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A chronobiological approach to therapy for depression

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In the modern world, the discrepancy between biological and social rhythms in the presence of the existing genetic predisposition increases a risk for the occurrence and chronicity of depression. To solve this problem, various approaches, including a chronobiological one, are applied.
Objective: to explore the relationship between chronobiological characteristics and psychopharmacotherapy in patients with depression.
Patients and methods Eighty patients with depression, among whom women (68.7%) predominated, were examined. The age of the patients was 18–75 years (47.6±15.6 years). Their chronotype was identified using the Morningness–Eveningness Questionnaire (MEQ) to determine the type of circadian rhythm. Changes in the patients' status were clinically assessed utilizing the psychometric indicators.
Results. Sleep disorders were most pronounced in recurrent depression (4.1±1.1 scores) (Montgomery–Asberg Depression Rating Scale, MADRS, item 4). The inverted pattern of daily variations was more frequently observed in patients with a first depressive episode (p<0.05).
According to MEQ scores, the investigators identified three groups of patients with morning (5%), intermediate (65%), and evening (30%) chronotypes. At the same type, the latter chronotype was clearly associated with the positive family history of affective disorders, earlier onset of depression, a larger number of experienced episodes, a higher average duration of an episode in the history, younger age, and severe condition when visiting a physician's office required additional psychopharmacotherapy. It was more effective to use antidepressants in the morning, if the patient had an evening chronotype, and in the evening, if he/she had a morning/intermediate chronotype.
Conclusion. The patients with initially different chronotypes showed differences in the premorbid, onset, and course of the disease. The account of a chronotype can be considered as one of the approaches to optimize psychopharmacotherapy.

About the Author

M. Yu. Gerasimchuk
Faculty of General Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
Russian Federation

11, Rossolimo St., Build. 9, Moscow 119021

Department of Psychiatry and Narcology


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For citations:

Gerasimchuk M.Yu. A chronobiological approach to therapy for depression. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):31-35. (In Russ.)

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