Sleep and circadian rhythms in mood disorders

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65629/1/j.1600-0447.2007.00968.x.pd

Sleep deprivation in Depression:What do we know, where do we go?

Manipulations of the sleep-wake cycle, whether of duration (total or partial sleep deprivation [SD]) or timing (partial SD, phase advance), have profound and rapid effects on depressed mood in 60% of all diagnostic subgroups of affective disorders. Relapse after recovery sleep is less when patients are receiving medication; it may be prevented by co-administration of lithium, pindolol, serotonergic antidepressants, bright light, or a subsequent phase advance procedure. Diurnal and day-to-day mood variability predict both short-term response to SD and long-term response to antidepressant drug treatment. These mood patterns can be understood in terms of a "two-process model of mood regulation" based on the model well established for sleep regulation: the interaction of circadian and homeostatic processes. The therapeutic effect of SD is postulated to be linked to changes in disturbed circadian- and sleep-wake-dependent phase relationships and concomitant increase of slow-wave-sleep pressure; additionally SD-induced sleepiness may counteract the hyperarousal state in depression. This model has the advantage of providing a comprehensive theoretical framework and stringent protocols ("constant routine, " "forced desynchrony") to dissect out specific disturbances. Many aspects tie in with current serotonergic receptor hypotheses of SD action. A treatment inducing euthymia in severely depressed patients within hours is an important therapeutic option that has come of age for clinical use. Biol Psychiatry 1999;46:445-453 (C) 1999 Society of Biological Psychiatry

The significance of sleep physiological disturbances in depression.

Since the discovery of the antidepressant effects of interventions in the sleep-wake cycle, a number of hypotheses have emerged according to which disturbances in sleep physiology are not merely expressions but essential components of the pathophysiology of depression. Three hypotheses are presented, the "Phase-advance", the "S-deficiency" and the "ACh-hypersensitivity" hypotheses. They explain the therapeutic effects of total, partial and selective sleep deprivation as consequences of the normalization of disturbed sleep regulation. The question is dealt with whether there are indications that the hypothesized sleep regulatory disturbances exist and whether there is a relationship between the effects of sleep deprivation on sleep regulation and clinical state. None of the hypotheses is totally supported, none can be fully rejected

The significance of sleep physiological disturbances in depression.

Since the discovery of the antidepressant effects of interventions in the sleep-wake cycle, a number of hypotheses have emerged according to which disturbances in sleep physiology are not merely expressions but essential components of the pathophysiology of depression. Three hypotheses are presented, the "Phase-advance", the "S-deficiency" and the "ACh-hypersensitivity" hypotheses. They explain the therapeutic effects of total, partial and selective sleep deprivation as consequences of the normalization of disturbed sleep regulation. The question is dealt with whether there are indications that the hypothesized sleep regulatory disturbances exist and whether there is a relationship between the effects of sleep deprivation on sleep regulation and clinical state. None of the hypotheses is totally supported, none can be fully rejected

The judgment of facial expressions by depressed patients, their partners and controls

Background: Research has shown that cognitive and interpersonal processes play significant roles in depression development and maintenance. Depressed patients judgments of emotions displayed in facial expressions, as well as those of their partners, allow for better understanding of these processes. Methods: In this study, twenty major depression outpatients, their partners and control persons (matched on the sex and age of the partner) judged facial expressions as to the emotions they felt were portrayed, at the patients outpatient admission. It was expected that the patients would judge the facial expression more negatively and less positively than their partners and that the partners would judge more negatively and less positively than the controls. Results: It was found that while both the patients and partners judged less positive emotions than the controls, the patients and partners did not judge the expressions differently. A trend in the same direction was found between the three groups as to judgment of negative emotions. Conclusion: These findings are related back to interpersonal and cognitive theories of depression. Limitation: A limitation of this study was the somewhat small patient population available for study. Clinical Relevance: This study helps to shed light on the similarity between interpersonal and cognitive processes of depressed patients and their partners. (C) 1998 Elsevier Science B.V

The Prevalence of Seasonal Affective Disorder in The Netherlands: A Prospective and Retrospective Study of Seasonal Mood Variation in the General Population

Background: The aim of the present study was to assess the prevalence of seasonal affective disorder (SAD) in The Netherlands. Methods: The subjects (n = 5356), randomly selected from community registers, were given the Seasonal Pattern Assessment Questionnaire and the Centre for Epidemiological Studies Depression Scale over a period of 13 months. The response rate was 52.6%. Results: Three percent of the respondents met the criteria for winter SAD, 0.1% for summer SAD. The criteria for subsyndromal SAD, a milder form of SAD, were met by 8.5%, 0.3% of whom showed a summer pattern. Younger women received a diagnosis of SAD more often than men or older women. Conclusions: SAD subjects were significantly more often unemployed or on sick leave than other subjects. Respondents who met winter SAD criteria were significantly more depressed than healthy subjects, in both winter and summer. Finally, month of completion had no influence on the number of subjects meeting the SAD criteria.