Childhood emergencies

May 2010

Clinical

Circadian rhythms and depression

Volume 39, No.5, May 2010 Pages 307-310

Philip Boyce

Erin Barriball

Background

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.

Objective/s

This article discusses circadian rhythms and the disruption to them associated with depression, and reviews nonpharmaceutical and pharmaceutical interventions to shift circadian rhythms.

Discussion

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 melatonergic receptors.

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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Correspondence afp@racgp.org.au

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