Wirz-Justice Anna
Centre for Chronobiology, Psychiatric University Clinics, Basel, Switzerland.
Dialogues Clin Neurosci. 2008;10(3):337-43. doi: 10.31887/DCNS.2008.10.3/awjustice.
Diurnal variation of depressive symptoms appears to be part of the core of depression. Yet, longitudinal investigation of an individual's pattern, regularity, relation to clinical state, and clinical improvement reveals little homogeneity. Morning lows, afternoon slump, evening worsening-all can occur during a single depressive episode. Mood variability, or the propensity to produce mood swings, appears to be the characteristic that most predicts capacity to respond to treatment. Laboratory studies have revealed that mood, like physiological variables such as core body temperature, is regulated by a circadian clock interacting with the sleep homeostat. Many depressed patients, particularly bipolar patients, show delayed sleep phase (late chronotype). Even small shifts in the timing and duration of sleep affect mood state (sleep deprivation and sleep phase advance have an antidepressant effect). The implications for treatment are to stabilize mood state by enhancing synchronization of the sleep-wake cycle with the biological clock (eg, with light therapy).
抑郁症状的昼夜变化似乎是抑郁症核心的一部分。然而，对个体模式、规律性、与临床状态的关系以及临床改善情况的纵向研究显示，几乎没有一致性。晨低、午后萎靡、傍晚加重——所有这些情况都可能在单次抑郁发作期间出现。情绪变异性，即产生情绪波动的倾向，似乎是最能预测对治疗反应能力的特征。实验室研究表明，情绪与诸如核心体温等生理变量一样，受与睡眠稳态相互作用的生物钟调节。许多抑郁症患者，尤其是双相情感障碍患者，表现出睡眠相位延迟（晚睡型）。即使睡眠的时间和时长有微小变化也会影响情绪状态（睡眠剥夺和睡眠相位提前具有抗抑郁作用）。对治疗的启示是通过增强睡眠 - 觉醒周期与生物钟的同步性（例如，通过光照疗法）来稳定情绪状态。
