Boyce P, Hopwood M
Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
Acta Psychiatr Scand Suppl. 2013(444):16-23. doi: 10.1111/acps.12175.
Disturbances in circadian rhythms have been associated with major depression and may be an underlying mechanism for the disorder. Resynchronisation of circadian rhythms may provide a new approach to treatment, especially by manipulating melatonin secretion. Melatonin is secreted at night and is a stable marker of circadian rhythms. The timing of its secretion can be changed by exogenous melatonin, agonism of specific melatonin receptors in the suprachiasmatic nucleus, its suppression by light and by sleep deprivation.
As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128 (Suppl. 444): 2-15; and 'Getting depression clinical practice guidelines right: time for change?' Kuiper et al. Acta Psychiatr Scand 2013;128 (Suppl. 444): 24-30.] addressing chronobiology, in this article, we conducted a selective review of studies that have examined the antidepressant effects of exogenous melatonin, light therapy, sleep deprivation and melatonin receptor agonists.
Antidepressant effects were identified for bright light therapy, especially for seasonal affective disorder; sleep deprivation, although its antidepressant effect is time limited; and for the novel antidepressant agomelatine with agonistic properties for the MT1 and MT2 receptors and antagonism of 5HT2c receptor. The role of melatonin as an antidepressant has yet to be demonstrated.
Shifting the circadian secretion of melatonin using the strategies reviewed offers a new approach to treating depression.
昼夜节律紊乱与重度抑郁症相关，可能是该疾病的潜在机制。昼夜节律重新同步化可能提供一种新的治疗方法，特别是通过调节褪黑素分泌。褪黑素在夜间分泌，是昼夜节律的一个稳定标志物。其分泌时间可通过外源性褪黑素、视交叉上核中特定褪黑素受体的激动作用、光照和睡眠剥夺对其的抑制作用来改变。
作为一系列关于时间生物学的论文[《情绪障碍的时间生物学》，马尔希和凯珀。《斯堪的纳维亚精神病学学报》2013年；128（增刊444）：2 - 15；以及《正确制定抑郁症临床实践指南：是时候改变了？》，凯珀等人。《斯堪的纳维亚精神病学学报》2013年；128（增刊444）：24 - 30。]的一部分，在本文中，我们对研究外源性褪黑素、光疗、睡眠剥夺和褪黑素受体激动剂的抗抑郁作用的研究进行了选择性综述。
已确定强光疗法具有抗抑郁作用，尤其是对季节性情感障碍；睡眠剥夺也有抗抑郁作用，尽管其抗抑郁作用时间有限；新型抗抑郁药阿戈美拉汀对MT1和MT2受体具有激动特性且对5HT2c受体具有拮抗作用。褪黑素作为抗抑郁药的作用尚未得到证实。
使用所综述的策略改变褪黑素的昼夜分泌为治疗抑郁症提供了一种新方法。
