Kuiper S, McLean L, Fritz K, Lampe L, Malhi G S
CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Acta Psychiatr Scand Suppl. 2013(444):24-30. doi: 10.1111/acps.12176.
As part of a series of papers ['Chronobiology of mood disorders' Malhi & Kuiper. Acta Psychiatr Scand 2013;128(Suppl. 444):2-15; and 'It's time we managed depression: The emerging role of chronobiology' Malhi et al. Acta Psychiatr Scand 2013;128(Suppl. 444):1] examining chronobiology in the context of depression, this article examines recent western clinical practice guidelines (CPGs) for the treatment of depression with respect to the recommendations they make, in particular as regards chronobiological treatments, and briefly considers the implications of their methodology and approach.
Five international treatment guidelines, which had been published in the past 5 years, were identified, representing North American and European views. Chosen guidelines were reviewed by the authors, and the relevant recommendations were distributed for discussion and subsequent synthesis.
Most current guidelines do not address chronobiology in detail. Chronotherapeutic recommendations are tentative, although agomelatine is considered as an option for major depression and bright light therapy for seasonal affective disorder. Sleep deprivation is not routinely recommended.
Recommendations are limited by the lack of reliable therapeutic markers for chronotherapeutics. Current evidence supports use of light therapy in seasonal depression, but in non-seasonal depression there is insufficient evidence to support reliance on chronotherapeutics over existing treatment modalities.
作为一系列探讨抑郁症背景下时间生物学的论文（《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《是时候我们来治疗抑郁症了：时间生物学的新作用》，马尔希等人，《斯堪的纳维亚精神病学学报》2013年；128（增刊444）：1）的一部分，本文考察了近期西方治疗抑郁症的临床实践指南（CPGs），涉及它们所提出的建议，特别是关于时间生物学治疗方面的建议，并简要考虑了其方法和途径的影响。
确定了过去5年发表的5份国际治疗指南，代表北美和欧洲的观点。作者对选定的指南进行了审查，并分发了相关建议以供讨论和后续综合。
大多数现行指南没有详细涉及时间生物学。时间治疗的建议是初步的，尽管阿戈美拉汀被视为重度抑郁症的一种选择，而强光疗法用于季节性情感障碍。不常规推荐睡眠剥夺。
由于缺乏可靠的时间治疗标志物，建议受到限制。目前的证据支持在季节性抑郁症中使用光疗，但在非季节性抑郁症中，没有足够的证据支持依赖时间生物学治疗而非现有治疗方式。
