Department of Psychiatry, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
, 652 Dufferin Street, Toronto, ON, M6K 2B4, Canada.
Eur Arch Psychiatry Clin Neurosci. 2018 Mar;268(2):107-118. doi: 10.1007/s00406-017-0835-5. Epub 2017 Sep 11.
Major depressive disorder (MDD) remains the most prevalent mental disorder and a leading cause of disability, affecting approximately 100 million adults worldwide. The disorder is characterized by a constellation of symptoms affecting mood, anxiety, neurochemical balance, sleep patterns, and circadian and/or seasonal rhythm entrainment. However, the mechanisms underlying the association between chronobiological parameters and depression remain unknown. A PubMed search was conducted to review articles from 1979 to the present, using the following search terms: "chronobiology," "mood," "sleep," and "circadian rhythms." We aimed to synthesize the literature investigating chronobiological theories of mood disorders. Current treatments primarily include tricyclic antidepressants and selective serotonin reuptake inhibitors, which are known to increase extracellular concentrations of monoamine neurotransmitters. However, these antidepressants do not treat the sleep disturbances or circadian and/or seasonal rhythm dysfunctions associated with depressive disorders. Several theories associating sleep and circadian rhythm disturbances with depression have been proposed. Current evidence supports the existence of associations between these, but the direction of causality remains elusive. Given the existence of chronobiological disturbances in depression and evidence regarding their treatment in improving depression, a chronobiological approach, including timely use of light and melatonin agonists, could complement the treatment of MDD.
重度抑郁症（MDD）仍然是最常见的精神障碍之一，也是导致残疾的主要原因，全球约有 1 亿成年人受其影响。这种疾病的特征是一系列影响情绪、焦虑、神经化学平衡、睡眠模式以及昼夜节律和/或季节性节律同步的症状。然而，昼夜节律参数与抑郁症之间关联的机制仍不清楚。我们使用“chronobiology”、“mood”、“sleep”和“circadian rhythms”等搜索词，对 1979 年至今的文献进行了 PubMed 检索，旨在综合调查情绪障碍昼夜节律理论的文献。目前的治疗方法主要包括三环类抗抑郁药和选择性 5-羟色胺再摄取抑制剂，它们已知能增加单胺神经递质的细胞外浓度。然而，这些抗抑郁药并不能治疗与抑郁症相关的睡眠障碍或昼夜节律和/或季节性节律功能障碍。有几个将睡眠和昼夜节律紊乱与抑郁症联系起来的理论已经提出。目前的证据支持这些理论之间存在关联，但因果关系的方向仍难以捉摸。鉴于抑郁症中存在昼夜节律紊乱的情况，以及关于它们在改善抑郁症方面的治疗效果的证据，昼夜节律方法，包括及时使用光和褪黑素激动剂，可能会补充 MDD 的治疗方法。
