Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milano, Italy.
Expert Rev Neurother. 2011 Jul;11(7):961-70. doi: 10.1586/ern.11.61.
Alteration of the sleep-wake cycle and of the sleep structure are core symptoms of a major depressive episode, and occur both in course of bipolar disorder and of major depressive disorder. Many other circadian rhythms, such as the daily profiles of body temperature, cortisol, thyrotropin, prolactin, growth hormone, melatonin and excretion of various metabolites in the urine, are disrupted in depressed patients, both unipolar and bipolar individuals. These disrupted rhythms seem to return to normality with patient recovery. Research on circadian rhythms and sleep have led to the definition of nonpharmacological therapies of mood disorder that can be used in everyday practice. These strategies, named chronotherapeutics, are based on controlled exposures to environmental stimuli that act on biological rhythms, and demonstrate good efficacy in the treatment of illness episodes. They include manipulations of the sleep-wake rhythm (such as partial and total sleep deprivation, and sleep phase advance) and of the exposure to the light-dark cycle (light therapy and dark therapy). In recent years, an increasing literature about the safety and efficacy of chronobiological treatments in everyday psychiatric settings has supported the inclusion of these techniques among the first-line antidepressant strategies for patients affected by mood disorders.
睡眠-觉醒周期和睡眠结构的改变是重性抑郁发作的核心症状，既发生在双相障碍中，也发生在重性抑郁障碍中。许多其他的昼夜节律，如体温、皮质醇、促甲状腺激素、催乳素、生长激素、褪黑素和尿液中各种代谢物的排泄的日常节律，在单相和双相抑郁患者中都被打乱了。这些紊乱的节律似乎随着患者的康复而恢复正常。对昼夜节律和睡眠的研究导致了非药物治疗心境障碍的方法的定义，可以在日常实践中使用。这些策略被称为时间治疗学，是基于对环境刺激的控制暴露，这些刺激作用于生物节律，并在治疗疾病发作方面显示出良好的疗效。它们包括对睡眠-觉醒节律的操纵（如部分和完全睡眠剥夺，以及睡眠相位提前）和对光-暗周期的暴露（光疗和暗疗）。近年来，越来越多的关于在日常精神科环境中进行生物钟治疗的安全性和有效性的文献支持将这些技术纳入一线抗抑郁策略，用于受心境障碍影响的患者。
