Depression is a common disorder in primary care. Disruptions to the circadian rhythms
associated with depression have received little attention yet offer new and exciting
approaches to treatment.
This article discusses circadian rhythms and the disruption to them associated with
depression, and reviews nonpharmaceutical and pharmaceutical interventions to shift
Features of depression suggestive of a disturbance to circadian rhythms include early
morning waking, diurnal mood changes, changes in sleep architecture, changes in
timing of the temperature nadir, and peak cortisol levels. Interpersonal social rhythm
therapy involves learning to manage interpersonal relationships more effectively
and stabilisation of social cues, such as including sleep and wake times, meal times,
and timing of social contact. Bright light therapy is used to treat seasonal affective
disorders. Agomelatine is an antidepressant that works in a novel way by targeting
Over the past 5–10 years, there has been growing community awareness about depression, with an increased emphasis on its treatment in primary care. Evidence based pharmacological and psychological treatments for depression have been outlined in clinical practice guidelines.1,2 These treatments are recommended on the basis of severity rather than depression type. While such an approach makes treatment decisions relatively straightforward, it does not take into account the different causal explanations for depression; particularly whether the depression is predominantly biological, such as that seen in melancholia3,4 and bipolar depression, or the result of psychosocial factors.
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