Malhi G S, Kuiper S
Department of Psychiatry, CADE Clinic, Royal North Shore Hospital Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Acta Psychiatr Scand Suppl. 2013(444):2-15. doi: 10.1111/acps.12173.
As part of a series of papers examining chronobiology ['Getting depression clinical guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013;128(Suppl. 444):24-30; and 'Manipulating melatonin in managing mood' Boyce & Hopwood. ActaPsychiatrScand 2013;128(Suppl. 444):16-23], in this article, we review and synthesise the extant literature pertaining to the chronobiology of depression and provide a preliminary model for understanding the neural systems involved.
A selective literature search was conducted using search engines such as MEDLINE/PubMed, combining terms associated with chronobiology and mood disorders.
We propose that understanding of sleep-wake function and mood can be enhanced by simultaneously considering the circadian system, the sleep homoeostat and the core stress system, all of which are likely to be simultaneously disrupted in major mood disorders. This integrative approach is likely to allow flexible modelling of a much broader range of mood disorder presentations and phenomenology.
A preliminary multifaceted model is presented, which will require further development and testing. Future depression research should aim to examine multiple systems concurrently in order to derive a more sophisticated understanding of the underlying neurobiology.
作为一系列探讨生物钟学的论文的一部分（“正确制定抑郁症临床指南：变革时机已到？” 凯珀等人。《斯堪的纳维亚精神病学学报》2013 年；128（增刊 444）：24 - 30；以及 “在情绪管理中调节褪黑素” 博伊斯和霍普伍德。《斯堪的纳维亚精神病学学报》2013 年；128（增刊 444）：16 - 23），在本文中，我们回顾并综合了与抑郁症生物钟学相关的现有文献，并提供了一个理解所涉及神经系统的初步模型。
使用诸如 MEDLINE/PubMed 等搜索引擎进行了选择性文献检索，将与生物钟学和情绪障碍相关的术语相结合。
我们提出，通过同时考虑昼夜节律系统、睡眠稳态和核心应激系统，可以增强对睡眠 - 觉醒功能和情绪的理解，所有这些系统在主要情绪障碍中可能同时受到干扰。这种综合方法可能允许对更广泛的情绪障碍表现和现象学进行灵活建模。
提出了一个初步的多方面模型，该模型需要进一步开发和测试。未来的抑郁症研究应旨在同时检查多个系统，以便对潜在的神经生物学有更深入的理解。
