSID #463871
  • Gelenberg, A; Thase, M; Saunders E. Recognition and Treatment of Depression by the Primary Care Practitioner. The Medical Roundtable: General Medicine Edition. 1(1):34-41 (2012).
  • Fouche, A; Saunders, EFH; Craig, T. "Depression and Anxiety in Patients with Hereditary Angioedema." In Press Annals of Allergy, Asthma, and Immunology, 2013.
  • Jen, A; Saunders, EFH; Ornstein, R; Kamali, M; McInnis, M. "Impulsivity, Alcohol Use Disorders and Anxiety Disorders associated with Eating Disorders in Bipolar Disorder" International Journal of Bipolar Disorders 1:16, 2013.
  • Saunders, EFH; Novick, D; Fernandez-Mendoza, J; Kamali, M; Ryan, KA; Evans, S; Langenecker, S; Gelenberg, AJ; McInnis, M. "Poor Sleep Quality during Euthymia in Bipolar Disorder: Role of Personality Traits, Stressful Life Events, and Rapid Cycling." International Journal of Bipolar Disorders, 1:13, 2013.
  • Aggarwal, R; Baweja, R; Saunders, EFH; Singareddy, R. CPAP-induced mania in bipolar disorder: a case report. Bipolar Disorders 2013. PMCID #23980584 Doi:10.1111/bdi.12112
  • Saunders, EFH; Nazir, R; Kamali, M; Ryan, KA; Evans, S; Langenecker, S; Gelenberg, AJ; McInnis, M. "Migraine headache Comorbidity Worsens Course of Illness in a Longitudinal Study of Bipolar Disorder"–In Press, Journal of Clinical Psychiatry

Book Chapters

  • Dupuy JM, Wittmann, C.W., Saunders, E.F.H, Gelenberg, A.J., Freeman, M.P. Lithium In: Schatzberg A, Nemeroff, C.B., editor. Essentials of Clinical Psychopharmacology. Arlington, VA: American Psychiatric Association; 2013. p. 419-38.

Selected Abstracts

  • Saunders, EFH; Fernandez-Mendoza, J; Sheikh, M; Langenecker, S; McInnis, M; Vgontzas, A; Gelenberg, A. Are sleep complaints associated with subsequent mood variability in bipolar disorder? Abstract presented at the American College of Neuropsychopharmacology, Miami, Florida, December 5-9, 2010.
  • Saunders, EFH; Fernandez-Mendoza, J; Joshi, A; Prossin, AR; Kamali, M; Langenecker, S; Vgontzas, A; McInnis, MG; Gelenberg AJ. Evening circadian preference is associated with long sleep duration, sleepiness and worse overall functioning due to illness in bipolar disorder. Presented at the 9th International Conference on Bipolar Disorders, Pittsburgh, Pennsylvania, June 8-10, 2011.
  • McInnis, MG; Brucksch, C; Greenberg, S; Grove, L; Harrington, G; Kamali, M;Langenecker, SA; Prossin, A; Ryan, K; Saunders, EFH H.C. Prechter Longitudinal Study of Bipolar Disorder: Baseline descriptive analysis of individuals with and without bipolar disorder. Presented at the 9th International Conference on Bipolar Disorder, June 9-11, 2011, Pittsburgh, PA
  • Kamali, M; Saunders, EFH; Prossin, AR; Russell, C; Ryan, KA; Vederman, AC; Langenecker, SA; McInnis, MG. Personality traits and their relationship with bipolar disorder and suicidal behavior. Presented at the 9th International Conference on Bipolar Disorder, June 9-11, 2011 Pittsburgh, PA
  • Saunders, EFH; Fernandez-Mendoza, J; Kamali, M; Langenecker, S; Bixler, E; Vgontzas, A; McInnis, MG; Gelenberg AJ. Sleep abnormalities in women with bipolar disorder may be mediated through abnormal response to light exposure and bedtime cortisol. Presented at the American College of Neuropsychopharmacology, Waikoloa, Hawaii, December 4-8, 2011.
  • Saunders, EFH; Fernandez-Mendoza, J; Kamali, M; Langenecker, S; Ryan, K, McInnis, M, Gelenberg, A. Sleep Disturbance predicts the Frequency of Clinically Significant Depressive Symptoms in Women with Bipolar Disorder. NCDEU, Phoenix, Arizona, May 29-Jun 1, 2012.
  • Saunders, EFH; Kamali, M; Gelenberg, AJ; McInnis, M. Migraine Comorbidity Worsens Course of Illness in a Longitudinal Study of Bipolar Disorder. Presented at the American College of Neuropsychopharmacology, Hollywood, Florida December 2-6, 2012.
  • Langenecker, SA; Vederman, A; Zoellner,S; Kamali, M; Saunders EFH; McInnis, MG; Zubieta, JK; Burmeister, M. Relationship of SYNE1 and Processing Speed with Interference Resolution in Bipolar Disorder. Presented at the American College of Neuropsychopharmacology, Hollywood, Florida December 2-6, 2012.
  • Saunders, EFH; Novick, D; Fernandez-Mendoza, J; Kamali, M; Langenecker, S; Gelenberg, AJ; McInnis, M. "Determinants of Poor Sleep Quality in Inter-episode Bipolar Disorder" Presented at NCDEU, Hollywood, Florida, May 28-31, 2013.
  • Saunders, EFH; Fernandez-Mendoza, J; Jacobs, A; Adebomojo, A; Bixler, E; Gelenberg, A. "Night-to-night Variability of Sleep Schedule is associated with Excessive Daytime Sleepiness in Bipolar Disorder" Presented at International Conference on Bipolar Disorders, Miami Beach, Florida, June 13-16, 2013.
  • Saunders, EFH; Seaman, S; Fernandez-Mendoza, J; Jacobs, A; Gelenberg, A "Sleep Misperception in Bipolar Disorder: Are our patients getting 7 hours of sleep?" Presented at the annual meeting of the American College of Neuropsychopharmacology, Hollywood, Florida Dec 3-6, 2013.
  • Crane, N.A., Kamali, M., Bhaumik, R., Ryan, K.A., Marshall, D.F., Saunders, E.F., Kassel, M.T., Weldon, A.L., McInnis, M.G., & Langenecker, S.A. (February, 2014). Developing Dimensional, Integrated Constructs of Self-Report and Neuropsychological Data for Inhibitory Control. To be presented at the 42nd annual meeting of the International Neuropsychological Society, Seattle, WA, February 12-15.
  • Saunders, EFH; Fernandez-Mendoza, J; Kamali, M; Langenecker, S; Bixler, E; Vgontzas, A; McInnis, MG; Gelenberg AJ. Sleep abnormalities in women with bipolar disorder may be mediated through abnormal response to light exposure and bedtime cortisol. PSU Women's Health Conference, April 8, 2014.