Tölle R
Klinik und Poliklinik für Psychiatrie, Westfälischen Wilhelms-Universität Münster.
Fortschr Neurol Psychiatr. 1991 Apr;59(4):103-16. doi: 10.1055/s-2007-1000684.
New symptom-statistical, chronobiological and experimental investigations concerning diurnal variation in endogenous depression (melancholia) are reported and interpreted referring to psychopathological, biological and phenomenological aspects. According to recent studies, the so-called typical diurnal variation of mood (with morning low) is not as frequent, as it was assumed before, and even intraindividually unstable. Although more frequent than other daily rhythmus, the so called typical diurnal variation should not be used for diagnostic purposes, because it is quite frequent in different depressive states as well. During their healthy intervals endogenous depressive patients show not rarely an analogous diurnal variation of mood; this was also found in healthy subjects. Therefore the so called typical variation in mood is not specific, and it is questionable whether it is a marker of endogenous depression at all. Concerning circadian rhythm biological functions were examined more often than the depressive symptomatology itself (especially temperature, heart rate, cortisol and other neuroendocrine parameters). Unexpectedly there were only slight variations of the circadian diurnal curves in melancholic patients compared to healthy subjects. The circadian rhythm in endogenous depression does not seem to be very different from the physiological diurnal course. Comparing the biological circadian curves in endogenous depression to the curves of the depression symptomatology, the similarities outline the differences. Sleep research didn't show any results, supporting the suggestion of a specific rhythm variation either. Therefore the opinion, that the circadian rhythm is altered basically in melancholia, cannot be maintained, neither psychopathologically nor biologically. Experiments of time estimation in the course of the day could'nt explain the diurnal variation in mood either.
报告了关于内源性抑郁症(忧郁症)昼夜变化的新的症状统计学、生物钟学和实验研究,并从心理病理学、生物学和现象学方面进行了解释。根据最近的研究,所谓的典型情绪昼夜变化(早晨情绪低落)并不像之前所认为的那样频繁,甚至在个体内部也不稳定。虽然比其他日常节律更频繁,但所谓的典型昼夜变化不应被用于诊断目的,因为它在不同的抑郁状态中也相当常见。在内源性抑郁症患者的健康间歇期,他们也常常表现出类似的情绪昼夜变化;在健康受试者中也发现了这一现象。因此,所谓的典型情绪变化并不具有特异性,它是否是内源性抑郁症的一个标志物也值得怀疑。关于昼夜节律,对生物功能的检查比对抑郁症状本身的检查更为频繁(尤其是体温、心率、皮质醇和其他神经内分泌参数)。出乎意料的是,与健康受试者相比,忧郁症患者的昼夜曲线只有轻微变化。内源性抑郁症的昼夜节律似乎与生理昼夜过程并没有太大不同。将内源性抑郁症中的生物昼夜曲线与抑郁症状曲线进行比较,相似之处凸显了差异。睡眠研究也没有显示出任何结果来支持特定节律变化的观点。因此,无论是从心理病理学还是生物学角度来看,认为忧郁症中昼夜节律基本改变的观点都无法成立。一天当中的时间估计实验也无法解释情绪的昼夜变化。