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Chronobiology and Treatment in Depression

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Understanding Depression

Abstract

Whereas major depressive disorder (MDD) is a leading public health problem, remission rates are low despite good adherence of patients and the wide range of existing antidepressant drugs. Treatments acting on sleep and circadian rhythms are promising antidepressant treatments as they may relieve numerous sleep homeostasis abnormalities and circadian rhythm disruptions that are observed from the molecular to the behavioral level in MDD. Thus chronotherapies that aimed to (re)synchronize and stabilize biological rhythms (including sleep/wake patterns), such as bright light therapy (BLT), melatonin and its agonists, sleep deprivation, and social rhythm therapies, may be useful treatments in MDD. Four types of chronotherapies have shown efficacy in the treatment of MDD both in unipolar or bipolar disorders and seasonal or nonseasonal subtypes: BLT, agomelatine, sleep deprivation, and phase advance. Melatonin is efficient as an adjuvant treatment in unipolar or bipolar MDD when insomnia or delayed phase syndrome is associated. Psychotherapies focused on sleep or rhythms (IPSRT, CBT-I) are effective on sleep disorders, depressive symptoms, and the prevention of depressive relapses. The combination of several chronotherapies is possible and allows to potentiate the effects of each, with the relevant combination of rapid action chronotherapies to longer action ones (such as BLT + sleep deprivation). The risk of manic switch must be monitored in individuals with BD or at risk. These strategies of antidepressant chronotherapies in individuals with BD should be proposed only with a mood stabilizer, where lithium seems to have interesting chronobiological properties.

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Authors and Affiliations

  1. Inserm, U1144, Paris, France

    Pierre A. Geoffroy & Sunthavy Yeim

  2. Université Paris Descartes, UMR-S 1144, Paris, France

    Pierre A. Geoffroy & Sunthavy Yeim

  3. Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, France

    Pierre A. Geoffroy & Sunthavy Yeim

  4. AP-HP, GH Saint-Louis—Lariboisière—F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Paris, France

    Pierre A. Geoffroy & Sunthavy Yeim

  5. Fondation FondaMental, Créteil, France

    Pierre A. Geoffroy

  6. Neurosciences Department, Hôpital Fernand Widal, Paris, France

    Pierre A. Geoffroy

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    Yong-Ku Kim

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Geoffroy, P.A., Yeim, S. (2018). Chronobiology and Treatment in Depression. In: Kim, YK. (eds) Understanding Depression. Springer, Singapore. https://doi.org/10.1007/978-981-10-6577-4_9

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