Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia.
Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia; School of Medicine, University of Notre Dame, Sydney, Australia.
Neurosci Biobehav Rev. 2021 Jul;126:79-101. doi: 10.1016/j.neubiorev.2021.02.045. Epub 2021 Mar 6.
Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.
主要的情绪综合征是最常见和最具致残性的精神障碍之一。然而，它们潜在的病理生理机制缺乏明确的划分，这是预防和优化治疗的主要障碍。24 小时昼夜节律系统的功能障碍是一种候选机制，它与情绪综合征在遗传、行为和神经生物学上有关。在这里，我们概述了一种新的临床表型的证据，我们称之为“昼夜节律性抑郁”。我们提出，昼夜节律性抑郁的关键临床特征包括 24 小时睡眠-觉醒周期紊乱、运动活动减少、主观能量降低和体重增加。疾病过程包括发病年龄早、有双相性的表现（定义为客观运动和主观能量/情绪状态之间的双向关联）、对传统抗抑郁药物反应不佳以及同时存在的心血管代谢和炎症紊乱。识别这种表型可能具有临床价值，因为针对昼夜节律的策略显示出减轻抑郁症状和稳定疾病过程的潜力。需要进一步研究情绪综合征中潜在的昼夜节律紊乱，以评估这种表型的临床效用，并指导昼夜节律靶向干预的最佳使用。
