Circadian Rhythm Mechanisms in Affective Illness and in Antidepressant Drug Action

作者：Thomas A. Wehr, Anna Wirz‐Justice · 发表于：Pharmacopsychiatry · 年份：1982 · DOI：10.1055/s-2007-1019506 · 被引用次数：257 · 研究领域：Circadian rhythm and melatonin、Mental Health Research Topics、Tryptophan and brain disorders

A number of circadian rhythms (e.g. body temperature, REM sleep, cortisol) appear to be abnormally phase-advanced in depression. Partial sleep deprivation in the second half of the night and phase-advance of the sleep-wake cycle induce temporary clinical remission: these experiments indicate that abnormally advanced rhythms are not merely an epiphenomenon but play an important role in the pathogenesis of depression. They lead to the hypothesis that depression occurs in susceptible individuals when a sleep-sensitive phase of the circadian system becomes advanced from the first hours of waking into the last hours of sleep and interacts with sleep to cause depression. At the switch out of depression into mania, many patients spontaneously experience one or more consecutive 48-hour sleep-wake cycles. A parallel can be drawn to experimental simulation of a 48-hour sleep-wake cycle with one night's total sleep deprivation, which is known to switch patients out of depression, sometimes into mania. Similar circabidian sleep-wake cycles occur in normal persons under conditions of isolation from external time cues. Antidepressant drugs such as lithium, a MAOI, and a tricyclic, delay the phase and lengthen the period of circadian rhythms. MAOI and tricyclic drugs also promote dissociation of oscillatory components of the circadian system, which is compatible with their capacity to precipitate mania. These antidepressants appear to selectively modulate the frequency of the postulated cir...