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