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Tang H, Chen S, Yi L, Xu S, Yang H, Li Z, He Y, Liao Y, Chen X, Liu C, Gu L, Yuan N, Chen C, Tang J. Circadian Rhythms Correlated in DNA Methylation and Gene Expression Identified in Human Blood and Implicated in Psychiatric Disorders. Am J Med Genet B Neuropsychiatr Genet 2024:e33005. [PMID: 39319595 DOI: 10.1002/ajmg.b.33005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/25/2024] [Accepted: 08/05/2024] [Indexed: 09/26/2024]
Abstract
Circadian rhythms modulate the biology of many human tissues and are driven by a nearly 24-h transcriptional feedback loop. Dynamic DNA methylation may play a role in driving 24-h rhythms of gene expression in the human brain. However, little is known about the degree of circadian regulation between the DNA methylation and the gene expression in the peripheral tissues, including human blood. We hypothesized that 24-h rhythms of DNA methylation play a role in driving 24-h RNA expression in human blood. To test this hypothesis, we analyzed DNA methylation levels and RNA expression in blood samples collected from eight healthy males at six-time points over 24 h. We assessed 442,703 genome-wide CpG sites in methylation and 12,364 genes in expression for 24-h rhythmicity using the cosine model. Our analysis revealed significant rhythmic patterns in 6345 CpG sites and 21 genes. Next, we investigated the relationship between methylation and expression using powerful circadian signals. We found a modest negative correlation (ρ = -0.83, p = 0.06) between the expression of gene TXNDC5 and the methylation at the nearby CpG site (cg19116172). We also observed that circadian CpGs significantly overlapped with genetic risk loci of schizophrenia and autism spectrum disorders. Notably, one gene, TXNDC5, showed a significant correlation between circadian methylation and expression and has been reported to be association with neuropsychiatric diseases.
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Affiliation(s)
- Haiyan Tang
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanshan Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Hunan Provincial Brain Hospital (The Second people's Hospital of Hunan Province), Changsha, Hunan, China
| | - Liu Yi
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sheng Xu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Huihui Yang
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zongchang Li
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Ying He
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanhui Liao
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xiaogang Chen
- Department of Psychiatry, Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunyu Liu
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Lin Gu
- RIKEN AIP, Tokyo, Japan
- Research Center for Advanced Science and Technology (RCAST), The University of Tokyo, Tokyo, Japan
| | - Ning Yuan
- Hunan Provincial Brain Hospital (The Second people's Hospital of Hunan Province), Changsha, Hunan, China
| | - Chao Chen
- Center for Medical Genetics & Hunan Key Laboratory of Medical Genetics, School of Life Sciences, and Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Central South University, Changsha, China
- National Clinical Research Center on Mental Disorders, the Second Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinsong Tang
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Zhejiang, China
- Hunan Provincial Brain Hospital (The Second people's Hospital of Hunan Province), Changsha, Hunan, China
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Crouse JJ, Park SH, Byrne EM, Mitchell BL, Chan K, Scott J, Medland SE, Martin NG, Wray NR, Hickie IB. Evening Chronotypes With Depression Report Poorer Outcomes of Selective Serotonin Reuptake Inhibitors: A Survey-Based Study of Self-Ratings. Biol Psychiatry 2024; 96:4-14. [PMID: 38185236 DOI: 10.1016/j.biopsych.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/20/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Preliminary evidence suggests that evening chronotype is related to poorer efficacy of selective serotonin reuptake inhibitors. It is unknown whether this is specific to particular medications, self-rated chronotype, or efficacy. METHODS In the Australian Genetics of Depression Study (n = 15,108; 75% women; 18-90 years; 68% with ≥1 other lifetime diagnosis), a survey recorded experiences with 10 antidepressants, and the reduced Morningness-Eveningness Questionnaire was used to estimate chronotype. A chronotype polygenic score was calculated. Age- and sex-adjusted regression models (Bonferroni-corrected) estimated associations among antidepressant variables (how well the antidepressant worked [efficacy], duration of symptom improvement, side effects, discontinuation due to side effects) and self-rated and genetic chronotypes. RESULTS The chronotype polygenic score explained 4% of the variance in self-rated chronotype (r = 0.21). Higher self-rated eveningness was associated with poorer efficacy of escitalopram (odds ratio [OR] = 1.04; 95% CI, 1.02 to 1.06; p = .000035), citalopram (OR = 1.03; 95% CI, 1.01 to 1.05; p = .004), fluoxetine (OR = 1.03; 95% CI, 1.01 to 1.05; p = .001), sertraline (OR = 1.02; 95% CI, 1.01 to 1.04; p = .0008), and desvenlafaxine (OR = 1.03; 95% CI, 1.01 to 1.05; p = .004), and a profile of increased side effects (80% of those recorded; ORs = 0.93-0.98), with difficulty getting to sleep the most common. Self-rated chronotype was unrelated to duration of improvement or discontinuation. The chronotype polygenic score was only associated with suicidal thoughts and attempted suicide (self-reported). While our measures are imperfect, and not of circadian phase under controlled conditions, the model coefficients suggest that dysregulation of the phenotypic chronotype relative to its genetic proxy drove relationships with antidepressant outcomes. CONCLUSIONS The idea that variation in circadian factors influences response to antidepressants was supported and encourages exploration of circadian mechanisms of depressive disorders and antidepressant treatments.
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Affiliation(s)
- Jacob J Crouse
- Brain and Mind Centre, the University of Sydney, Sydney, New South Wales, Australia.
| | - Shin Ho Park
- Brain and Mind Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Enda M Byrne
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia; Child Health Research Centre, the University of Queensland, Brisbane, Queensland, Australia
| | - Brittany L Mitchell
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Karina Chan
- Brain and Mind Centre, the University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Brain and Mind Centre, the University of Sydney, Sydney, New South Wales, Australia; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sarah E Medland
- Mental Health and Neuroscience Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Nicholas G Martin
- Department of Genetics and Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Naomi R Wray
- Institute for Molecular Bioscience, the University of Queensland, Brisbane, Queensland, Australia; Department of Psychiatry, University of Oxford, Oxford, United Kingdom; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom
| | - Ian B Hickie
- Brain and Mind Centre, the University of Sydney, Sydney, New South Wales, Australia
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Li X, Yu J, Jiang S, Fang L, Li Y, Ma S, Kong H, Qin X, Zhu D. Circadian rhythms of melatonin and its relationship with anhedonia in patients with mood disorders: a cross-sectional study. BMC Psychiatry 2024; 24:165. [PMID: 38413912 PMCID: PMC10900661 DOI: 10.1186/s12888-024-05606-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Mood disorders are strongly associated with melatonin disturbances. However, it is unclear whether there is a difference in melatonin concentrations and melatonin circadian rhythm profiles between depression and bipolar disorder. In addition, the relationship between anhedonia, a common symptom of affective disorders, and its melatonin circadian rhythm remains under-investigated. METHODS Thirty-four patients with depression disorder, 20 patients diagnosed with bipolar disorder and 21 healthy controls participated in this study. The Revised Physical Anhedonia Scale (RPAS) was performed to assess anhedonia. Saliva samples were collected from all subjects at fixed time points (a total of 14 points) in two consecutive days for measuring the melatonin concentrations to fit circadian rhythms of subjects. Melatonin circadian rhythms were compared between the three groups using ANOVA. Partial correlation analysis and linear regression analysis were used to explore the correlation between melatonin rhythm variables and anhedonia. RESULTS We found that the peak phase of melatonin in the depression group was significantly advanced compared to the control group (P < 0.001) and the bipolar disorder group (P = 0.004). The peak phase of melatonin and RPAS showed a negative correlation (P = 0.003) in depression patients, which was also demonstrated in the multiple linear regression model (B=-2.47, P = 0.006). CONCLUSIONS These results suggest that circadian rhythms of melatonin are differentiated in depression and bipolar disorder and correlate with anhedonia in depression. Future research needs to explore the neurobiological mechanisms linking anhedonia and melatonin circadian rhythms in depressed patients.
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Affiliation(s)
- Xinyu Li
- The School of Mental Health and Psychological Sciences, Anhui Medical University, 230032, Hefei, China
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China
| | - Jiakuai Yu
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China
| | - Shuo Jiang
- Institutes of Physical Science and Information Technology, Anhui University, 230039, Hefei, China
| | - Liang Fang
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China
| | - Yifei Li
- The School of Mental Health and Psychological Sciences, Anhui Medical University, 230032, Hefei, China
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China
| | - Shuangshuang Ma
- School of Nursing, Anhui Medical University, 230032, Hefei, China
| | - Hui Kong
- The School of Mental Health and Psychological Sciences, Anhui Medical University, 230032, Hefei, China
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China
| | - Ximing Qin
- Institutes of Physical Science and Information Technology, Anhui University, 230039, Hefei, China.
| | - Daomin Zhu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, 230032, Hefei, China.
- Department of Sleep Disorders, Anhui Mental Health Center, 230022, Hefei, China.
- Department of Sleep Disorders, Hefei Fourth People's Hospital, 230022, Hefei, China.
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Yang YQ, Tiliwaerde M, Gao NN, Zhang TT, Ji HX, Gu W, Jin ZL. Mechanism of GW117 antidepressant action: melatonin receptor-mediated regulation of sleep rhythm. Eur J Pharmacol 2024; 964:176299. [PMID: 38160931 DOI: 10.1016/j.ejphar.2023.176299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Alterations in circadian sleep patterns constitute a salient manifestation in major depressive disorder. GW117, an emergent antidepressant, functions as an agonist for melatonin 1 and melatonin 2 (MT1/MT2) receptors, in tandem with antagonism of the serotonin (5-HT) 2C receptor. The present investigation is dedicated to elucidating the role and underlying mechanisms by which GW117 ameliorates circadian sleep disruptions. Utilizing an adapted chronic unpredictable mild stress protocol, we induced a depressive-like phenotype and perturbed circadian rhythms in rodent models. Our methodological approach integrated quantitative polymerase chain reaction (qPCR) in real-time, enzyme-linked immunosorbent assay (ELISA), and immunoblotting techniques to probe alterations in the expression of core circadian genes and homeostatic sleep markers. The impact of GW117 was assessed across various dosages (10, 20, and 40 mg/kg) on these molecular signatures. In a parallel examination, we evaluated the influence of GW117 (administered at 15, 40, and 60 mg/kg) on the sleep patterns of healthy mice. The results showed that GW117 significantly improved sleep-wake circadian rhythms, altered sleep architecture, and shortened sleep latency. Furthermore, GW117 increased the expression of several clock genes in the hypothalamus of chronic unpredictable mild stress model rats and normal mice. It also regulated circadian biomarkers, including melatonin and cortisol. Based on our findings, we propose that the beneficial effects of GW117 on sleep rhythms may be due to the melatonin system-mediated activation of the Wnt/β-catenin signaling pathway.
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Affiliation(s)
- Ya-Qi Yang
- Department of Pharmacy, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China; Department of Pharmacology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Murezati Tiliwaerde
- Department of Pharmacology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Na-Na Gao
- Department of Gastrointestinal Surgery and Clinical Nutrition, Beijing Shijitan Hospital, Captial Medical University, Beijing, 100038, China.
| | - Ting-Ting Zhang
- Department of Neurology, Xuanwu Hospital, Captial Medical University, Beijing, 100053, China
| | - Hong-Xian Ji
- Beijing Guangwei Pharmaceutical Technology Co., Ltd, Beijing, 100044, China
| | - Wei Gu
- Beijing Guangwei Pharmaceutical Technology Co., Ltd, Beijing, 100044, China
| | - Zeng-Liang Jin
- Department of Pharmacology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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Dollish HK, Tsyglakova M, McClung CA. Circadian rhythms and mood disorders: Time to see the light. Neuron 2024; 112:25-40. [PMID: 37858331 PMCID: PMC10842077 DOI: 10.1016/j.neuron.2023.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/09/2023] [Accepted: 09/20/2023] [Indexed: 10/21/2023]
Abstract
The importance of time is ever prevalent in our world, and disruptions to the normal light/dark and sleep/wake cycle have now become the norm rather than the exception for a large part of it. All mood disorders, including seasonal affective disorder (SAD), major depressive disorder (MDD), and bipolar disorder (BD), are strongly associated with abnormal sleep and circadian rhythms in a variety of physiological processes. Environmental disruptions to normal sleep/wake patterns, light/dark changes, and seasonal changes can precipitate episodes. Moreover, treatments that target the circadian system have proven to be therapeutic in certain cases. This review will summarize much of our current knowledge of how these disorders associate with specific circadian phenotypes, as well as the neuronal mechanisms that link the circadian clock with mood regulation. We also discuss what has been learned from therapies that target circadian rhythms and how we may use current knowledge to develop more individually designed treatments.
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Affiliation(s)
- Hannah K Dollish
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA
| | - Mariya Tsyglakova
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA
| | - Colleen A McClung
- Department of Psychiatry, University of Pittsburgh School of Medicine, 450 Technology Drive, Suite 223, Pittsburgh, PA 15219, USA.
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Hickie IB, Iorfino F, Rohleder C, Song YJC, Nichles A, Zmicerevska N, Capon W, Guastella AJ, Leweke FM, Scott J, McGorry P, Mihalopoulos C, Killackey E, Chong MK, McKenna S, Aji M, Gorban C, Crouse JJ, Koethe D, Battisti R, Hamilton B, Lo A, Hackett ML, Hermens DF, Scott EM. EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders. BMJ Open 2023; 13:e072082. [PMID: 37821139 PMCID: PMC10583041 DOI: 10.1136/bmjopen-2023-072082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as 'highly personalised and measurement-based care' (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. METHOD AND ANALYSIS This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15-25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. ETHICS AND DISSEMINATION This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. TRIAL REGISTRATION NUMBER ACTRN12622000882729.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine Mannheim, Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jan Scott
- Newcastle University, Newcastle upon Tyne, UK
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McKenna
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- headspace Camperdown, Camperdown, New South Wales, Australia
| | - Alice Lo
- Mind Plasticity, Sydney, New South Wales, Australia
| | - Maree L Hackett
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Jiménez-Correa U, Bonilla N, Álvarez-García HB, Méndez-Alonzo G, Barrera-Medina A, Santana-Miranda R, Poblano A, Marín-Agudelo HA. Delayed sleep phase disorder during the COVID-19 pandemic and its health implications. CNS Spectr 2023; 28:581-586. [PMID: 36852604 DOI: 10.1017/s109285292300007x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Circadian rhythm sleep disorders are alterations that are characterized by a shift in the sleep-wake cycle relative to day and night, such as the delayed sleep phase disorder (DSPD), which is a retard of at least 2 hours in the sleep start. Typically, the patient falls asleep after 2 a.m. and wakes up after 10 a.m. and with symptom of sleep onset insomnia. The prevalence of DSPD in young adults is 0.48%, increasing to 3.3% in adolescents. Interestingly, patients with COVID-19 infection report anxiety due to the intensive care unit lockdown and constant exposure to bright light. In addition, post-COVID patients have an increased risk of developing DSPD. For example, in adolescent post-COVID patients, the prevalence of DSPD increases to 63.3%. Patients with DSPD also have alterations in metabolic health, poor school performance, cognitive impairment, and a higher risk of developing other diseases. The objective of the present review is therefore to describe the characteristics of DSPD during the COVID-19 pandemic and to outline its possible implications for physical health (eg, metabolism) and mental health (eg, anxiety or depression).
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Affiliation(s)
- Ulises Jiménez-Correa
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, México
| | - Naylea Bonilla
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, México
| | | | - Gerardo Méndez-Alonzo
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, México
- Department of Neurology, MIG Hospital, Mexico City, México
| | - Andrés Barrera-Medina
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, México
| | | | - Adrián Poblano
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, México
- Laboratory of Cognitive Neurophysiology, National Institute of Rehabilitation, Mexico City, México
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8
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Yin J, Wang H, Li S, Zhao L, You Y, Yang J, Liu Y. Nonlinear relationship between sleep midpoint and depression symptoms: a cross-sectional study of US adults. BMC Psychiatry 2023; 23:671. [PMID: 37715146 PMCID: PMC10503124 DOI: 10.1186/s12888-023-05130-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Despite the close relationship between sleep-wake cycles and depression symptoms, the relationship between sleep midpoint and depression symptoms in adults remains understudied. METHODS In this cross-sectional study, 18280 adults aged ≥ 18 years from the National Health and Nutrition Examination Survey (NHANES) 2015-2020 were analyzed. Covariates included age, sex, race/ethnicity, education level, marital status, family income, body mass index, smoking status, drinking status, physical activity, comorbid condition, sleep duration, and sleep disturbance were adjusted in multivariate regression models. RESULTS Weighted restricted cubic spline based on the complex sampling design of NHANES showed that in participants with a sleep midpoint from 2:18 AM to 6:30 AM, the prevalence of depression symptoms increased by 0.2 times (adjusted odds ratio [OR] = 1.20, 95% confidence interval [CI]: 1.08-1.33) per 1-h increment in sleep midpoint compared to the reference point of 2:18 AM. For participants with a sleep midpoint after 6:30 AM and before 2:18 AM the next day, the relationship between sleep midpoint and depression symptoms was not significant after adjusting for all covariates (adjusted OR = 1.01, 95% CI: 0.99-1.03). CONCLUSIONS The findings indicate a significant nonlinear association between sleep midpoint and depression symptoms in a nationally representative sample of adults.
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Affiliation(s)
- Jiahui Yin
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Huayang Wang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siyuan Li
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Leiyong Zhao
- Department of Psychosomatic Medicine, Affliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yanwei You
- Division of Sports Science & Physical Education, Tsinghua University, Beijing, China
| | - Jiguo Yang
- College of Acupuncture and Massage, Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Yuanxiang Liu
- Department of Neurology, Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China.
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Yang HJ, Cheng WJ, Hsiao MC, Huang SC, Kubo T, Hang LW, Lee WS. Rest-activity rhythm associated with depressive symptom severity and attention among patients with major depressive disorder: a 12-month follow-up study. Front Psychiatry 2023; 14:1214143. [PMID: 37663595 PMCID: PMC10469591 DOI: 10.3389/fpsyt.2023.1214143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Patients with depressive disorder demonstrate rest-activity rhythm disturbances and cognitive function impairment. This study examined the association of individual rest-activity rhythm changes over time with mood symptoms and attention. Methods We recruited 15 adult outpatients with a diagnosis of major depressive disorder from a single medical center and observed them for 12 months. Weekly rest-activity parameters, including rhythm characteristics generated from nonparametric circadian rhythm analysis, were retrieved from actigraphy data. Attention was evaluated weekly with a smartphone-based psychomotor vigilance test upon awakening. Depressive symptom severity was evaluated using the Beck Depression Inventory (BDI) fortnightly. The association of rest-activity parameters with BDI score and attention was examined using generalized linear mixed regression. A fixed-effects analysis was used to examine the association between rest-activity parameters and depressive episodes. Results An advanced bedtime and most active continuous 10 h starting time were associated with depressive symptom severity but also associated with higher vigilance test performance. A longer sleep duration, mainly due to an earlier bedtime, was associated with depressive symptom severity. Compared to remission, sleep duration was 27.8 min longer during depressive episodes, and bed time was 24 min earlier. A shorter sleep duration and increased activity during sleep were associated with poorer attention. Discussion Rest-activity rhythms change with mood symptoms among patients with depressive disorder. The circadian rhythms of rest-activity among patients with depressive disorder should be distinguished during various mood states in future studies.
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Affiliation(s)
- Hang-Ju Yang
- Department of Emergency Medicine, Jen Ai Hospital Dali Branch, Taichung, Taiwan
| | - Wan-Ju Cheng
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Mi-Chun Hsiao
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Sheng-Che Huang
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Tomohide Kubo
- National Institute of Occupational Safety and Health, Kawasaki, Japan
| | - Liang-Wen Hang
- Department of Pulmonary and Critical Care Medicine, Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
- School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan
| | - Wei-Sheng Lee
- Center for Drug Abuse and Addiction, China Medical University Hospital, China Medical University, Taichung, Taiwan
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10
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Wong TR, Hickie IB, Carpenter JS, Scott EM, Guastella AJ, Vidafar P, Scott J, Hermens DF, Crouse JJ. Dynamic modelling of chronotype and hypo/manic and depressive symptoms in young people with emerging mental disorders. Chronobiol Int 2023; 40:699-709. [PMID: 37132360 DOI: 10.1080/07420528.2023.2203241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/21/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
There is significant interest in the possible influence of chronotype on clinical states in young people with emerging mental disorders. We apply a dynamic approach (bivariate latent change score modelling) to examine the possible prospective influence of chronotype on depressive and hypo/manic symptoms in a youth cohort with predominantly depressive, bipolar, and psychotic disorders (N = 118; 14-30-years), who completed a baseline and follow-up assessment of these constructs (mean interval = 1.8-years). Our primary hypotheses were that greater baseline eveningness would predict increases in depressive but not hypo/manic symptoms. We found moderate to strong autoregressive effects for chronotype (β = -0.447 to -0.448, p < 0.001), depressive (β = -0.650, p < 0.001) and hypo/manic symptoms (β = -0.819, p < 0.001). Against our predictions, baseline chronotypes did not predict change in depressive (β = -0.016, p = 0.810) or hypo/manic symptoms (β = 0.077, p = 0.104). Similarly, the change in chronotype did not correlate with the change in depressive symptoms (β = -0.096, p = 0.295) nor did the change in chronotype and the change in hypo/manic symptoms (β = -0.166, p = 0.070). These data suggest that chronotypes may have low utility for predicting future hypo/manic and depressive symptoms in the short term, or that more frequent assessments over longer periods are needed to observe these associations. Future studies should test whether other circadian phenotypes (e.g. sleep-wake variability) are better indicators of illness course.
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Affiliation(s)
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Australia
| | | | | | | | | | - Jan Scott
- Brain and Mind Centre, University of Sydney, Australia
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK
- Université de Paris, Paris, France
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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11
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Hickie IB, Merikangas KR, Carpenter JS, Iorfino F, Scott EM, Scott J, Crouse JJ. Does circadian dysrhythmia drive the switch into high- or low-activation states in bipolar I disorder? Bipolar Disord 2023; 25:191-199. [PMID: 36661342 PMCID: PMC10947388 DOI: 10.1111/bdi.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Emerging evidence suggests a role of circadian dysrhythmia in the switch between "activation" states (i.e., objective motor activity and subjective energy) in bipolar I disorder. METHODS We examined the evidence with respect to four relevant questions: (1) Are natural or environmental exposures that can disrupt circadian rhythms also related to the switch into high-/low-activation states? (2) Are circadian dysrhythmias (e.g., altered rest/activity rhythms) associated with the switch into activation states in bipolar disorder? (3) Do interventions that affect the circadian system also affect activation states? (4) Are associations between circadian dysrhythmias and activation states influenced by other "third" factors? RESULTS Factors that naturally or experimentally alter circadian rhythms (e.g., light exposure) have been shown to relate to activation states; however future studies need to measure circadian rhythms contemporaneously with these natural/experimental factors. Actigraphic measures of circadian dysrhythmias are associated prospectively with the switch into high- or low-activation states, and more studies are needed to establish the most relevant prognostic actigraphy metrics in bipolar disorder. Interventions that can affect the circadian system (e.g., light therapy, lithium) can also reduce the switch into high-/low-activation states. Whether circadian rhythms mediate these clinical effects is an unknown but valuable question. The influence of age, sex, and other confounders on these associations needs to be better characterised. CONCLUSION Based on the reviewed evidence, our view is that circadian dysrhythmia is a plausible driver of transitions into high- and low-activation states and deserves prioritisation in research in bipolar disorders.
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Affiliation(s)
- Ian B. Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Kathleen R. Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research ProgramNational Institute of Mental HealthBethesdaMarylandUSA
| | - Joanne S. Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Frank Iorfino
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Elizabeth M. Scott
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
| | - Jan Scott
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
- Norwegian University of Science and TechnologyTrondheimNorway
- Université de ParisParisFrance
| | - Jacob J. Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, Faculty of Medicine and HealthUniversity of SydneyNew South WalesSydneyAustralia
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12
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Codoñer-Franch P, Gombert M, Martínez-Raga J, Cenit MC. Circadian Disruption and Mental Health: The Chronotherapeutic Potential of Microbiome-Based and Dietary Strategies. Int J Mol Sci 2023; 24:ijms24087579. [PMID: 37108739 PMCID: PMC10146651 DOI: 10.3390/ijms24087579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Mental illness is alarmingly on the rise, and circadian disruptions linked to a modern lifestyle may largely explain this trend. Impaired circadian rhythms are associated with mental disorders. The evening chronotype, which is linked to circadian misalignment, is a risk factor for severe psychiatric symptoms and psychiatric metabolic comorbidities. Resynchronization of circadian rhythms commonly improves psychiatric symptoms. Furthermore, evidence indicates that preventing circadian misalignment may help reduce the risk of psychiatric disorders and the impact of neuro-immuno-metabolic disturbances in psychiatry. The gut microbiota exhibits diurnal rhythmicity, as largely governed by meal timing, which regulates the host's circadian rhythms. Temporal circadian regulation of feeding has emerged as a promising chronotherapeutic strategy to prevent and/or help with the treatment of mental illnesses, largely through the modulation of gut microbiota. Here, we provide an overview of the link between circadian disruption and mental illness. We summarize the connection between gut microbiota and circadian rhythms, supporting the idea that gut microbiota modulation may aid in preventing circadian misalignment and in the resynchronization of disrupted circadian rhythms. We describe diurnal microbiome rhythmicity and its related factors, highlighting the role of meal timing. Lastly, we emphasize the necessity and rationale for further research to develop effective and safe microbiome and dietary strategies based on chrononutrition to combat mental illness.
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Affiliation(s)
- Pilar Codoñer-Franch
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, 46010 Valencia, Spain
- Department of Pediatrics, University Hospital Doctor Peset, Foundation for the Promotion of Health and Bio-Medical Research in the Valencian Region (FISABIO), 46017 Valencia, Spain
| | - Marie Gombert
- Biosciences Division, Center for Health Sciences, SRI International, Menlo Park, CA 94025, USA
| | - José Martínez-Raga
- Department of Psychiatry and Clinical Psychology, Hospital Universitario Doctor Peset, University of Valencia, 46017 Valencia, Spain
| | - María Carmen Cenit
- Microbial Ecology, Nutrition & Health Research Unit, Institute of Agrochemistry and Food Technology, National Research Council (IATA-CSIC), 46980 Valencia, Spain
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Souissi A, Dergaa I, Romdhani M, Ghram A, Irandoust K, Chamari K, Ben Saad H. Can melatonin reduce the severity of post-COVID-19 syndrome? EXCLI JOURNAL 2023; 22:173-187. [PMID: 36998709 PMCID: PMC10043401 DOI: 10.17179/excli2023-5864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 04/01/2023]
Abstract
This short review aimed at (i) providing an update on the health benefits associated with melatonin supplementation, while (ii) considering future potential research directions concerning melatonin supplementation use relative to Coronavirus disease of 2019 (COVID-19). A narrative review of the literature was undertaken to ascertain the effect of exogenous melatonin administration on humans. Night-time melatonin administration has a positive impact on human physiology and mental health. Indeed, melatonin (i) modulates the circadian components of the sleep-wake cycle; (ii) improves sleep efficiency and mood status; (iii) improves insulin sensitivity; and (iv) reduces inflammatory markers and oxidative stress. Melatonin has also remarkable neuroprotective and cardioprotective effects and may therefore prevent deterioration caused by COVID-19. We suggest that melatonin could be used as a potential therapy in the post-COVID-19 syndrome, and therefore call for action the research community to investigate on the potential use of exogenous melatonin to enhance the quality of life in patients with post-COVID-19 syndrome. See also Figure 1(Fig. 1).
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Affiliation(s)
- Amine Souissi
- Université de Sousse, Faculté de Médecine de Sousse, Hôpital Farhat HACHED, Laboratoire de Recherche (Insuffisance Cardiaque, LR12SP09), Sousse, Tunisie
- *To whom correspondence should be addressed: Amine Souissi, Université de Sousse, Faculté de Médecine de Sousse, Hôpital Farhat HACHED, Laboratoire de Recherche (Insuffisance Cardiaque, LR12SP09), Sousse, Tunisie, E-mail:
| | - Ismail Dergaa
- Primary Health Care Corporation (PHCC), Doha, P.O. Box 26555, Qatar
| | - Mohamed Romdhani
- Research Unit: Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis, Tunisia
- Motricité-Interactions-Performance, MIP, UR4334, Le Mans Université, Le Mans, France
| | - Amine Ghram
- Université de Sousse, Faculté de Médecine de Sousse, Hôpital Farhat HACHED, Laboratoire de Recherche (Insuffisance Cardiaque, LR12SP09), Sousse, Tunisie
| | - Khadijeh Irandoust
- Department of Sport Sciences, Imam Khomeini International University, Qazvin, Iran
| | - Karim Chamari
- Aspetar, Orthopedic and Sports Medicine Hospital, FIFA Medical Center of Excellence, Doha, Qatar
| | - Helmi Ben Saad
- Université de Sousse, Faculté de Médecine de Sousse, Hôpital Farhat HACHED, Laboratoire de Recherche (Insuffisance Cardiaque, LR12SP09), Sousse, Tunisie
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14
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Qi JS, Su Q, Li T, Liu GW, Zhang YL, Guo JH, Wang ZJ, Wu MN. Agomelatine: a potential novel approach for the treatment of memory disorder in neurodegenerative disease. Neural Regen Res 2023; 18:727-733. [DOI: 10.4103/1673-5374.353479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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He X, Zhang R, Li Z, Yao Z, Xie X, Bai R, Li L, Zhang X, Zhang S, Shen Y, Li S, Hui Z, Liu R, Chen J. Sini powder with paroxetine ameliorates major depressive disorder by modulating circadian rhythm: A randomized, double-blind, placebo-controlled trial. J Pineal Res 2022; 73:e12832. [PMID: 36073608 DOI: 10.1111/jpi.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 08/12/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Abstract
Circadian rhythm disorder is a significant risk factor for mental diseases, and the recovery of circadian rhythm function has gradually become a signal of effective antidepressant therapy. Sini powder (SNP) is a classical, traditional Chinese formula for depression treatment. However, few clinical reports have been recorded. This randomized, double-blinded, controlled trial (ChiCTR1900022700) aimed to explore the efficacy of SNP on depression via regulating circadian rhythm. In total, 36 patients with major depressive disorder (MDD) were enrolled for 4-weeks medication and 6-weeks follow-up. HAMD-24 score and circadian rhythm index, including dim light melatonin onset (DLMO) and phase angle difference (PAD), were included in the assessment. DLMO and PAD were statistically significant in the SNP group after 4 weeks of treatment (p < .05) and with greater improvement in DLMO (p = .03). In addition, DLMO and the HAMD-24 score showed a positive correlation (p < .05); the HAMD-24 score degree decreased significantly over time (p < .001). Similarly, interaction effects were shown significantly between group and time (p = .049). The duration of SNP supplementation was relatively short, and the sample size was relatively small. SNP granules combined with paroxetine tablets have definite efficacy in improving the circadian rhythms of MDD patients, reflecting the therapeutic advantages of traditional Chinese medicine as antidepressants.
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Affiliation(s)
- Xu He
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Ruihuan Zhang
- Department of Encephalopathy, Yulin Hospital of Traditional Chinese Medicine, Yulin, China
| | - Zhe Li
- Department of First Clinical Medicine, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Zhen Yao
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xiaoxia Xie
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Ruoxue Bai
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Lan Li
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Xu Zhang
- Department of First Clinical Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Sha Zhang
- Department of Basic Medicine, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Yan Shen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Shaowei Li
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Zhenliang Hui
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
| | - Rongrong Liu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Jun Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Chinese Medicine, Xi'an, China
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16
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Carpenter JS, Zmicerevska N, Crouse JJ, Nichles A, Garland A, Song YJC, Wilson C, Rohleder C, McHugh C, Leweke FM, Koethe D, Scott EM, Hickie IB. Effects of adjunctive brexpiprazole on sleep-wake and circadian parameters in youth with depressive disorders: study protocol for a clinical trial. BMJ Open 2022; 12:e056298. [PMID: 36691133 PMCID: PMC9454051 DOI: 10.1136/bmjopen-2021-056298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Sleep-wake and circadian disturbance is a key feature of mood disorders with a potential causal role and particular relevance to young people. Brexpiprazole is a second-generation antipsychotic medication with demonstrated efficacy as an adjunct to antidepressant treatment for major depressive disorder (MDD) in adults, with preliminary evidence suggesting greater effectiveness in subgroups of depressed patients with sleep disturbances. This clinical trial aims to evaluate the relationships between changes in sleep-wake and circadian parameters and changes in depressive symptoms following adjunctive brexpiprazole treatment in young adults with MDD and sleep-wake disturbance. METHODS AND ANALYSIS This study is designed as a 16 week (8 weeks active treatment, 8 weeks follow-up) mechanistic, open-label, single-arm, phase IV clinical trial and aims to recruit 50 young people aged 18-30 with MDD and sleep-wake cycle disturbance through an early intervention youth mental health clinic in Sydney, Australia. At baseline, participants will undergo multidimensional outcome assessment and subsequently receive 8 weeks of open-label treatment with brexpiprazole as adjunctive to their stable psychotropic medication. Following 4 weeks of treatment, clinical and self-report measures will be repeated. Ambulatory sleep-wake monitoring will be conducted continuously for the duration of treatment. After 8 weeks of treatment, all multidimensional outcome assessments will be repeated. Follow-up visits will be conducted 4 and 8 weeks after trial completion (including sleep-wake, clinical and self-report assessments). Circadian rhythm biomarkers including salivary melatonin, cortisol and core body temperature will be collected during an in-lab assessment. Additionally, metabolic, inflammatory and genetic risk markers will be collected at baseline and after 8 weeks of treatment. ETHICS AND DISSEMINATION This trial protocol has been approved by the Human Research Ethics Committee of the Sydney Local Health District (X19-0417 and 2019/ETH12986, Protocol Version 1-3, dated 25 February 2021). The results of this study, in deidentified form, will be disseminated through publication in peer-reviewed journals, scholarly book chapters, presentation at conferences and publication in conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12619001456145.
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Affiliation(s)
- Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alexandra Garland
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- The University of Notre Dame Australia School of Medicine Sydney Campus, Darlinghurst, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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McGowan NM, Kim DS, de Andres Crespo M, Bisdounis L, Kyle SD, Saunders KEA. Hypnotic and Melatonin/Melatonin-Receptor Agonist Treatment in Bipolar Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 2022; 36:345-363. [PMID: 35305257 DOI: 10.1007/s40263-022-00911-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic relapsing-remitting psychiatric disorder. Sleep and circadian rhythm disturbances persist during acute mood episodes of the disorder and during euthymia. However, the treatment potential of hypnotic agents that might be used to manage sleep disturbance in BD is not well understood. Similarly, melatonin and medications with a melatonin-receptor agonist mechanism of action may have chronotherapeutic potential for treating people with the disorder, but the impact of these substances on sleep and circadian rhythms and core symptoms in BD is unclear. OBJECTIVE Our aim was to conduct a systematic review and meta-analysis evaluating the current evidence for hypnotic and melatonin/melatonin-receptor agonist pharmacotherapy for symptoms of sleep disturbance, mania, and depression in patients with BD. METHODS AMED, Embase, MEDLINE and PsychINFO databases were searched for studies published in English from the date of inception to 31 October 2021. Studies included in this review were randomised controlled trials (RCTs) and non-controlled/non-randomised studies for BD that examined hypnotic medications selected based on a common pattern of usage for treating insomnia (i.e. chloral, clomethiazole, diphenhydramine, doxepin, doxylamine, promethazine, suvorexant, zaleplon, zolpidem, zopiclone, and eszopiclone) and melatonin and the melatonin-receptor agonist drugs ramelteon and agomelatine. Risk of bias was assessed using the RoB2 and AXIS tools. Pooled effect sizes for RCT outcomes were estimated using random-effects models. RESULTS A total of eleven studies (six RCTs and five experimental feasibility studies) involving 1279 participants were included. Each study examined melatonin or melatonin-receptor agonists. No studies of hypnotics were found that fulfilled the review inclusion criteria. Pilot feasibility studies suggested beneficial treatment effects for symptoms of sleep disturbance, depression, and mania. However, the pooled effect of the two available RCT studies assessing sleep quality via Pittsburgh Sleep Quality Index scores was not statistically significant (g = - 0.04 [95% CI - 0.81 to 0.73]) and neither was the pooled effect for depressive symptoms (four studies; g = - 0.10 [95% CI - 0.27 to 0.08]). Some RCT evidence suggests ramelteon might prevent relapse into depression in BD. The largest efficacy signal detected was for manic symptoms (four studies; g = - 0.44 [95% CI - 1.03 to 0.14]) but there was substantial heterogeneity between studies and patient characteristics. In the two RCTs assessing manic symptoms during acute mania, adjunctive melatonin demonstrated superior treatment effects versus placebo. CONCLUSIONS There is a paucity of studies examining pharmacological interventions for sleep and circadian rhythm disturbance in BD. Few studies assessed sleep-related symptoms, and none quantitatively examined endogenous melatonin patterns or other circadian rhythms. Melatonin may be a promising candidate for the adjunctive treatment of bipolar mania. However, dose-finding studies and studies with larger sample sizes are needed to confirm its efficacy. We recommend parallel monitoring of sleep and circadian rhythms in future trials. Chronobiology-informed trial designs are needed to improve the quality of future studies. PROTOCOL REGISTRATION PROSPERO (CRD42020167528).
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Affiliation(s)
- Niall M McGowan
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK. .,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - David S Kim
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Marta de Andres Crespo
- Medical Sciences Division, Clinical Medical School, The John Radcliffe Hospital, University of Oxford Academic Centre, Oxford, UK
| | - Lampros Bisdounis
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kate E A Saunders
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
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18
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Chan JW, Chan NY, Li SX, Lam SP, Chau SWH, Liu Y, Zhang J, Wing YK. Change in circadian preference predicts sustained treatment outcomes in patients with unipolar depression and evening preference. J Clin Sleep Med 2022; 18:523-531. [PMID: 34534071 PMCID: PMC8805013 DOI: 10.5664/jcsm.9648] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Eveningness is associated with worse outcomes in depression. It remained unclear if eveningness could be altered with chronobiological therapy and whether such a change would predict long-term outcomes of depression. METHODS Data from a randomized controlled trial of 5-week adjunctive bright light therapy with a gradual advance protocol conducted in 91 adult patients with nonseasonal unipolar depression and eveningness (Morningness-Eveningness Questionnaire, score ≤ 41) was examined. "Change of eveningness" was defined by Morningness-Eveningness Questionnaire score over 41 at posttreatment week 5 and "persistent change of eveningness" was defined as maintenance of Morningness-Eveningness Questionnaire score > 41 throughout the follow-up period from week 5 to posttreatment 5 months. RESULTS Thirty-three participants (36%) had change of eveningness at week 5. Generalized estimating equations models showed that a change of eveningness at week 5 predicted a 2-fold increase in remission of depression over the 5-month follow up (odds ratio = 2.61 95% confidence interval 1.20-5.71, P = .016). Twenty-five participants (75.7%) had a persistent change and were more likely to achieve a remission of depression over the 5-month follow up (odds ratio = 3.18, 95% confidence interval: 1.35-7.50, P = .008). CONCLUSIONS One-third of the patients with depression changed their evening-preference after 5-week of chronotherapeutic treatment, and such change predicted a higher likelihood of depression remission over 5 months of follow-up. CLINICAL TRIAL REGISTRATION Registry: Chinese Clinical Trial Registry; Name: Adjunctive light treatment in major depressive disorder patients with evening chronotype-A randomized controlled trial; URL: https://www.chictr.org.cn/showprojen.aspx?proj=11672; Identifier: ChiCTR-IOR-15006937. CITATION Chan JWY, Chan NY, Li SX, et al. Change in circadian preference predicts sustained treatment outcomes in patients with unipolar depression and evening preference. J Clin Sleep Med. 2022;18(2):523-531.
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Affiliation(s)
- Joey W.Y. Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region,Address correspondence to: Joey W.Y. Chan, FHKAM (Psych), Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR; Tel: (852)39197593; Fax: (852)26475321;
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Steven Wai Ho Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region,Guangdong Mental Health Center, Guangdong Provincial People’s Hospital, Guangdong, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
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19
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Bokhan N, Roshchina O, Simutkin G, Levchuk L, Ivanova S. Anhedonia as target symptom in personalized therapy of patients with mood disorders and alcohol use disorder comorbidity. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:92-97. [DOI: 10.17116/jnevro202212203192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Crouse JJ, Carpenter JS, Song YJC, Hockey SJ, Naismith SL, Grunstein RR, Scott EM, Merikangas KR, Scott J, Hickie IB. Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention. Lancet Psychiatry 2021; 8:813-823. [PMID: 34419186 DOI: 10.1016/s2215-0366(21)00034-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
A rate-limiting step in the prevention and early intervention of depressive disorders in young people is our insufficient understanding of causal mechanisms. One plausible pathophysiological pathway is disturbance in the 24 h sleep-wake cycle and the underlying circadian system. Abnormalities in circadian rhythms are well documented in adults with various depressive disorders and have been linked to core clinical features, including unstable mood, daytime fatigue, non-restorative sleep, reduced motor activity, somatic symptoms, and appetite and weight change. In this Review, we summarise four areas of research: basic circadian biology and animal models of circadian disturbances; developmental changes in circadian rhythms during adolescence and implications for the emergence of adolescent-onset depressive syndromes; community and clinical studies linking 24 h sleep-wake cycle disturbances and depressive disorders; and clinical trials of circadian-based treatments. We present recommendations based on a highly personalised, early intervention model for circadian-linked depression in young people.
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Affiliation(s)
- Jacob J Crouse
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
| | - Joanne S Carpenter
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju C Song
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Samuel J Hockey
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Sleep and Circadian Research Group, Sydney, NSW, Australia
| | - Elizabeth M Scott
- St Vincent's and Mater Clinical School, The University of Notre Dame, Sydney, NSW, Australia
| | - Kathleen R Merikangas
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ian B Hickie
- Youth Mental Health and Technology Team, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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21
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Porteous M, Fogel S, Ray L, Hickie IB, Carpenter JS, Louati K, Robillard R. Increased spindle density correlates with sleep continuity improvements following an eight-week course of a melatonin agonist in people with depression: A proof-of-concept study with agomelatine. Eur J Neurosci 2021; 54:5112-5119. [PMID: 34089546 DOI: 10.1111/ejn.15340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/27/2021] [Accepted: 05/23/2021] [Indexed: 11/27/2022]
Abstract
Sleep fragmentation and reductions in sleep spindles have been observed in individuals with depression. Sleep spindles are known to play a protective role for sleep, and there are indications that melatonin agents can enhance spindles in healthy people. Whether agomelatine, a melatonin agonist indicated for the treatment of depression, may increase spindle density sufficiently to impact sleep continuity in people with depression remains unknown. This proof-of-concept study investigated changes in spindles following agomelatine intake in young adults with depression and assessed how they may relate to potential changes in sleep continuity and depressive symptoms. This study was based on an open-label design. Fifteen participants between 17 and 28 years of age (mean = 22.2; standard deviation [SD] = 3.4) with a diagnosis of a depressive disorder underwent polysomnography before and after an intervention including a 1 hr psychoeducation session centered on sleep and circadian rhythms, and an 8-week course of agomelatine (25-50 mg) with a guided sleep phase advance. Fast spindle density significantly increased from pre- to post-intervention. This increase in spindle density significantly correlated with a reduction in wake after sleep onset, and a similar trend was found with increased sleep efficiency. There was no significant correlation between spindle parameters and depressive symptoms. These findings suggest that agomelatine may contribute to enhanced sleep consolidation, possibly in part through the modulation of spindle production. This should be confirmed by larger randomized control trials.
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Affiliation(s)
- Meggan Porteous
- Sleep Research Unit, University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.,Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Stuart Fogel
- Sleep Research Unit, University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.,Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Laura Ray
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Khaoula Louati
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Rebecca Robillard
- Sleep Research Unit, University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, ON, Canada.,Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
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22
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Circadian depression: A mood disorder phenotype. Neurosci Biobehav Rev 2021; 126:79-101. [PMID: 33689801 DOI: 10.1016/j.neubiorev.2021.02.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/18/2021] [Accepted: 02/28/2021] [Indexed: 12/15/2022]
Abstract
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.
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23
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Yan T, Qiu Y, Yu X, Yang L. Glymphatic Dysfunction: A Bridge Between Sleep Disturbance and Mood Disorders. Front Psychiatry 2021; 12:658340. [PMID: 34025481 PMCID: PMC8138157 DOI: 10.3389/fpsyt.2021.658340] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 12/14/2022] Open
Abstract
Mounting evidence demonstrates a close relationship between sleep disturbance and mood disorders, including major depression disorder (MDD) and bipolar disorder (BD). According to the classical two-process model of sleep regulation, circadian rhythms driven by the light-dark cycle, and sleep homeostasis modulated by the sleep-wake cycle are disrupted in mood disorders. However, the exact mechanism of interaction between sleep and mood disorders remains unclear. Recent discovery of the glymphatic system and its dynamic fluctuation with sleep provide a plausible explanation. The diurnal variation of the glymphatic circulation is dependent on the astrocytic activity and polarization of water channel protein aquaporin-4 (AQP4). Both animal and human studies have reported suppressed glymphatic transport, abnormal astrocytes, and depolarized AQP4 in mood disorders. In this study, the "glymphatic dysfunction" hypothesis which suggests that the dysfunctional glymphatic pathway serves as a bridge between sleep disturbance and mood disorders is proposed.
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Affiliation(s)
- Tao Yan
- Department of Psychiatry, Changxing People's Hospital, Huzhou, China
| | - Yuefeng Qiu
- Department of Psychiatry, Zhejiang Hospital, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linglin Yang
- Department of Psychiatry, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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24
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Abstract
During the evolution of life, the temporal rhythm of our rotating planet was internalized in the form of circadian rhythms. Circadian rhythms are ~24h internal manifestations that drive daily patterns of physiology and behavior. These rhythms are entrained (synchronized) to the external environment, primarily by the light-dark cycle, and precisely controlled via molecular clocks located within the suprachiasmatic nucleus of the hypothalamus. Misalignment and/or disruption of circadian rhythms can have detrimental consequences for human health. Indeed, studies suggest strong associations between mental health and circadian rhythms. However, direct interactions between mood regulation and the circadian system are just beginning to be uncovered and appreciated. This chapter examines the relationship between disruption of circadian rhythms and mental health. The primary focus will be outlining the association between circadian disruption, in the form of night shift work, exposure to light at night, jet lag, and social jet lag, and psychiatric illness (i.e., anxiety, major depressive disorder, bipolar disorder, and schizophrenia). Additionally, we review animal models of disrupted circadian rhythms, which provide further evidence in support of a strong association between circadian disruption and affective responses. Finally, we discuss future directions for the field and suggest areas of study that require further investigation.
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Affiliation(s)
- William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States.
| | - James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
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25
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Kirlioglu SS, Balcioglu YH. Chronobiology Revisited in Psychiatric Disorders: From a Translational Perspective. Psychiatry Investig 2020; 17:725-743. [PMID: 32750762 PMCID: PMC7449842 DOI: 10.30773/pi.2020.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Several lines of evidence support a relationship between circadian rhythms disruption in the onset, course, and maintenance of mental disorders. Despite the study of circadian phenotypes promising a decent understanding of the pathophysiologic or etiologic mechanisms of psychiatric entities, several questions still need to be addressed. In this review, we aimed to synthesize the literature investigating chronobiologic theories and their associations with psychiatric entities. METHODS The Medline, Embase, PsycInfo, and Scopus databases were comprehensively and systematically searched and articles published between January 1990 and October 2019 were reviewed. Different combinations of the relevant keywords were polled. We first introduced molecular elements and mechanisms of the circadian system to promote a better understanding of the chronobiologic implications of mental disorders. Then, we comprehensively and systematically reviewed circadian system studies in mood disorders, schizophrenia, and anxiety disorders. RESULTS Although subject characteristics and study designs vary across studies, current research has demonstrated that circadian pathologies, including genetic and neurohumoral alterations, represent the neural substrates of the pathophysiology of many psychiatric disorders. Impaired HPA-axis function-related glucocorticoid rhythm and disrupted melatonin homeostasis have been prominently demonstrated in schizophrenia and other psychotic disorders, while alterations of molecular expressions of circadian rhythm genes including CLOCK, PER, and CRY have been reported to be involved in the pathogenesis of mood disorders. CONCLUSION Further translational work is needed to identify the causal relationship between circadian physiology abnormalities and mental disorders and related psychopathology, and to develop sound pharmacologic interventions.
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Affiliation(s)
- Simge Seren Kirlioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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26
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Bauducco S, Richardson C, Gradisar M. Chronotype, circadian rhythms and mood. Curr Opin Psychol 2020; 34:77-83. [DOI: 10.1016/j.copsyc.2019.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 01/14/2023]
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27
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Hoyos CM, Gordon C, Terpening Z, Norrie L, Lewis SJG, Hickie IB, Naismith SL. Circadian rhythm and sleep alterations in older people with lifetime depression: a case-control study. BMC Psychiatry 2020; 20:192. [PMID: 32349697 PMCID: PMC7191686 DOI: 10.1186/s12888-020-02606-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 04/16/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Depression is common in older people and is associated with underlying brain change increasing the risk of dementia. Sleep disturbance is frequently reported by those with lifetime depression, however whether circadian misalignment also exists is unclear. We aimed to examine circadian rhythms and sleep associations in older patients with and without lifetime depression. METHODS Thirty-four older people meeting DSM-IV criteria for lifetime major depression (mean age = 63.9 years), and 30 healthy controls (mean age = 65.7 years) were recruited. Participants underwent 2-weeks of actigraphy followed by a 3-night protocol including dim light melatonin onset (DLMO) assessment and overnight polysomnography (PSG) for sleep architecture. DLMO and phase angle of entrainment were computed. RESULTS Compared to controls, participants with depression had a significantly longer phase angle of entrainment (6.82 h ± 1.45 vs. 5.87 h ± 1.60, p = 0.02, Cohens-d = 0.62). A small to moderate yet non-significant difference in DLMO times, with earlier DLMO (34 ± 27 min) observed in depression (20:36 ± 1:48 vs. 21:10 ± 1:48, p = 0.22, Cohens-d = 0.32). Individuals with depression had longer sleep latency and latency to rapid eye movement sleep than controls (all p < 0.05). CONCLUSION Circadian advancement and alterations to the timing of sleep and REM onset are evident in older people with lifetime major depression, despite having only mild residual symptoms. Further research examining the prognostic significance of these changes is warranted as well as chronotherapeutic treatment studies.
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Affiliation(s)
- Camilla M. Hoyos
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Brain and Mind Centre, Healthy Brain Ageing Program, Sydney, NSW Australia ,grid.417229.b0000 0000 8945 8472CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Christopher Gordon
- grid.417229.b0000 0000 8945 8472CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney, NSW Australia
| | - Zoe Terpening
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW Australia ,grid.1005.40000 0004 4902 0432Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louisa Norrie
- grid.437825.f0000 0000 9119 2677St Vincent’s Hospital Older People’s Mental Health Service, Darlinghurst, NSW Australia
| | - Simon J. G. Lewis
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW Australia
| | - Ian B. Hickie
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW Australia
| | - Sharon L. Naismith
- grid.1013.30000 0004 1936 834XThe University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Brain and Mind Centre, Healthy Brain Ageing Program, Sydney, NSW Australia
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28
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Boafo A, Greenham S, Sullivan M, Bazaid K, Suntharalingam S, Silbernagel L, Magner K, Robillard R. Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists. Child Adolesc Psychiatry Ment Health 2020; 14:10. [PMID: 32175006 PMCID: PMC7063733 DOI: 10.1186/s13034-020-00316-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/20/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. METHODS Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects. RESULTS Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin and trazodone were identified as the first treatment of choice by 83% and 10% of respondents respectively, and trazodone was identified as the second treatment of choice by 56% of respondents for treating sleep disturbances in children and adolescents with depression. Melatonin (97%), trazodone (81%), and quetiapine (73%) were rated by a majority of respondents as effective. Doxepin, zaleplon, tricyclic antidepressants, zolpidem, or lorazepam were rarely prescribed due to lack of evidence and/or concerns about adverse effects, long-term safety, suitability for youth, suicidality, and dependence/tolerance. CONCLUSIONS Melatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression. More empirical evidence on the efficacy, tolerability and indications for using these medications and newer group of sleep medications in this population is needed.
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Affiliation(s)
- Addo Boafo
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada ,Sleep Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, ON Canada
| | - Stephanie Greenham
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255School of Psychology, University of Ottawa, Ottawa, ON Canada
| | - Marla Sullivan
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada
| | - Khalid Bazaid
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Sinthuja Suntharalingam
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Lana Silbernagel
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Katherine Magner
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada
| | - Rébecca Robillard
- Sleep Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255School of Psychology, University of Ottawa, Ottawa, ON Canada
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Hickie IB, Scott EM, Cross SP, Iorfino F, Davenport TA, Guastella AJ, Naismith SL, Carpenter JS, Rohleder C, Crouse JJ, Hermens DF, Koethe D, Markus Leweke F, Tickell AM, Sawrikar V, Scott J. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health. Med J Aust 2020; 211 Suppl 9:S3-S46. [PMID: 31679171 DOI: 10.5694/mja2.50383] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change. Consequently, the effects of adolescent-onset mood and psychotic syndromes can have long term consequences. A key clinical challenge for youth mental health is to develop and test new systems that align with current evidence for comorbid presentations and underlying neurobiology, and are useful for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. Our highly personalised and measurement-based care model includes three core concepts: ▶ A multidimensional assessment and outcomes framework that includes: social and occupational function; self-harm, suicidal thoughts and behaviour; alcohol or other substance misuse; physical health; and illness trajectory. ▶ Clinical stage. ▶ Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on proposed pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). The model explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within this highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care as well as utilisation of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality, mental health care for young people. CHAPTER 1: MULTIDIMENSIONAL OUTCOMES IN YOUTH MENTAL HEALTH CARE: WHAT MATTERS AND WHY?: Mood and psychotic syndromes present one of the most serious public health challenges that we face in the 21st century. Factors including prevalence, age of onset, and chronicity contribute to substantial burden and secondary risks such as alcohol or other substance misuse. Mood and psychotic syndromes most often emerge during adolescence and young adulthood, a period characterised by major physical and social change; thus, effects can have long term consequences. We propose five key domains which make up a multidimensional outcomes framework that aims to address the specific needs of young people presenting to health services with emerging mental illness. These include social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Impairment and concurrent morbidity are well established in young people by the time they present for mental health care. Despite this, services and health professionals tend to focus on only one aspect of the presentation - illness type, stage and trajectory - and are often at odds with the preferences of young people and their families. There is a need to address the disconnect between mental health, physical health and social services and interventions, to ensure that youth mental health care focuses on the outcomes that matter to young people. CHAPTER 2: COMBINING CLINICAL STAGE AND PATHOPHYSIOLOGICAL MECHANISMS TO UNDERSTAND ILLNESS TRAJECTORIES IN YOUNG PEOPLE WITH EMERGING MOOD AND PSYCHOTIC SYNDROMES: Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care. CHAPTER 3: A COMPREHENSIVE ASSESSMENT FRAMEWORK FOR YOUTH MENTAL HEALTH: GUIDING HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE USING MULTIDIMENSIONAL AND OBJECTIVE MEASURES: There is an urgent need for improved care for young people with mental health problems, in particular those with subthreshold mental disorders that are not sufficiently severe to meet traditional diagnostic criteria. New comprehensive assessment frameworks are needed to capture the biopsychosocial profile of a young person to drive highly personalised and measurement-based mental health care. We present a range of multidimensional measures involving five key domains: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness type, stage and trajectory. Objective measures include: neuropsychological function; sleep-wake behaviours and circadian rhythms; metabolic and immune markers; and brain structure and function. The recommended multidimensional measures facilitate the development of a comprehensive clinical picture. The objective measures help to further develop informative and novel insights into underlying pathophysiological mechanisms and illness trajectories to guide personalised care plans. A panel of specific multidimensional and objective measures are recommended as standard clinical practice, while others are recommended secondarily to provide deeper insights with the aim of revealing alternative clinical paths for targeted interventions and treatments matched to the clinical stage and proposed pathophysiological mechanisms of the young person. CHAPTER 4: PERSONALISING CARE OPTIONS IN YOUTH MENTAL HEALTH: USING MULTIDIMENSIONAL ASSESSMENT, CLINICAL STAGE, PATHOPHYSIOLOGICAL MECHANISMS, AND INDIVIDUAL ILLNESS TRAJECTORIES TO GUIDE TREATMENT SELECTION: New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: ▶A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. ▶Clinical stage. ▶Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective - categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio. CHAPTER 5: A SERVICE DELIVERY MODEL TO SUPPORT HIGHLY PERSONALISED AND MEASUREMENT-BASED CARE IN YOUTH MENTAL HEALTH: Over the past decade, we have seen a growing focus on creating mental health service delivery models that better meet the unique needs of young Australians. Recent policy directives from the Australian Government recommend the adoption of stepped-care services to improve the appropriateness of care, determined by severity of need. Here, we propose that a highly personalised approach enhances stepped-care models by incorporating clinical staging and a young person's current and multidimensional needs. It explicitly aims to prevent progression to more complex and severe forms of illness and is better aligned to contemporary models of the patterns of emergence of psychopathology. Inherent within a highly personalised approach is the incorporation of other evidence-based processes, including real-time measurement-based care and use of multidisciplinary teams of health professionals. Data-driven local system modelling and personalised health information technologies provide crucial infrastructure support to these processes for better access to, and higher quality of, mental health care for young people.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Notre Dame Australia, Sydney, NSW
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | | | | | | | - Jacob J Crouse
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - Dagmar Koethe
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | | | - Vilas Sawrikar
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,University of Edinburgh, Edinburgh, UK
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
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Walker WH, Walton JC, DeVries AC, Nelson RJ. Circadian rhythm disruption and mental health. Transl Psychiatry 2020; 10:28. [PMID: 32066704 PMCID: PMC7026420 DOI: 10.1038/s41398-020-0694-0] [Citation(s) in RCA: 383] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/15/2019] [Accepted: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Circadian rhythms are internal manifestations of the solar day that permit adaptations to predictable environmental temporal changes. These ~24-h rhythms are controlled by molecular clockworks within the brain that are reset daily to precisely 24 h by exposure to the light-dark cycle. Information from the master clock in the mammalian hypothalamus conveys temporal information to the entire body via humoral and neural communication. A bidirectional relationship exists between mood disorders and circadian rhythms. Mood disorders are often associated with disrupted circadian clock-controlled responses, such as sleep and cortisol secretion, whereas disruption of circadian rhythms via jet lag, night-shift work, or exposure to artificial light at night, can precipitate or exacerbate affective symptoms in susceptible individuals. Evidence suggests strong associations between circadian rhythms and mental health, but only recently have studies begun to discover the direct interactions between the circadian system and mood regulation. This review provides an overview of disrupted circadian rhythms and the relationship to behavioral health and psychiatry. The focus of this review is delineating the role of disruption of circadian rhythms on mood disorders using human night shift studies, as well as jet lag studies to identify links. We also review animal models of disrupted circadian rhythms on affective responses. Lastly, we propose low-cost behavioral and lifestyle changes to improve circadian rhythms and presumably behavioral health.
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Affiliation(s)
- William H Walker
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University, Morgantown, WV, 26506, USA.
| | - James C Walton
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University, Morgantown, WV, 26506, USA
| | - A Courtney DeVries
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University, Morgantown, WV, 26506, USA
- Department of Medicine, West Virginia University, Morgantown, WV, 26506, USA
| | - Randy J Nelson
- Department of Neuroscience, Rockefeller Neuroscience Institute West Virginia University, Morgantown, WV, 26506, USA
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Wilson C, Carpenter J, Hickie I. The Role of the Sleep-Wake Cycle in Adolescent Mental Illness. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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