Sleep and circadian rhytms in treatment-resistant depression
DOI:
https://doi.org/10.25118/2763-9037.2014.v4.240Keywords:
Depression, Treatment resistant depression, Treatment of sleep disordersAbstract
Sleep and circadian rhythm disturbances are key features of depression. Changes in sleep-wake cycle are often prodromal symptoms of depressive disorders and play a role in the pathophysiology of mood disorders. They predict the onset of a new episode, increase the risk of relapse and recurrence and can also be correlated with a growth in the risk of suicide. Persistent sleep disorders can increase refractoriness to treatment. Patients with treatment resistantdepression have an important circadian deregulation and decreased delta rhythm amplitude during sleep. The available treatments for sleep disorders include hypnotic medications and non-pharmacological interventions. Drugs such as benzodiazepine receptor agonists, melatonin agonists and serotonin type 2C receptors antagonists have been shown to be effective in the treatment of sleep problems in depressive patients. Nonpharmacological interventions such as cognitive-behavioral therapy and phototherapy are also useful, particularly when associated with antidepressant medication.
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