睡眠轻干预可使褪黑素节律提前，改善围绝经期和绝经后抑郁症：初步研究结果。
Sleep-light interventions that shift melatonin rhythms earlier improve perimenopausal and postmenopausal depression: preliminary findings.
机构信息
From the Department of Psychiatry, University of California, San Diego, CA.
出版信息
Menopause. 2023 Aug 1;30(8):798-806. doi: 10.1097/GME.0000000000002216. Epub 2023 Jul 18.
OBJECTIVE
Testing the hypothesis that a sleep-light intervention, which phase-advances melatonin rhythms, will improve perimenopausal-postmenopausal (P-M; by follicle-stimulating hormone) depression.
METHODS
In at-home environments, we compared two contrasting interventions: (1) an active phase-advance intervention: one night of advanced/restricted sleep from 9 pm to 1 am , followed by 8 weeks of morning bright white light for 60 min/d within 30 minutes of awakening, and (2) a control phase-delay intervention: one night of delayed/restricted sleep (sleep from 3 to 7 am ) followed by 8 weeks of evening bright white light for 60 min/d within 90 minutes of bedtime. We tested 17 P-M participants, 9 normal controls and 8 depressed participants (DPs) (by Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] criteria). Clinicians assessed mood by structured interviews and subjective mood ratings. Participants wore actigraphs to measure sleep and activity and collected overnight urine samples for the melatonin metabolite, 6-sulfatoxymelatonin (6-SMT), before, during, and after interventions.
RESULTS
Baseline depressed mood correlated with delayed 6-SMT offset time (cessation of melatonin metabolite [6-SMT] secretion) ( r = +0.733, P = 0.038). After phase-advance intervention versus phase-delay intervention, 6-SMT offset (start of melatonin and 6-SMT decrease) was significantly advanced in DPs (mean ± SD, 2 h 15 min ± 12 min; P = 0.042); advance in 6-SMT acrophase (time of maximum melatonin and 6-SMT secretion) correlated positively with mood improvement ( r = +0.978, P = 0.001). Mood improved (+70%, P = 0.007) by both 2 and 8 weeks.
CONCLUSIONS
These preliminary findings reveal significantly phase-delayed melatonin rhythms in DP versus normal control P-M women. Phase-advancing melatonin rhythms improves mood in association with melatonin advance. Thus, sleep-light interventions may potentially offer safe, rapid, nonpharmaceutical, well-tolerated, affordable home treatments for P-M depression.
目的
验证假说，即睡眠-光照干预可使褪黑素节律提前，从而改善围绝经期-绝经后（通过卵泡刺激素）抑郁。
方法
在家庭环境中，我们比较了两种截然不同的干预措施：（1）主动相位提前干预：从晚上 9 点到凌晨 1 点提前/限制睡眠一晚，然后在醒来后 30 分钟内进行 8 周的早晨明亮的白光治疗，每天 60 分钟；（2）对照相位延迟干预：从晚上 3 点到早上 7 点延迟/限制睡眠一晚，然后在睡前 90 分钟内进行 8 周的傍晚明亮的白光治疗，每天 60 分钟。我们测试了 17 名围绝经期-绝经后（P-M）参与者、9 名正常对照组和 8 名抑郁组（DP）参与者（根据精神障碍诊断和统计手册[第五版]标准）。临床医生通过结构化访谈和主观情绪评分评估情绪。参与者佩戴活动记录仪以测量睡眠和活动，并在干预前、期间和之后收集过夜尿液样本以测量褪黑素代谢物 6-硫酸褪黑素（6-SMT）。
结果
基线抑郁情绪与褪黑素代谢物 6-SMT 消退时间（褪黑素分泌停止）的延迟相关（ r = +0.733，P = 0.038）。与相位延迟干预相比，DP 患者的 6-SMT 消退（褪黑素和 6-SMT 减少的开始）在相位提前干预后显著提前（平均±标准差，2 小时 15 分钟±12 分钟；P = 0.042）；6-SMT 顶峰（褪黑素和 6-SMT 分泌的最大值）的提前与情绪改善呈正相关（ r = +0.978，P = 0.001）。2 周和 8 周后，情绪均有改善（+70%，P = 0.007）。
结论
这些初步发现揭示了 DP 与正常对照组 P-M 女性相比，褪黑素节律明显延迟。提前褪黑素节律与褪黑素提前相关，可改善情绪。因此，睡眠-光照干预可能为围绝经期-绝经后抑郁提供安全、快速、非药物、耐受性好、经济实惠的家庭治疗方法。
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