Due to bipolar disorder clinical heterogeneity, a plethora of studies have provided new genetic, epigenetic, molecular, and cellular findings associated with its pathophysiology.
Genome-wide association studies and epigenetic evidence points to genotype–phenotype interactions
associated with inflammation, oxidative stress, abnormalities in signaling pathways, hypothalamic–
pituitary–adrenal axis, and circadian rhythm linked to mitochondrial dysfunction in bipolar disorder.
Although the literature is constantly increasing, most of the genetic variants proposed as biomarkers remain
to be validated by independent groups and use bigger samples and longitudinal approaches to enhance
their power and predictive ability.