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Chen CW, Yeh WL, Charoensaensuk V, Lin C, Yang LY, Xie SY, Lane HY, Lin CH, Wang YW, Tsai CF, Lu DY. Ramelteon protects against social defeat stress-associated abnormal behaviors. Pharmacol Biochem Behav 2024; 241:173794. [PMID: 38834160 DOI: 10.1016/j.pbb.2024.173794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
Psychological stress affects the neuroendocrine regulation, which modulates mental status and behaviors. Melatonin, a hormone synthesized primarily by the pineal gland, regulates many brain functions, including circadian rhythms, pain, sleep, and mood. Selective pharmacological melatonin agonist ramelteon has been clinically used to treat mood and sleep disorders. Posttraumatic stress disorder (PTSD) is a psychiatric condition associated with severe trauma; it is generally triggered by traumatic events, which lead to severe anxiety and uncontrollable trauma recall. We recently reported that repeated social defeat stress (RSDS) may induce robust anxiety-like behaviors and social avoidance in mice. In the present study, we investigated whether melatonin receptor activation by melatonin and ramelteon regulates RSDS-induced behavioral changes. Melatonin treatment improved social avoidance and anxiety-like behaviors in RSDS mice. Moreover, treatment of the non-selective MT1/MT2 receptor agonist, ramelteon, markedly ameliorated RSDS-induced social avoidance and anxiety-like behaviors. Moreover, activating melatonin receptors also balanced the expression of monoamine oxidases, glucocorticoid receptors, and endogenous antioxidants in the hippocampus. Taken together, our findings indicate that the activation of both melatonin and ramelteon regulates RSDS-induced anxiety-like behaviors and PTSD symptoms. The current study also showed that the regulatory effects of neuroendocrine mechanisms and cognitive behaviors on melatonin receptor activation in repeated social defeat stress.
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MESH Headings
- Animals
- Indenes/pharmacology
- Mice
- Male
- Stress, Psychological/metabolism
- Stress, Psychological/drug therapy
- Social Defeat
- Melatonin/pharmacology
- Anxiety/drug therapy
- Anxiety/psychology
- Behavior, Animal/drug effects
- Hippocampus/drug effects
- Hippocampus/metabolism
- Receptors, Glucocorticoid/metabolism
- Receptors, Glucocorticoid/agonists
- Receptor, Melatonin, MT1/agonists
- Receptor, Melatonin, MT1/metabolism
- Receptor, Melatonin, MT2/agonists
- Receptor, Melatonin, MT2/metabolism
- Mice, Inbred C57BL
- Monoamine Oxidase/metabolism
- Receptors, Melatonin/agonists
- Receptors, Melatonin/metabolism
- Stress Disorders, Post-Traumatic/drug therapy
- Stress Disorders, Post-Traumatic/psychology
- Stress Disorders, Post-Traumatic/metabolism
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Affiliation(s)
- Chao-Wei Chen
- Institute of Translational Medicine and New Drug Development, China Medical University, Taichung, Taiwan
| | - Wei-Lan Yeh
- Institute of Translational Medicine and New Drug Development, China Medical University, Taichung, Taiwan; Department of Biochemistry, School of Medicine, China Medical University, Taichung, Taiwan
| | - Vichuda Charoensaensuk
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Chingju Lin
- Department of Physiology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Liang-Yo Yang
- Department of Physiology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Yun Xie
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Wang
- Department of Biotechnology and Pharmaceutical Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Cheng-Fang Tsai
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan.
| | - Dah-Yuu Lu
- Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan.
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Liu H, Wu Y, Zhu H, Wang P, Chen T, Xia A, Zhao Z, He D, Chen X, Xu J, Ji L. Association between napping and type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1294638. [PMID: 38590820 PMCID: PMC10999583 DOI: 10.3389/fendo.2024.1294638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
As the incidence of type 2 diabetes mellitus (T2DM) is increasing rapidly and its consequences are severe, effective intervention and prevention, including sleep-related interventions, are urgently needed. As a component of sleep architecture, naps, alone or in combination with nocturnal sleep, may influence the onset and progression of T2DM. Overall, napping is associated with an increased risk of T2DM in women, especially in postmenopausal White women. Our study showed that napping >30 minutes (min) increased the risk of T2DM by 8-21%. In addition, non-optimal nighttime sleep increases T2DM risk, and this effect combines with the effect of napping. For nondiabetic patients, napping >30 min could increase the risks of high HbA1c levels and impaired fasting glucose (IFG), which would increase the risk of developing T2DM later on. For diabetic patients, prolonged napping may further impair glycemic control and increase the risk of developing diabetic complications (e.g., diabetic nephropathy) in the distant future. The following three mechanisms are suggested as interpretations for the association between napping and T2DM. First, napping >30 min increases the levels of important inflammatory factors, including interleukin 6 and C-reactive protein, elevating the risks of inflammation, associated adiposity and T2DM. Second, the interaction between postmenopausal hormonal changes and napping further increases insulin resistance. Third, prolonged napping may also affect melatonin secretion by interfering with nighttime sleep, leading to circadian rhythm disruption and further increasing the risk of T2DM. This review summarizes the existing evidence on the effect of napping on T2DM and provides detailed information for future T2DM intervention and prevention strategies that address napping.
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Affiliation(s)
- Hongyi Liu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Yingxin Wu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Hui Zhu
- Department of Internal Medicine, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Penghao Wang
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Tao Chen
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Anyu Xia
- Department of Clinical Medicine, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Zhijia Zhao
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Da He
- Department of Obstetrics and Gynecology, Yinzhou District Maternal and Child Health Care Institute, Ningbo, Zhejiang, China
| | - Xiang Chen
- Department of Obstetrics and Gynecology, Yinzhou District Maternal and Child Health Care Institute, Ningbo, Zhejiang, China
| | - Jin Xu
- School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
| | - Lindan Ji
- Zhejiang Key Laboratory of Pathophysiology, Health Science Center, Ningbo University, Ningbo, China
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Health Science Center, Ningbo University, Ningbo, Zhejiang, China
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Parry BL, Meliska CJ, Sorenson DL, Martinez LF, Lopez AM, Dawes SE, Elliott JA, Hauger RL. Sleep-light interventions that shift melatonin rhythms earlier improve perimenopausal and postmenopausal depression: preliminary findings. Menopause 2023; 30:798-806. [PMID: 37463404 PMCID: PMC10524957 DOI: 10.1097/gme.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Testing the hypothesis that a sleep-light intervention, which phase-advances melatonin rhythms, will improve perimenopausal-postmenopausal (P-M; by follicle-stimulating hormone) depression. METHODS In at-home environments, we compared two contrasting interventions: (1) an active phase-advance intervention: one night of advanced/restricted sleep from 9 pm to 1 am , followed by 8 weeks of morning bright white light for 60 min/d within 30 minutes of awakening, and (2) a control phase-delay intervention: one night of delayed/restricted sleep (sleep from 3 to 7 am ) followed by 8 weeks of evening bright white light for 60 min/d within 90 minutes of bedtime. We tested 17 P-M participants, 9 normal controls and 8 depressed participants (DPs) (by Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] criteria). Clinicians assessed mood by structured interviews and subjective mood ratings. Participants wore actigraphs to measure sleep and activity and collected overnight urine samples for the melatonin metabolite, 6-sulfatoxymelatonin (6-SMT), before, during, and after interventions. RESULTS Baseline depressed mood correlated with delayed 6-SMT offset time (cessation of melatonin metabolite [6-SMT] secretion) ( r = +0.733, P = 0.038). After phase-advance intervention versus phase-delay intervention, 6-SMT offset (start of melatonin and 6-SMT decrease) was significantly advanced in DPs (mean ± SD, 2 h 15 min ± 12 min; P = 0.042); advance in 6-SMT acrophase (time of maximum melatonin and 6-SMT secretion) correlated positively with mood improvement ( r = +0.978, P = 0.001). Mood improved (+70%, P = 0.007) by both 2 and 8 weeks. CONCLUSIONS These preliminary findings reveal significantly phase-delayed melatonin rhythms in DP versus normal control P-M women. Phase-advancing melatonin rhythms improves mood in association with melatonin advance. Thus, sleep-light interventions may potentially offer safe, rapid, nonpharmaceutical, well-tolerated, affordable home treatments for P-M depression.
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Affiliation(s)
- Barbara L. Parry
- Department of Psychiatry, University of California, San Diego
- Corresponding Author: University of California, San Diego, Department of Psychiatry
- Center for Circadian Biology (Drs. Parry, Meliska, Elliott), University of California, San Diego
| | | | | | | | - Ana M. Lopez
- Department of Psychiatry, University of California, San Diego
| | | | - Jeffrey A. Elliott
- Department of Psychiatry, University of California, San Diego
- Center for Circadian Biology (Drs. Parry, Meliska, Elliott), University of California, San Diego
| | - Richard L. Hauger
- Department of Psychiatry, University of California, San Diego
- Center for Behavior Genetics of Aging (Dr. Hauger) Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System (Dr. Hauger)
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Parry BL, Meliska CJ, Sorenson DL, Martinez LF, Lopez AM, Dawes SE, Elliott JA, Hauger RL. Critically-timed sleep+light interventions differentially improve mood in pregnancy vs. postpartum depression by shifting melatonin rhythms. J Affect Disord 2023; 324:250-258. [PMID: 36586616 DOI: 10.1016/j.jad.2022.12.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/13/2022] [Accepted: 12/18/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Testing the hypothesis that combined wake + light therapy improves mood in pregnant vs. postpartum depressed participants (DP) by differentially altering melatonin and sleep timing. METHODS Initially 89 women, 37 pregnant (21 normal controls-NC; 16 DP) and 52 postpartum (27 NCs; 25 DP), were randomized to a parallel trial of a phase-delay intervention (PDI): 1-night of early-night wake therapy (sleep 3-7 am) + 6-weeks of evening bright white light (Litebook Advantage) for 60 min starting 90 min before bedtime, vs. a Phase-advance intervention (PAI): 1-night of late-night wake therapy (sleep 9 pm-1 am) + 6-weeks of morning bright white light for 60 min within 30 min of wake time. Blinded clinicians assessed mood weekly by structured interview, and participants completed subjective ratings, a Morningness-Eveningness questionnaire, actigraphy, and collected 2 overnight urine samples for 6-sulphatoxy melatonin (6-SMT). RESULTS In pregnant DP, mood improved more after the PDI vs. PAI (p = .016), whereas in postpartum DP, mood improved more after the PAI vs. PDI (p = .019). After wake therapy, 2 weeks of light treatment was as efficacious as 6 weeks (p > .05). In postpartum DP, PAI phase-advanced 6-SMT offset and acrophase (p < .05), which correlated positively with mood improvement magnitude (p = .003). LIMITATIONS Small N. CONCLUSIONS Mood improved more after 2 weeks of the PDI in pregnant DP, but more after 2 weeks of PAI in postpartum DP in which improvement magnitude correlated with 6-SMT phase-advance. Thus, critically-timed Sleep + Light Interventions provide safe, efficacious, rapid-acting, well-tolerated, at-home, non-pharmaceutical treatments for peripartum DP.
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Affiliation(s)
- Barbara L Parry
- Department of Psychiatry, University of California, San Diego, United States of America; The Center for Circadian Biology, United States of America.
| | - Charles J Meliska
- Department of Psychiatry, University of California, San Diego, United States of America
| | - Diane L Sorenson
- Department of Psychiatry, University of California, San Diego, United States of America
| | - L Fernando Martinez
- Department of Psychiatry, University of California, San Diego, United States of America
| | - Ana M Lopez
- Department of Psychiatry, University of California, San Diego, United States of America
| | - Sharron E Dawes
- Department of Psychiatry, University of California, San Diego, United States of America
| | - Jeffrey A Elliott
- Department of Psychiatry, University of California, San Diego, United States of America; The Center for Circadian Biology, United States of America
| | - Richard L Hauger
- Department of Psychiatry, University of California, San Diego, United States of America; Center for Behavior Genetics of Aging, United States of America; Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare, System, United States of America
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Parry BL, Meliska CJ, Martinez LF, Lopez AM, Sorenson DL, Dawes SE, Elliott JA, Hauger RL. A 1-week sleep and light intervention improves mood in premenstrual dysphoric disorder in association with shifting melatonin offset time earlier. Arch Womens Ment Health 2023; 26:29-37. [PMID: 36520251 PMCID: PMC9908689 DOI: 10.1007/s00737-022-01283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
To test the hypothesis that 1 week of combined sleep and light interventions (SALI), which phase-advance (shift earlier) melatonin circadian rhythms, improves mood significantly more than phase-delay (shift later) SALI. After a 2-month diagnostic evaluation for premenstrual dysphoric disorder (PMDD per DSM-5 criteria) in a university clinical research setting, 44 participants enrolled in baseline studies were randomized in the luteal phase at home to (A) a phase-advance intervention (PAI): 1 night of late-night wake therapy (LWT: sleep 9 pm-1 am) followed by 7 days of the morning (AM) bright white light (BWL), or (B) a phase-delay intervention (PDI): 1 night of early-night wake therapy (EWT: sleep 3-7 am) plus 7 days of the evening (PM) BWL. After a month of no intervention, participants underwent the alternate intervention. Outcome measures were mood, the melatonin metabolite, 6-sulfatoxymelatonin (6-SMT), and actigraphy (to assess protocol compliance). At baseline, atypical depression correlated positively with phase delay in 6-SMT offset time (r = .456, p = .038). PAI advanced 6-SMT offset from baseline more than PDI (p < .05), and improved raw mood scores more than PDI (p < .05). As hypothesized, percent improvement in mood correlated positively with a phase advance from baseline in 6-SMT offset time (p < .001). Treatment with 1 night of advanced/restricted sleep followed by 7 days of AM BWL (PAI) was more efficacious in reducing PMDD depression symptoms than a PDI; mood improvement occurred in association with phase advance in 6-SMT offset time. Combined SALIs offer safe, efficacious, rapid-acting, well-tolerated, non-pharmacological, non-hormonal, affordable, repeatable home interventions for PMDD. Clinical Trials.gov NCT # NCT01799733.
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Affiliation(s)
- Barbara L Parry
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA, 92093-0804, USA.
- Center for Circadian Biology, San Diego, CA, USA.
| | | | - L Fernando Martinez
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA, 92093-0804, USA
- Center for Circadian Biology, San Diego, CA, USA
- Center for Behavior Genetics of Aging, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA, USA
| | - Ana M Lopez
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA, 92093-0804, USA
- Center for Circadian Biology, San Diego, CA, USA
- Center for Behavior Genetics of Aging, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA, USA
| | - Diane L Sorenson
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA, 92093-0804, USA
- Center for Circadian Biology, San Diego, CA, USA
- Center for Behavior Genetics of Aging, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA, USA
| | - Sharron E Dawes
- Department of Psychiatry, University of California, 9500 Gilman Dr., La Jolla, La Jolla, CA, 92093-0804, USA
- Center for Circadian Biology, San Diego, CA, USA
- Center for Behavior Genetics of Aging, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA, USA
| | | | - Richard L Hauger
- Center for Behavior Genetics of Aging, San Diego, CA, USA
- Center of Excellence for Stress and Mental Health (CESAMH), VA, San Diego Healthcare System, San Diego, CA, USA
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Kirlioglu SS, Balcioglu YH. Chronobiology Revisited in Psychiatric Disorders: From a Translational Perspective. Psychiatry Investig 2020; 17:725-743. [PMID: 32750762 PMCID: PMC7449842 DOI: 10.30773/pi.2020.0129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Several lines of evidence support a relationship between circadian rhythms disruption in the onset, course, and maintenance of mental disorders. Despite the study of circadian phenotypes promising a decent understanding of the pathophysiologic or etiologic mechanisms of psychiatric entities, several questions still need to be addressed. In this review, we aimed to synthesize the literature investigating chronobiologic theories and their associations with psychiatric entities. METHODS The Medline, Embase, PsycInfo, and Scopus databases were comprehensively and systematically searched and articles published between January 1990 and October 2019 were reviewed. Different combinations of the relevant keywords were polled. We first introduced molecular elements and mechanisms of the circadian system to promote a better understanding of the chronobiologic implications of mental disorders. Then, we comprehensively and systematically reviewed circadian system studies in mood disorders, schizophrenia, and anxiety disorders. RESULTS Although subject characteristics and study designs vary across studies, current research has demonstrated that circadian pathologies, including genetic and neurohumoral alterations, represent the neural substrates of the pathophysiology of many psychiatric disorders. Impaired HPA-axis function-related glucocorticoid rhythm and disrupted melatonin homeostasis have been prominently demonstrated in schizophrenia and other psychotic disorders, while alterations of molecular expressions of circadian rhythm genes including CLOCK, PER, and CRY have been reported to be involved in the pathogenesis of mood disorders. CONCLUSION Further translational work is needed to identify the causal relationship between circadian physiology abnormalities and mental disorders and related psychopathology, and to develop sound pharmacologic interventions.
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Affiliation(s)
- Simge Seren Kirlioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Yasin Hasan Balcioglu
- Department of Psychiatry, Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
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Robillard R, Naismith S, Rogers N, Scott E, Ip T, Hermens D, Hickie I. Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: Comparison of unipolar and bipolar phenotypes. Eur Psychiatry 2020; 28:412-6. [DOI: 10.1016/j.eurpsy.2013.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 03/20/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022] Open
Abstract
AbstractThis study evaluated the potential of circadian measures as early markers of mood disorders subtypes. Patients with bipolar disorders had significantly lower levels and later onset of melatonin secretion than those with unipolar depression. Furthermore, abnormal phase angles between sleep, melatonin and temperature were found in several patients.
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Fang S, Zhou J. Association of Daytime Napping and Diagnosed Diabetes in Middle-Aged Premenopausal, Middle-Aged Postmenopausal, and Older Postmenopausal Chinese Women. Am J Health Promot 2019; 33:1107-1114. [PMID: 31167538 DOI: 10.1177/0890117119854918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine associations of daytime napping and diagnosed diabetes in middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal Chinese women. DESIGN Quantitative, cross-sectional. SETTING 2015 cross-sectional data from China Health and Retirement Longitudinal Study. Participants were recruited from 150 counties/districts and 450 villages/resident committees. PARTICIPANTS Six thousand nine hundred and forty women aged 45 years and older (mean age = 61 years) stratified by age and menopausal status. MEASURES The outcome was self-reported diagnosed diabetes. The exposure was self-reported daytime napping (0, >0-≤60, or >60 min/d). Participants were stratified to middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal women according to their age (≤60 or >60 years) and menopausal status. ANALYSIS One-way analysis of variance and χ2 tests were conducted to explore differences on characteristics of middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal women. Multiple logistic regressions were used to estimate adjusted odds ratios (ORs) for diagnosed diabetes according to daytime napping in the total sample, middle-aged premenopausal, middle-aged postmenopausal, and older postmenopausal Chinese women. RESULTS Participants' mean self-reported daytime napping duration was 34 minutes. Women who napped more than 60 minutes were more likely to report diagnosed diabetes (OR = 1.39, 95% confidence interval (CI), 1.09-1.76) comparing to those who did not nap, after adjusting for potential confounders. No statistical significance of interaction term between daytime napping and age/menopausal status was detected (P = .602 and P = .558) among total women. The stratified analysis revealed the significant association among middle-aged postmenopausal women napping more than 60 minutes (OR = 1.81, 95% CI, 1.18-2.77). The association, however, was found to be insignificant in middle-aged premenopausal women and older postmenopausal women. CONCLUSIONS Long daytime nap (>60 min/d) was associated with diagnosed diabetes in middle-aged postmenopausal women in China.
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Affiliation(s)
- Shu Fang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junmin Zhou
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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Mental health in elite athletes: International Olympic Committee consensus statement (2019). Br J Sports Med 2019; 53:667-699. [DOI: 10.1136/bjsports-2019-100715] [Citation(s) in RCA: 349] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2019] [Indexed: 11/03/2022]
Abstract
Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.
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10
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Youngstedt SD, Elliott JA, Kripke DF. Human circadian phase-response curves for exercise. J Physiol 2019; 597:2253-2268. [PMID: 30784068 PMCID: PMC6462487 DOI: 10.1113/jp276943] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/28/2019] [Indexed: 01/09/2023] Open
Abstract
KEY POINTS Exercise elicits circadian phase-shifting effects, but additional information is needed. The phase-response curve describing the magnitude and direction of circadian rhythm phase shifts, depending on the time of the zeigeber (time cue) stimulus, is the most fundamental chronobiological tool for alleviating circadian misalignment and related morbidity. Fifty-one older and 48 young adults followed a circadian rhythms measurement protocol for up to 5.5 days, and performed 1 h of moderate treadmill exercise for 3 consecutive days at one of eight times of the day/night. Temporal changes in the phase of 6-sulphatoxymelatonin (aMT6s) were measured from evening onset, cosine acrophase, morning offset and duration of excretion. Significant phase-response curves were established for aMT6 onset and acrophase with large phase delays from 7:00 pm to 10:00 pm and large phase advances at both 7:00 am and from 1:00 pm to 4:00 pm. Delays or advances would be desired, for example, for adjustment to westward or eastward air travel, respectively. Along with known synergism with bright light, the above PRCs with a second phase advance region (afternoon) could support both practical and clinical applications. ABSTRACT Although bright light is regarded as the primary circadian zeitgeber, its limitations support exploring alternative zeitgebers. Exercise elicits significant circadian phase-shifting effects, but fundamental information regarding these effects is needed. The primary aim of the present study was to establish phase-response curves (PRCs) documenting the size and direction of phase shifts in relation to the circadian time of exercise. Aerobically fit older (n = 51; 59-75 years) and young adults (n = 48; 18-30 years) followed a 90 min laboratory ultrashort sleep-wake cycle (60 min wake/30 min sleep) for up to 5½ days. At the same clock time on three consecutive days, each participant performed 60 min of moderate treadmill exercise (65-75% of heart rate reserve) at one of eight times of day/night. To describe PRCs, phase shifts were measured for the cosine-fitted acrophase of urinary 6-sulphatoxymelatonin (aMT6s), as well as for the evening rise, morning decline and change in duration of aMT6s excretion. Significant PRCs were found for aMT6s acrophase, onset and duration, with peak phase advances corresponding to clock times of 7:00 am and from 1:00 pm to 4:00 pm, delays from 7:00 pm to 10:00 pm, and minimal shifts around 4:00 pm and 2:00 am. There were no significant age or sex differences. The amplitudes of the aMT6s onset and acrophase PRCs are comparable to expectations for bright light of equal duration. The phase advance to afternoon exercise and the exercise-induced PRC for change in aMT6s duration are novel findings. The results support further research exploring additive phase-shifting effects of bright light and exercise and health benefits.
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Affiliation(s)
- Shawn D Youngstedt
- College of Nursing and Health Innovation and College of Health Solutions, Arizona State University, Phoenix, AZ, USA.,Phoenix VA Health Care System, Phoenix, AZ, USA
| | - Jeffrey A Elliott
- Department of Psychiatry, University of California, San Diego, CA, USA.,Center for Circadian Biology, University of California, San Diego, CA, USA
| | - Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, CA, USA
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Liu J, Clough SJ, Dubocovich ML. Role of the MT1and MT2melatonin receptors in mediating depressive- and anxiety-like behaviors in C3H/HeN mice. GENES BRAIN AND BEHAVIOR 2017; 16:546-553. [DOI: 10.1111/gbb.12369] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/20/2016] [Accepted: 01/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- J. Liu
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo (SUNY); Buffalo NY USA
| | - S. J. Clough
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo (SUNY); Buffalo NY USA
| | - M. L. Dubocovich
- Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biomedical Sciences; University at Buffalo (SUNY); Buffalo NY USA
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12
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Bumb JM, Enning F, Mueller JK, van der List T, Rohleder C, Findeisen P, Noelte I, Schwarz E, Leweke FM. Differential melatonin alterations in cerebrospinal fluid and serum of patients with major depressive disorder and bipolar disorder. Compr Psychiatry 2016; 68:34-9. [PMID: 27234180 DOI: 10.1016/j.comppsych.2016.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Melatonin, which plays an important role for regulation of circadian rhythms and the sleep/wake cycle has been linked to the pathophysiology of major depressive and bipolar disorder. Here we investigated melatonin levels in cerebrospinal fluid (CSF) and serum of depression and bipolar patients to elucidate potential differences and commonalities in melatonin alterations across the two disorders. METHODS Using enzyme-linked immunosorbent assays, CSF and serum melatonin levels were measured in 108 subjects (27 healthy volunteers, 44 depressed and 37 bipolar patients). Covariate adjusted multiple regression analysis was used to investigate group differences in melatonin levels. RESULTS In CSF, melatonin levels were significantly decreased in bipolar (P<0.001), but not major depressive disorder. In serum, we observed a significant melatonin decrease in major depressive (P=0.003), but not bipolar disorder. No associations were found between serum and CSF melatonin levels or between melatonin and measures of symptom severity or sleep disruptions in either condition. CONCLUSION This study suggests the presence of differential, body fluid specific alterations of melatonin levels in bipolar and major depressive disorder. Further, longitudinal studies are required to explore the disease phase dependency of melatonin alterations and to mechanistically explore the causes and consequences of site-specific alterations.
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Affiliation(s)
- J M Bumb
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - F Enning
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J K Mueller
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Till van der List
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - C Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Findeisen
- Institute for Clinical Chemistry, Medical Faculty Mannheim, Heidelberg University, Germany
| | - I Noelte
- Department of Neuroradiology, University Hospital Mannheim, Mannheim, Germany
| | - E Schwarz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - F M Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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13
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Differential effect of depression versus thermoregulation in postmenopausal sleep disturbance. Menopause 2015; 22:1032-4. [DOI: 10.1097/gme.0000000000000529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kripke DF, Elliott JA, Welsh DK, Youngstedt SD. Photoperiodic and circadian bifurcation theories of depression and mania. F1000Res 2015; 4:107. [PMID: 26180634 PMCID: PMC4490783 DOI: 10.12688/f1000research.6444.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/26/2022] Open
Abstract
Seasonal effects on mood have been observed throughout much of human history. Seasonal changes in animals and plants are largely mediated through the changing photoperiod (i.e., the photophase or duration of daylight). We review that in mammals, daylight specifically regulates SCN (suprachiasmatic nucleus) circadian organization and its control of melatonin secretion. The timing of melatonin secretion interacts with gene transcription in the pituitary pars tuberalis to modulate production of TSH (thyrotropin), hypothalamic T3 (triiodothyronine), and tuberalin peptides which modulate pituitary production of regulatory gonadotropins and other hormones. Pituitary hormones largely mediate seasonal physiologic and behavioral variations. As a result of long winter nights or inadequate illumination, we propose that delayed morning offset of nocturnal melatonin secretion, suppressing pars tuberalis function, could be the main cause for winter depression and even cause depressions at other times of year. Irregularities of circadian sleep timing and thyroid homeostasis contribute to depression. Bright light and sleep restriction are antidepressant and conversely, sometimes trigger mania. We propose that internal desynchronization or bifurcation of SCN circadian rhythms may underlie rapid-cycling manic-depressive disorders and perhaps most mania. Much further research will be needed to add substance to these theories.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, CA, 92093-0603, USA
| | - Jeffrey A Elliott
- Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, CA, 92093-0603, USA
| | - David K Welsh
- Department of Psychiatry and Center for Circadian Biology, University of California, San Diego, CA, 92093-0603, USA
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, 85004-4431, USA
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Endo T, Kripke DF, Ancoli-Israel S. Wake up time, light, and mood in a population sample age 40-64 years. Psychiatry Investig 2015; 12:177-82. [PMID: 25866517 PMCID: PMC4390587 DOI: 10.4306/pi.2015.12.2.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Concern that disturbances of sleep and light exposures at night might increase cancer risks have been expressed, but little actual exposure data has been collected. Measurements from a representative population sample were examined to understand the magnitude of in-bed light exposure at night and possible correlates. METHODS From 1990 to 1994, a home survey of sleep disorders among adults ages 40-64 was conducted in the City of San Diego California, using stratified representative sampling techniques. Along with questionnaires, sleep logs, and 3-night wrist activity and pulse oximetry measures, bedside illumination was measured with a computer recording system. Questionnaires included the CESD depression scale and a scale of symptoms typical of winter depression. RESULTS Complete data were available from 286 men and women, whose mean in-bed intervals averaged 7 hours and 42 minutes. The mean room illumination during the first part of the night was mean 12.7 lux (median 3.2 lux) and during the last 2 hours in bed averaged 28.7 lux (median 18.9 lux). Nocturnal light exposure was positively correlated with age, male gender, summer season, time in bed, wake-up time, and depressive symptoms. CONCLUSION Complex bi-directional interactions may take place between sleep disturbances, depression, time in bed, wake-up-time, and in-bed illumination. The most crucial light exposures appear to occur in the last 2 hours in bed, largely after dawn, so daylight exposure may be an important factor.
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Affiliation(s)
| | - Daniel F. Kripke
- Department of Psychiatry, University of California, San Diego, CA, USA
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Kripke DF, Klimecki WT, Nievergelt CM, Rex KM, Murray SS, Shekhtman T, Tranah GJ, Loving RT, Lee HJ, Rhee MK, Shadan FF, Poceta JS, Jamil SM, Kline LE, Kelsoe JR. Circadian polymorphisms in night owls, in bipolars, and in non-24-hour sleep cycles. Psychiatry Investig 2014; 11:345-62. [PMID: 25395965 PMCID: PMC4225198 DOI: 10.4306/pi.2014.11.4.345] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 12/13/2022] Open
Abstract
People called night owls habitually have late bedtimes and late times of arising, sometimes suffering a heritable circadian disturbance called delayed sleep phase syndrome (DSPS). Those with DSPS, those with more severe progressively-late non-24-hour sleep-wake cycles, and those with bipolar disorder may share genetic tendencies for slowed or delayed circadian cycles. We searched for polymorphisms associated with DSPS in a case-control study of DSPS research participants and a separate study of Sleep Center patients undergoing polysomnography. In 45 participants, we resequenced portions of 15 circadian genes to identify unknown polymorphisms that might be associated with DSPS, non-24-hour rhythms, or bipolar comorbidities. We then genotyped single nucleotide polymorphisms (SNPs) in both larger samples, using Illumina Golden Gate assays. Associations of SNPs with the DSPS phenotype and with the morningness-eveningness parametric phenotype were computed for both samples, then combined for meta-analyses. Delayed sleep and "eveningness" were inversely associated with loci in circadian genes NFIL3 (rs2482705) and RORC (rs3828057). A group of haplotypes overlapping BHLHE40 was associated with non-24-hour sleep-wake cycles, and less robustly, with delayed sleep and bipolar disorder (e.g., rs34883305, rs34870629, rs74439275, and rs3750275 were associated with n=37, p=4.58E-09, Bonferroni p=2.95E-06). Bright light and melatonin can palliate circadian disorders, and genetics may clarify the underlying circadian photoperiodic mechanisms. After further replication and identification of the causal polymorphisms, these findings may point to future treatments for DSPS, non-24-hour rhythms, and possibly bipolar disorder or depression.
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Affiliation(s)
- Daniel F. Kripke
- Department of Psychiatry, University of California, San Diego, CA, USA
- Viterbi Family Sleep Center, Scripps Clinic, La Jolla, CA, USA
| | - Walter T. Klimecki
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ, USA
| | | | - Katharine M. Rex
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Sarah S. Murray
- Department of Pathology, Center for Advanced Laboratory Medicine, University of California, San Diego, CA, USA
| | - Tatyana Shekhtman
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Gregory J. Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | | | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Kyu Rhee
- Department of Psychology, Gyeongsang National University, Jinju, Republic of Korea
| | | | | | - Shazia M. Jamil
- Viterbi Family Sleep Center, Scripps Clinic, La Jolla, CA, USA
| | | | - John R. Kelsoe
- Department of Psychiatry, University of California, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
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Toffol E, Kalleinen N, Haukka J, Vakkuri O, Partonen T, Polo-Kantola P. The effect of hormone therapy on serum melatonin concentrations in premenopausal and postmenopausal women: a randomized, double-blind, placebo-controlled study. Maturitas 2014; 77:361-9. [PMID: 24602553 DOI: 10.1016/j.maturitas.2014.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/17/2014] [Accepted: 01/27/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Melatonin levels decrease physiologically with age, and possibly with the transition to menopause. The plausible influence of hormone therapy (HT) on melatonin is poorly understood. The aim of this randomized, placebo-controlled, double-blind trial was to investigate the effect of HT administration on serum melatonin concentrations in late premenopausal and postmenopausal women. STUDY DESIGN Analyses were carried out among 17 late premenopausal and 18 postmenopausal healthy women who participated in a prospective HT study in Finland. Serum melatonin was sampled at 20-min (21:00-24:00 h; 06:00-09:00 h) and 1-h (24:00-06:00 h) intervals at baseline and after 6 months with HT or placebo. MAIN OUTCOME MEASURES Melatonin levels and secretion profile after 6 months of HT compared to placebo. RESULTS Mean melatonin levels, mean melatonin exposure level (area under curve, AUC) and mean duration of melatonin secretion did not differ after 6 months with HT vs. placebo, irrespectively of the reproductive state. However, in postmenopausal women the melatonin peak time (acrophase) was delayed by 2.4h (2 h 21 min) on average after 6 months with HT vs. placebo (p<0.05). No interaction between time and group was detected when melatonin level was modelled before or after treatment. CONCLUSIONS Administration of HT to postmenopausal women alters melatonin peak time, but not melatonin levels. Further research on larger clinical samples is needed to better understand the effects of HT on melatonin profile.
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Affiliation(s)
- Elena Toffol
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland.
| | - Nea Kalleinen
- Sleep Research Unit, Department of Physiology, University of Turku, Lemminkäisenkatu 14-18A, 5th Floor, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, PL 52, Turku, Finland
| | - Jari Haukka
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland; Department of Public Health, Hjelt Institute, University of Helsinki, Mannerheimintie 172, Helsinki, Finland
| | - Olli Vakkuri
- Department of Physiology, University of Oulu, Aapistie 7, Oulu, Finland
| | - Timo Partonen
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare (THL), Mannerheimintie 170, Helsinki, Finland
| | - Päivi Polo-Kantola
- Sleep Research Unit, Department of Physiology, University of Turku, Lemminkäisenkatu 14-18A, 5th Floor, Turku, Finland; Department of Obstetrics and Gynaecology, Turku University Central Hospital and University of Turku, PL 52, Turku, Finland
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Broms U, Pitkäniemi J, Bäckmand H, Heikkilä K, Koskenvuo M, Peltonen M, Sarna S, Vartiainen E, Kaprio J, Partonen T. Long-term consistency of diurnal-type preferences among men. Chronobiol Int 2013; 31:182-8. [DOI: 10.3109/07420528.2013.836534] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Hickie IB, Naismith SL, Robillard R, Scott EM, Hermens DF. Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression. BMC Med 2013; 11:79. [PMID: 23521808 PMCID: PMC3760618 DOI: 10.1186/1741-7015-11-79] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 03/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical psychiatry has always been limited by the lack of objective tests to substantiate diagnoses and a lack of specific treatments that target underlying pathophysiology. One area in which these twin failures has been most frustrating is major depression. Due to very considerable progress in the basic and clinical neurosciences of sleep-wake cycles and underlying circadian systems this situation is now rapidly changing. DISCUSSION The development of specific behavioral or pharmacological strategies that target these basic regulatory systems is driving renewed clinical interest. Here, we explore the extent to which objective tests of sleep-wake cycles and circadian function - namely, those that measure timing or synchrony of circadian-dependent physiology as well as daytime activity and nighttime sleep patterns - can be used to identify a sub-class of patients with major depression who have disturbed circadian profiles. SUMMARY Once this unique pathophysiology is characterized, a highly personalized treatment plan can be proposed and monitored. New treatments will now be designed and old treatments re-evaluated on the basis of their effects on objective measures of sleep-wake cycles, circadian rhythms and related metabolic systems.
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Affiliation(s)
- Ian B Hickie
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW, 2050, Australia
| | - Sharon L Naismith
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW, 2050, Australia
| | - Rébecca Robillard
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW, 2050, Australia
| | - Elizabeth M Scott
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW, 2050, Australia
- School of Medicine, The University of Notre Dame, 160 Oxford St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - Daniel F Hermens
- Clinical Research Unit, Brain & Mind Research Institute, University of Sydney, 100 Mallett St, Camperdown, NSW, 2050, Australia
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Cardinali DP, Vidal MF, Vigo DE. Agomelatine: Its Role in the Management of Major Depressive Disorder. ACTA ACUST UNITED AC 2012. [DOI: 10.4137/cmpsy.s7989] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Circadian rhythm abnormalities, as shown by sleep/wake cycle disturbances, constitute one the most prevalent signs of depressive illness; advances or delays in the circadian phase are documented in patients with major depressive disorder (MDD), bipolar disorder, and seasonal affective disorder (SAD). The disturbances in the amplitude and phase of rhythm in melatonin secretion that occur in patients with depression resemble those seen in chronobiological disorders, thus suggesting a link between disturbed melatonin secretion and depressed mood. Based on this, agomelatine, the first MT1/MT2 melatonergic agonist displaying also 5-HT2C serotonergic antagonism, has been introduced as an antidepressant. Agomelatine has been shown to be effective in several animal models of depression and anxiety and it has beneficial effects in patients with MDD, bipolar disorder, or SAD. Among agomelatine's characteristics are a rapid onset of action and a pronounced effectiveness for correcting circadian rhythm abnormalities and improving the sleep/wake cycle. Agomelatine also improves the 3 functional dimensions of depression—emotional, cognitive, and social—thus aiding in the full recovery of patients to a normal life.
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Affiliation(s)
- Daniel P. Cardinali
- Department of Teaching and Research, Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - María F. Vidal
- Department of Teaching and Research, Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Daniel E. Vigo
- Department of Teaching and Research, Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
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Srinivasan V, De Berardis D, Shillcutt SD, Brzezinski A. Role of melatonin in mood disorders and the antidepressant effects of agomelatine. Expert Opin Investig Drugs 2012; 21:1503-22. [DOI: 10.1517/13543784.2012.711314] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Abstract
Antidepressant pharmacotherapy is to date the most often used treatment for depression, but the exact mechanism of action underlying its therapeutic effect is still unclear. Many theories have been put forward to account for depression, as well as antidepressant activity, but none of them is exhaustive. Neuroimmune endocrine impairment is found in depressed patients; high levels of circulating corticosteroids along with hyperactivation of the immune system, high levels of proinflammatory cytokines, low levels of melatonin in plasma and urine, and disentrainment of circadian rhythms have been demonstrated. Moreover, antidepressant treatment seems to correct or at least to interfere with these alterations. In this review, we summarize the complex neuroimmune endocrine and chronobiological alterations found in patients with depression and how these systems interact with each other. We also explain how antidepressant therapy can modify these systems, along with some possible mechanisms of action shown in animal and human models.
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Affiliation(s)
- Marco Antonioli
- Psychoimmunology Translational Laboratory, Health Science Research Centre, Roehampton University, London, UK
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Lee HJ, Rex KM, Nievergelt CM, Kelsoe JR, Kripke DF. Delayed sleep phase syndrome is related to seasonal affective disorder. J Affect Disord 2011; 133:573-9. [PMID: 21601293 PMCID: PMC3163003 DOI: 10.1016/j.jad.2011.04.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 04/05/2011] [Accepted: 04/27/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Both delayed sleep phase syndrome (DSPS) and seasonal affective disorder (SAD) may manifest similar delayed circadian phase problems. However, the relationships and co-morbidity between the two conditions have not been fully studied. The authors examined the comorbidity between DSPS and SAD. METHODS We recruited a case series of 327 DSPS and 331 controls with normal sleep, roughly matched for age, gender, and ancestry. Both DSPS and controls completed extensive questionnaires about sleep, the morningness-eveningness trait, depression, mania, seasonality of symptoms, etc. RESULTS The prevalences of SAD and subsyndromal SAD (S-SAD) were higher in DSPS compared to controls (χ(2)=12.65, p=0.002). DSPS were 3.3 times more likely to report SAD (odds ratio, 3.34; 95% CI, 1.41-7.93) compared to controls as defined by the Seasonal Pattern Assessment Questionnaire (SPAQ). Correspondingly, DSPS showed significantly higher seasonality scores compared to controls in mood, appetite, and energy level subscores and the global seasonality score (t=3.12, t=0.002; t=2.04, p=0.041; t=2.64, p=0.008; and t=2.15, p=0.032, respectively). Weight fluctuation during seasons and winter-summer sleep length differences were also significantly higher in DSPS than controls (t=5.16, p<0.001 and t=2.64, p=0.009, respectively). SAD and S-SAD reported significantly higher eveningness, higher depression self-ratings, and more previous mania symptoms compared to non-seasonal subjects regardless of whether they were DSPS or controls. CONCLUSIONS These cases suggested that DSPS is partially comorbid with SAD. These data support the hypothesis that DSPS and SAD may share a pathophysiological mechanism causing delayed circadian phase.
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Affiliation(s)
- Heon-Jeong Lee
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
| | - Katharine M. Rex
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA
| | - John R. Kelsoe
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA
| | - Daniel F. Kripke
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA
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Kripke DF, Nievergelt CM, Tranah GJ, Murray SS, McCarthy MJ, Rex KM, Parimi N, Kelsoe JR. Polymorphisms in melatonin synthesis pathways: possible influences on depression. J Circadian Rhythms 2011; 9:8. [PMID: 21827647 PMCID: PMC3177871 DOI: 10.1186/1740-3391-9-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/09/2011] [Indexed: 11/14/2022] Open
Abstract
Background It has been reported that rs4446909, a single nucleotide polymorphism (SNP) in the promoter of acetylserotonin methyltransferase (ASMT), influences the expression of the ASMT enzyme. The common G allele is associated with lower ASMT activity, and therefore, diminishes conversion of N-acetylserotonin to melatonin. The G allele was associated with recurrent depressive disorder in a Polish group. ASMT might also affect bipolar relapse, given evidence that N-acetylserotonin might stimulate TRKB receptors, and TRKB may influence mood relapse in bipolar disorder. Additionally, arylalkylamine N-acetyltransferase (AANAT) polymorphisms have been reported associated with depression, perhaps through their influence upon N-acetylserotonin or melatonin synthesis. Results To replicate and further explore these ideas, rs4446909 was genotyped in four research groups, as part of a panel of 610 SNPs surveyed by an Illumina Golden Gate assay. In 768 cases with delayed sleep phase disorder or matched controls, rs4446909 was indeed associated with the depressive symptoms on a self-report scale (P = 0.01, R2 = 0.007). However, there was no significant association of rs4446909 with self-reported depression in a sleep clinic patient group or with two groups of elderly men and women from multicenter studies, nor was the response to lithium treatment associated with rs4446909 in bipolar patients. No associations of two AANAT SNPs with depression were found. Conclusions The evidence did not support a strong influence of rs4446909 upon mood, but the partial replication may be consistent with a modest effect. It is possible that larger or younger subject groups with improved phenotype ascertainment might demonstrate more persuasive replication.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093, USA.
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Kripke DF, Langer RD, Elliott JA, Klauber MR, Rex KM. Mortality related to actigraphic long and short sleep. Sleep Med 2011; 12:28-33. [PMID: 20870457 PMCID: PMC3010336 DOI: 10.1016/j.sleep.2010.04.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/05/2010] [Accepted: 04/16/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND The folk belief that we should sleep 8 h seems to be incorrect. Numerous studies have shown that self-reported sleep longer than 7.5 h or shorter than 6.5 h predicts increased mortality risk. This study examined if prospectively-determined objective sleep duration, as estimated by wrist actigraphy, was associated with mortality risks. METHODS From 1995-1999, women averaging 67.6 years of age provided one-week actigraphic recordings. Survival could be estimated from follow-up continuing until 2009 for 444 of the women, with an average of 10.5 years before censoring. Multivariate age-stratified Cox regression models were controlled for history of hypertension, diabetes, myocardial infarction, cancer, and major depression. RESULTS Adjusted survival functions estimated 61% survival (54-69%, 95% C.I.) for those with sleep less than 300 min and 78% survival (73-85%, 95% C.I.) for those with actigraphic sleep longer than 390 min, as compared with survival of 90% (85-94%, 95% C.I.) for those with sleep of 300-390 min. Time-in-bed, sleep efficiency and the timing of melatonin metabolite excretion were also significant mortality risk factors. CONCLUSION This study confirms a U-shaped relationship between survival and actigraphically measured sleep durations, with the optimal objective sleep duration being shorter than the self-report optimums. People who sleep five or six hours may be reassured. Further studies are needed to identify any modifiable factors for this mortality and possible approaches to prevention.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA.
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Niederhofer H, von Klitzing K. Bright light treatment as add-on therapy for depression in 28 adolescents: a randomized trial. Prim Care Companion CNS Disord 2011; 13:PCC.11m01194. [PMID: 22454802 PMCID: PMC3304684 DOI: 10.4088/pcc.11m01194] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 06/22/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND In the last decade, a significant incidence of depression in the younger population has been observed. Bright light therapy, an effective therapeutic option for depressed adults, could also provide safe, economical, and effective rapid recovery in adolescents. METHOD The randomized trial included 28 inpatients (18 females and 10 males) between 14 and 17 years old with depressive complaints. The study was conducted between February and December of 2010 in Rodewisch, Germany. Half of the patients (n = 14) first received placebo (50 lux) 1 hour a day in the morning from 9:00 am to 10:00 am for 1 week and then received bright light therapy (2,500 lux) for 1 week in the morning from 9:00 am to 10:00 am. The other half (n = 14) first received bright light therapy and then received placebo. Patients were encouraged to continue ongoing treatment (fluoxetine 20 mg/day and 2 sessions of psychotherapy/week) because there were no changes in medication/dosage and psychotherapy since 1 month before the 4-week study period. For assessment of depressive symptoms, the Beck Depression Inventory (BDI) was administered 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, and on the day after and 1 week after bright light treatment. Saliva samples of melatonin and cortisol were collected at 8:00 am and 8:00 pm 1 week before and 1 day before placebo treatment, on the day between placebo and bright light treatment, on the day after bright light treatment, and 1 week after bright light treatment and were assayed for melatonin and cortisol to observe any change in circadian timing. RESULTS The BDI scores improved significantly (P = .015). The assays of saliva showed significant differences between treatment and placebo for evening melatonin (P = .040). No significant adverse reactions were observed. CONCLUSIONS Antidepressant response to bright light treatment in this age group was statistically superior to placebo. TRIAL REGISTRATION World Health Organization International Clinical Trials Registry Platform identifier: DRKS00003309.
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Affiliation(s)
- Helmut Niederhofer
- Child and Adolescent Psychiatry, Saechsisches Krankenhaus, Rodewisch (Dr Niederhofer); and Department of Child and Adolescent Psychiatry, University of Leipzig, Leipzig (Dr von Klitzing), Germany
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Srinivasan V, Singh J, Pandi-Perumal SR, Brown GM, Spence DW, Cardinali DP. Jet lag, circadian rhythm sleep disturbances, and depression: the role of melatonin and its analogs. Adv Ther 2010; 27:796-813. [PMID: 20827520 DOI: 10.1007/s12325-010-0065-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Indexed: 12/12/2022]
Abstract
Traveling through several time zones results in a constellation of symptoms known as jet lag. These include reduced alertness, daytime fatigue, loss of appetite, reduced cognitive skills, and disruption of the sleep/wake cycle. In susceptible air travel passengers, jet lag may exacerbate affective illness and result in psychiatric morbidity. Dysregulation of circadian rhythms and melatonin secretion represent the common underlying factor in jet lag and other circadian disorders. Recent studies have established the effectiveness of strategically timed administration of melatonin and appropriate timed exposure to environmental schedules including light in counteracting the dysregulation (chronobiologic actions). With the introduction of melatonergic agonists such as ramelteon and tasimelteon, which have both a stronger affinity for MT₁ and MT₂ melatonin receptors and a longer half-life, new therapeutic options now exist for treating the sleep disturbances associated with jet lag. The melatonin analogs are unique inasmuch as they can also enhance daytime alertness. The recently introduced melatonergic antidepressant agomelatine, which has established its supremacy over other antidepressants in having a significant chronobiologic activity, represents a good choice for treating depressive symptoms that are associated with jet lag.
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Single-nucleotide polymorphisms and mRNA expression for melatonin synthesis rate-limiting enzyme in recurrent depressive disorder. J Pineal Res 2010; 48:311-7. [PMID: 20433639 DOI: 10.1111/j.1600-079x.2010.00754.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Depressive disorder (DD) is characterised by disturbances in blood melatonin concentration. It is well known that melatonin is involved in the control of circadian rhythms, sleep included. The use of melatonin and its analogues has been found to be effective in depression therapy. Melatonin synthesis is a multistage process, where the last stage is catalysed by acetylserotonin methyltransferase (ASMT), the reported rate-limiting melatonin synthesis enzyme. Taking into account the significance of genetic factors in depression development, the gene for ASMT may become an interesting focus for studies in patients with recurrent DD. The goal of the study was to evaluate two single-nucleotide polymorphisms (SNPs) (rs4446909; rs5989681) of the ASMT gene, as well as mRNA expression for ASMT in recurrent DD-affected patients. We genotyped two polymorphisms in a group of 181 recurrent DD patients and in 149 control subjects. The study was performed using the polymerase chain reaction/restriction fragment length polymorphism method. The distribution of genotypes in both studied SNPs in the ASMT gene differed significantly between DD and healthy subjects. The presence of AA genotype of rs4446909 polymorphism and of GG genotype of rs5989681 polymorphism was associated with lower risk for having recurrent DD. In turn, patients with depression were characterised by reduced mRNA expression for ASMT. In addition, ASMT transcript level in both recurrent DD patients and in healthy subjects depended significantly on genotype distributions in both polymorphisms. In conclusion, our results suggest the ASMT gene as a susceptibility gene for recurrent DD.
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Kripke DF, Elliott JA, Youngstedt SD, Parry BL, Hauger RL, Rex KM. Weak evidence of bright light effects on human LH and FSH. J Circadian Rhythms 2010; 8:5. [PMID: 20459826 PMCID: PMC2885316 DOI: 10.1186/1740-3391-8-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Accepted: 05/11/2010] [Indexed: 11/23/2022] Open
Abstract
Background Most mammals are seasonal breeders whose gonads grow to anticipate reproduction in the spring and summer. As day length increases, secretion increases for two gonadotropins, luteinizing hormone (LH) and follicle stimulating hormone (FSH). This response is largely controlled by light. Light effects on gonadotropins are mediated through effects on the suprachiasmatic nucleus and responses of the circadian system. There is some evidence that seasonal breeding in humans is regulated by similar mechanisms, and that light stimulates LH secretion, but primate responses seem complex. Methods To gain further information on effects of bright light on LH and FSH secretion in humans, we analyzed urine samples collected in three experiments conducted for other goals. First, volunteers ages 18-30 years and 60-75 commenced an ultra-short 90-min sleep-wake cycle, during which they were exposed to 3000 lux light for 3 hours at balanced times of day, repeated for 3 days. Urine samples were assayed to explore any LH phase response curve. Second, depressed participants 60-79 years of age were treated with bright light or dim placebo light for 28 days, with measurements of urinary LH and FSH before and after treatment. Third, women of ages 20-45 years with premenstrual dysphoric disorder (PMDD) were treated to one 3-hour exposure of morning light, measuring LH and FSH in urine before and after the treatments. Results Two of the three studies showed significant increases in LH after light treatment, and FSH also tended to increase, but there were no significant contrasts with parallel placebo treatments and no significant time-of-day treatment effects. Conclusions These results gave some support for the hypothesis that bright light may augment LH secretion. Longer-duration studies may be needed to clarify the effects of light on human LH and FSH.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, La Jolla, California 92093, USA.
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Pandi-Perumal SR, Trakht I, Srinivasan V, Spence DW, Poeggeler B, Hardeland R, Cardinali DP. The effect of melatonergic and non-melatonergic antidepressants on sleep: weighing the alternatives. World J Biol Psychiatry 2010; 10:342-54. [PMID: 18609422 DOI: 10.1080/15622970701625600] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In DSM-IV the occurrence of disturbed sleep is one of the principal diagnostic criteria for major depressive disorder (MDD). Further, there is evidence of reciprocity between the two conditions such that, even in the absence of current depressive symptoms, disturbed sleep often predicts their development. The present review discusses the effects of antidepressants on sleep and evaluates the use of the recently developed melatonin agonist-selective serotonin antagonists on sleep and depression. Although many antidepressants such as the tricyclics, monoamine oxidase inhibitors, serotonin-norepinephrine reuptake inhibitors, several serotonin receptor antagonists and selective serotonin reuptake inhibitors (SSRIs) have all been found successful in treating depression, their use is often associated with a disruptive effect on sleep. SSRIs, currently the most widely prescribed of the antidepressants, are well known for their instigation or exacerbation of insomnia. The recently introduced novel melatonin agonist and selective serotonin antagonist antidepressant, agomelatine, which has melatonin MT(1) and MT(2) receptor agonist and 5-HT(2c) antagonist properties, has been useful in treating patients with MDD. Its rapid onset of action and effectiveness in improving the mood of depressed patients has been attributed to its ability to improve sleep quality. These properties underline the use of melatonin analogues as a promising alternative for the treatment of depression.
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Affiliation(s)
- Seithikurippu R Pandi-Perumal
- Division of Clinical Pharmacology and Experimental Therapeutics, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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Pandi-Perumal SR, Moscovitch A, Srinivasan V, Spence DW, Cardinali DP, Brown GM. Bidirectional communication between sleep and circadian rhythms and its implications for depression: Lessons from agomelatine. Prog Neurobiol 2009; 88:264-71. [DOI: 10.1016/j.pneurobio.2009.04.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Revised: 03/09/2009] [Accepted: 04/29/2009] [Indexed: 02/04/2023]
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Pathophysiology of depression: role of sleep and the melatonergic system. Psychiatry Res 2009; 165:201-14. [PMID: 19181389 DOI: 10.1016/j.psychres.2007.11.020] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 09/13/2007] [Accepted: 11/12/2007] [Indexed: 11/23/2022]
Abstract
Profound disturbances in sleep architecture occur in major depressive disorders (MDD) and in bipolar affective disorders. Reduction in slow wave sleep, decreased latency of rapid eye movement (REM) sleep and abnormalities in the timing of REM/non-REM sleep cycles have all been documented in patients with MDD. It is thus evident that an understanding of the basic mechanisms of sleep regulation is essential for an analysis of the pathophysiology of depressive disorders. The suprachiasmatic nucleus (SCN), which functions as the body's master circadian clock, plays a major role in the regulation of the sleep/wakefulness rhythm and interacts actively with the homeostatic processes that regulate sleep. The control of melatonin secretion by the SCN, the occurrence of high concentrations of melatonin receptors in the SCN, and the suppression of electrical activity in the SCN by melatonin all underscore the major influence which this neurohormone has in regulating the sleep/wake cycle. The transition from wakefulness to high sleep propensity is associated with the nocturnal rise of endogenous melatonin secretion. Various lines of evidence show that depressed patients exhibit disturbances in both the amplitude and shape of the melatonin secretion rhythm and that melatonin can improve the quality of sleep in these patients. The choice of a suitable antidepressant that improves sleep quality is thus important while treating a depressive disorder. The novel antidepressant agomelatine, which combines the properties of a 5-HT(2C) antagonist and a melatonergic MT(1)/MT(2) receptor agonist, has been found very effective for resetting the disturbed sleep/wake cycle and in improving the clinical status of MDD. Agomelatine has also been found useful in treating sleep problems and improving the clinical status of patients suffering from seasonal affective disorder.
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Parry BL, Meliska CJ, Martínez LF, López AM, Sorenson DL, Hauger RL, Elliott JA. Late, but not early, wake therapy reduces morning plasma melatonin: relationship to mood in Premenstrual Dysphoric Disorder. Psychiatry Res 2008; 161:76-86. [PMID: 18789826 PMCID: PMC3038844 DOI: 10.1016/j.psychres.2007.11.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Revised: 10/11/2007] [Accepted: 11/11/2007] [Indexed: 11/30/2022]
Abstract
Wake therapy improves mood in Premenstrual Dysphoric Disorder (PMDD), a depressive disorder in DSM-IV. We tested the hypothesis that the therapeutic effect of wake therapy in PMDD is mediated by altering sleep phase with melatonin secretion. We measured plasma melatonin every 30 min (18:00-09:00 h) in 19 PMDD and 18 normal control (NC) women during mid-follicular (MF) and late luteal (LL) menstrual cycle phases, and during LL interventions with early wake therapy (EWT) (sleep 03:00-07:00 h)(control condition) vs. late wake therapy (LWT) (sleep 21:00-01:00 h)(active condition). Melatonin offset was delayed and duration was longer in the symptomatic LL vs. asymptomatic MF phase in both NC and PMDD subjects. LWT, but not EWT, advanced offset and shortened duration vs. the LL baseline, although they improved mood equally. Later baseline LL morning melatonin offset was associated with more depressed mood in PMDD patients, and longer melatonin duration in the MF phase predicted greater mood improvement following LWT. That LWT, but not EWT, advanced melatonin offset and shortened duration while they were equally effective in improving mood suggests that decreasing morning melatonin secretion is not necessary for the therapeutic effects of wake therapy in PMDD.
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Affiliation(s)
- Barbara L. Parry
- Department of Psychiatry, University of California, San Diego,San Diego Veterans Affairs Healthcare System,Address correspondence to: Barbara L. Parry, M.D., Professor of Psychiatry, University of California, San Diego, Mailcode 0804, 9500 Gilman Dr., La Jolla, CA 92093-0804, Phone: 619 543-5592, Fax: 619 543-7519,
| | | | | | - Ana M. López
- Department of Psychiatry, University of California, San Diego
| | | | - Richard L. Hauger
- Department of Psychiatry, University of California, San Diego,San Diego Veterans Affairs Healthcare System
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Parry BL, Meliska CJ, Sorenson DL, López AM, Martínez LF, Nowakowski S, Hauger RL, Elliott JA. Increased melatonin and delayed offset in menopausal depression: role of years past menopause, follicle-stimulating hormone, sleep end time, and body mass index. J Clin Endocrinol Metab 2008; 93:54-60. [PMID: 18042653 PMCID: PMC2190736 DOI: 10.1210/jc.2006-2853] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The constellation of endocrine patterns accompanying menopausal depression remains incompletely characterized. OBJECTIVE Our objective was to test the hypothesis that the amplitude or phase (timing) of melatonin circadian rhythms differs in menopausal depressed patients (DP) vs. normal controls women (NC). DESIGN We measured plasma melatonin every 30 min from 1800-1000 h in dim light (<30 lux) or dark, serum gonadotropins and steroids (1800 and 0600 h), and mood (Hamilton and Beck depression ratings). SETTING The study was conducted at a university hospital. PARTICIPANTS AND SETTING Twenty-nine (18 NC, 11 DP) peri- or postmenopausal women participated. MAIN OUTCOME MEASURES We measured plasma melatonin (onset, offset, synthesis offset, duration, peak concentration, and area under the curve) and mood. RESULTS Multi- and univariate analyses of covariance showed that melatonin offset time was delayed (P = 0.045) and plasma melatonin was elevated in DP compared with NC (P = 0.044) across time intervals. Multiple regression analyses showed that years past menopause predicted melatonin duration and that melatonin duration, body mass index, years past menopause, FSH level, and sleep end time were significant predictors of baseline Hamilton (P = 0.0003) and Beck (P = 0.00004) depression scores. CONCLUSIONS Increased melatonin secretion that is phase delayed into the morning characterized menopausal DP vs. NC. Years past menopause, FSH, sleep end time, and body mass index may modulate effects of altered melatonin secretion in menopausal depression.
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Affiliation(s)
- Barbara L Parry
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093-0804, USA.
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Park DH, Kripke DF, Louis GJ, Elliott JA, Klauber MR, Rex KM, Tuunainen A, Langer RD. Self-reported sleep latency in postmenopausal women. J Korean Med Sci 2007; 22:1007-14. [PMID: 18162715 PMCID: PMC2694625 DOI: 10.3346/jkms.2007.22.6.1007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to access how self-reported sleep latency (SRSL) was affected by sleep habits, mood, and circadian rhythm in postmenopausal women. Subjects (n=384, 67.9+/-7.7 yr) completed sleep and mood questionnaires, sleep log and actigraphic data. The major urinary melatonin metabolite (6-sulphatoxymelatonin, aMT6s) was assayed in fractional urine specimens for two 24-hr intervals. Although SRSL (26.5+/-24.4 min) and actigraphic sleep latency (ASL; 27.8+/-20.0 min) were correlated (r(s)=0.361, p<0.001), the short SRSLs tended to be underestimated whereas the long SRSLs tended to be overestimated as compared to ASL. SRSL was positively correlated with the scales of insomnia, mood and hot flash, hypertension, use of anti-hypertensive drugs and the acrophase and the offset of aMT6s. SRSL was negatively correlated with the global assessment of functioning scale in DSM-IV (GAF scale), and light exposure and wrist activity. Multiple linear regression analysis showed that the best-fit model to predict SRSL was light exposure, GAF scale, and use of anti-hypertensive drugs. SRSL may be determined by psychophysiological factors as well as circadian rhythm function. Therapeutic approaches suggested for trouble falling asleep might include increased daylight exposure, improvements in general health, and modification of anti-hypertensive pharmacotherapy.
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Affiliation(s)
- Doo Heum Park
- Department of Psychiatry, Konkuk University School of Medicine, Seoul, Korea.
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Ljubicić D, Stipcević T, Pivac N, Jakovljević M, Mück-Seler D. The influence of daylight exposure on platelet 5-HT levels in patients with major depression and schizophrenia. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2007; 89:63-9. [PMID: 17937992 DOI: 10.1016/j.jphotobiol.2007.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 09/10/2007] [Accepted: 09/13/2007] [Indexed: 02/07/2023]
Abstract
Platelet serotonin (5-HT) can be used as a limited, peripheral model for the central 5-HT synaptosomes. Altered platelet 5-HT concentrations have been associated with psychiatric disorders like depression and schizophrenia. The aim of the present study was to compare platelet 5-HT concentrations during long, medium and short period of natural daylight exposure in a large number of medication-free male and female schizophrenic and depressed patients and sex-matched healthy controls. Platelet 5-HT concentration was determined spectrofluorimetrically in 240 (97 female, 143 male) schizophrenic and 258 (153 female, 105 male) nonpsychotic, nonsuicidal depressed medication-free patients and 328 (149 women, 179 men) healthy subjects during periods with short (<12), long (>12) and medium (average 12) hours of the natural daylight. Platelet 5-HT concentration was significantly lower in women compared to men in all groups. Healthy male subjects had significantly higher (p=0.011) platelet 5-HT concentrations during long compared to medium period. There were no significant differences (p>0.05) in platelet 5-HT concentration between different periods in healthy women. The significant increase in platelet 5-HT values were found in female (p=0.01) and male (p=0.029) depressed patients during long compared to short period. There were no significant associations between platelet 5-HT concentrations and different periods in both male and female schizophrenic patients. The results indicate the sex-related differences in the serotonergic system. The alterations of platelet 5-HT concentrations, observed across period with different durations of daylight exposure, point to a direct or indirect effect of light on peripheral 5-HT system that could be related to different sensitivity of the pineal gland to light and/or melatonin influence on 5-HT metabolism.
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Affiliation(s)
- Dulijano Ljubicić
- Psychiatric Clinic, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Kripke DF, Elliott JA, Youngstedt SD, Rex KM. Circadian phase response curves to light in older and young women and men. J Circadian Rhythms 2007; 5:4. [PMID: 17623102 PMCID: PMC1988787 DOI: 10.1186/1740-3391-5-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 07/10/2007] [Indexed: 11/10/2022] Open
Abstract
Background The phase of a circadian rhythm reflects where the peak and the trough occur, for example, the peak and trough of performance within the 24 h. Light exposure can shift this phase. More extensive knowledge of the human circadian phase response to light is needed to guide light treatment for shiftworkers, air travelers, and people with circadian rhythm phase disorders. This study tested the hypotheses that older adults have absent or weaker phase-shift responses to light (3000 lux), and that women's responses might differ from those of men. Methods After preliminary health screening and home actigraphic recording baselines, 50 young adults (ages 18–31 years) and 56 older adults (ages 59–75 years) remained in light-controlled laboratory surroundings for 4.7 to 5.6 days, while experiencing a 90-min ultra-short sleep-wake cycle. Following at least 30 h in-lab baseline, over the next 51 h, participants were given 3 treatments with 3000 lux white light, each treatment for 3 h, centered at one of 8 clock times. The circadian rhythms of urinary aMT6s (a melatonin metabolite), free cortisol, oral temperature, and wrist activity were assessed at baseline and after treatment. Results Light (3000 lux for 3 h on 3 days) induced maximal phase shifts of about 3 h. Phase shifts did not differ significantly in amplitude among older and young groups or among women and men. At home and at baseline, compared to the young, the older adults were significantly phase-advanced in sleep, cortisol, and aMT6s onset, but not advanced in aMT6s acrophase or the temperature rhythm. The inflection from delays to advances was approximately 1.8 h earlier among older compared to young participants in reference to their aMT6s rhythm peaks, and it was earlier in clock time. Conclusion In these experimental conditions, 3000 lux light could shift the phase of circadian rhythms to about the same extent among older and young adults, but the optimal light timing for phase shifting differed. For an interval near 4 PM, bright light produced only negligible phase shifts for either age group.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry and Sam and Rose Stein Institute on Aging, University of California, San Diego #0667, La Jolla, California 92093-0667, USA
| | - Jeffrey A Elliott
- Department of Psychiatry and Sam and Rose Stein Institute on Aging, University of California, San Diego #0667, La Jolla, California 92093-0667, USA
| | - Shawn D Youngstedt
- Department of Exercise Science, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA and Dorn VA Medical Center, Columbia, SC 29209, USA
| | - Katharine M Rex
- Department of Psychiatry and Sam and Rose Stein Institute on Aging, University of California, San Diego #0667, La Jolla, California 92093-0667, USA
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Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, Parry B, Cardinali DP. Melatonin in mood disorders. World J Biol Psychiatry 2006; 7:138-51. [PMID: 16861139 DOI: 10.1080/15622970600571822] [Citation(s) in RCA: 165] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The cyclic nature of depressive illness, the diurnal variations in its symptomatology and the existence of disturbed sleep-wake and core body temperature rhythms, all suggest that dysfunction of the circadian time keeping system may underlie the pathophysiology of depression. As a rhythm-regulating factor, the study of melatonin in various depressive illnesses has gained attention. Melatonin can be both a 'state marker' and a 'trait marker' of mood disorders. Measurement of melatonin either in saliva or plasma, or of its main metabolite 6-sulfatoxymelatonin in urine, have documented significant alterations in melatonin secretion in depressive patients during the acute phase of illness. Not only the levels but also the timing of melatonin secretion is altered in bipolar affective disorder and in patients with seasonal affective disorder (SAD). A phase delay of melatonin secretion takes place in SAD, as well as changes in the onset, duration and offset of melatonin secretion. Bright light treatment, that suppresses melatonin production, is effective in treating bipolar affective disorder and SAD, winter type. This review discusses the role of melatonin in the pathophysiology of bipolar disorder and SAD.
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Affiliation(s)
- Venkataramanujan Srinivasan
- Department of Physiology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan
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Parry BL, Fernando Martínez L, Maurer EL, López AM, Sorenson D, Meliska CJ. Sleep, rhythms and women's mood. Part II. Menopause. Sleep Med Rev 2006; 10:197-208. [PMID: 16618548 DOI: 10.1016/j.smrv.2005.09.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review summarizes studies of sleep and other biological rhythms in menopausal women with major depression compared with healthy control subjects. Where feasible, we focused on studies in women who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for a major depressive episode (MDE) compared with matched normal control subjects and the Staging System for Reproductive Aging in Women (STRAW) criteria. The aim was to review supporting evidence for the hypothesis that a disruption of the normal temporal relationship between sleep and other biological rhythms, such as melatonin, cortisol, thyroid stimulating hormone (TSH) or prolactin, occur during the menopausal transition. As a result, depressive disorders occur in predisposed women. Treatment strategies, designed to correct these altered phase (timing) or amplitude abnormalities, thereby improve mood. Although there may be some common features to menopausal depression compared with other depressive disorders related to the reproductive cycle (e.g. premenstrual dysphoric disorder or postpartum major depression), such as increased morning melatonin secretion, a specific profile of sleep and biological rhythms may distinguish healthy from depressed women during menopause. Further work is needed to characterize more fully the particular abnormalities associated with well-defined menopausal depression in order to develop treatment strategies targeted more specifically to pathogenesis.
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Affiliation(s)
- Barbara L Parry
- Department of Psychiatry 0804, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0804, USA.
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Jean-Louis G, Kripke DF, Elliott JA, Zizi F, Wolintz AH, Lazzaro DR. Daily illumination exposure and melatonin: influence of ophthalmic dysfunction and sleep duration. J Circadian Rhythms 2005; 3:13. [PMID: 16321164 PMCID: PMC1325258 DOI: 10.1186/1740-3391-3-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 12/01/2005] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ocular pathology lessens light's efficacy to maintain optimal circadian entrainment. We examined whether ophthalmic dysfunction explains unique variance in melatonin excretion of older adults over and above the variance explained by daily illumination, medical, and sociodemographic factors. We also examined whether ophthalmic dysfunction influences relationships between ambient illumination and melatonin. METHODS Thirty older adults (mean age = 69 years; Blacks = 42% and Whites = 58%) of both genders participated in the study. Demographic and health data were collected at baseline. Participants underwent eye exams at SUNY Downstate Medical Center, wore an actigraph to monitor illumination and sleep, and collected urine specimens to estimate aMT6s concentrations. RESULTS Hierarchical regression analysis showed that illumination factors explained 29% of the variance in aMT6s mesor. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 10%, 2%, and 2%, respectively. Illumination factors explained 19% of the variance in aMT6s acrophase. The proportion of variance explained by ophthalmic factors, sleep duration, and race was 11%; 17%; and 2%, respectively. Controlling for sleep duration and race reduced the correlations between illumination and melatonin, whereas controlling for ophthalmic factors did not. CONCLUSION Ophthalmic exams showed that elevated intraocular pressure and large cup-to-disk ratios were independently associated with earlier melatonin timing. Lower illumination exposure also had independent associations with earlier melatonin timing. Conceivably, ophthalmic and illumination factors might have an additive effect on the timing of melatonin excretion, which in turn might predispose individuals to experience early morning awakenings.
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Affiliation(s)
- Girardin Jean-Louis
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, New York, NY
- Brooklyn Research Foundation on Minority Health, KJMC, New York, NY
- Department of Psychiatry, Maimonides Medical Center, New York, NY
| | - Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, CA
| | | | - Ferdinand Zizi
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, New York, NY
- Brooklyn Research Foundation on Minority Health, KJMC, New York, NY
| | - Arthur H Wolintz
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, New York, NY
- Brooklyn Research Foundation on Minority Health, KJMC, New York, NY
| | - Douglas R Lazzaro
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, New York, NY
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41
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Loving RT, Kripke DF, Elliott JA, Knickerbocker NC, Grandner MA. Bright light treatment of depression for older adults [ISRCTN55452501]. BMC Psychiatry 2005; 5:41. [PMID: 16283925 PMCID: PMC1298312 DOI: 10.1186/1471-244x-5-41] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 11/09/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of insomnia and depression in the elder population is significant. It is hoped that use of light treatment for this group could provide safe, economic, and effective rapid recovery. METHODS In this home-based trial we treated depressed elderly subjects with bright white (8,500 Lux) and dim red (<10 Lux) light for one hour a day at three different times (morning, mid-wake and evening). A placebo response washout was used for the first week. Wake treatment was conducted prior to the initiation of treatment, to explore antidepressant response and the interaction with light treatment. Urine and saliva samples were collected during a 24-hour period both before and after treatment and assayed for aMT6s and melatonin respectively to observe any change in circadian timing. Subjects wore a wrist monitor to record light exposure and wrist activity. Daily log sheets and weekly mood (GDS) and physical symptom (SAFTEE) scales were administered. Each subject was given a SCID interview and each completed a mood questionnaire (SIGH-SAD-SR) before and after treatment. Also, Hamilton Depression Rating (SIGH-SAD version) interviews were conducted by a researcher who was blind to the treatment condition. A control group of healthy, age-matched, volunteers was studied for one day to obtain baseline data for comparison of actigraphy and hormone levels. RESULTS Eighty-one volunteers, between 60 and 79 years old, completed the study. Both treatment and placebo groups experienced mood improvement. Average GDS scores improved 5 points, the Hamilton Depression Rating Scale (HDRS) 17 scores (extracted from the self-rated SIGH-SAD-SR) improved 6 points. There were no significant treatment effects or time-by-treatment interactions. No significant adverse reactions were observed in either treatment group. The assays of urine and saliva showed no significant differences between the treatment and placebo groups. The healthy control group was active earlier and slept earlier but received less light than the depressed group at baseline. CONCLUSION Antidepressant response to bright light treatment in this age group was not statistically superior to placebo. Both treatment and placebo groups experienced a clinically significant overall improvement of 16%.
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Affiliation(s)
- Richard T Loving
- Department of Psychiatry, University of California, San Diego, USA
| | - Daniel F Kripke
- Department of Psychiatry, University of California, San Diego, USA
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42
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Kripke DF, Youngstedt SD, Elliott JA, Tuunainen A, Rex KM, Hauger RL, Marler MR. Circadian phase in adults of contrasting ages. Chronobiol Int 2005; 22:695-709. [PMID: 16147900 DOI: 10.1080/07420520500180439] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is evidence that aging may impair phase-shifting responses to light synchronizers, which could lead to disturbed or malsynchronized circadian rhythms. To explore this hypothesis, 62 elder participants (age, 58 to 84 years) and 25 young adults (age, 19 to 40 years) were studied, first with baseline 1-wk wrist actigraphy at home and then by 72 h in-laboratory study using an ultra-short sleep-wake cycle. Subjects were awake for 60 minutes in 50 lux followed by 30 minutes of darkness for sleep. Saliva samples were collected for melatonin, and urine samples were collected for aMT6s (a urinary metabolite of melatonin) and free cortisol every 90 minutes. Oral temperatures were also measured every 90 minutes. The timing of the circadian rhythms was not significantly more variable among the elders. The times of lights-out and wake-up at home and urinary free cortisol occurred earlier among elders, but the acrophases (cosinor analysis-derived peak time) of the circadian rhythm of salivary melatonin, urinary aMT6s, and oral temperature were not significantly phase-advanced among elders. The estimated duration of melatonin secretion was 9.9 h among elders and 8.4 h among young adults (p < 0.025), though the estimated half-life of blood melatonin was shorter among elders (p < 0.025), and young adults had higher saliva melatonin and urinary aMT6s levels. In summary, there was no evidence for circadian desynchronization associated with aging, but there was evidence of some rearrangement of the internal phase-angles among the studied circadian rhythms.
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Affiliation(s)
- D F Kripke
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-0667, USA.
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43
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Abstracts of the 11th World Congress on the Menopause. Climacteric 2005; 8 Suppl 2:1-238. [PMID: 16183612 DOI: 10.1080/13697130512331390481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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44
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Pandi-Perumal SR, Zisapel N, Srinivasan V, Cardinali DP. Melatonin and sleep in aging population. Exp Gerontol 2005; 40:911-25. [PMID: 16183237 DOI: 10.1016/j.exger.2005.08.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2005] [Revised: 08/04/2005] [Accepted: 08/23/2005] [Indexed: 11/23/2022]
Abstract
The neurohormone melatonin is released from the pineal gland in close association with the light-dark cycle. There is a temporal relationship between the nocturnal rise in melatonin secretion and the 'opening of the sleep gate' at night. This association, as well as the sleep promoting effect of exogenous melatonin, implicates the pineal product in the physiological regulation of sleep. Aging is associated with a significant reduction in sleep continuity and quality. A decreased production of melatonin with age is documented in a majority of studies. Diminished nocturnal melatonin secretion with severe disturbances in sleep/wake rhythm has been consistently reported in Alzheimer's disease (AD). A recent survey on the effects of melatonin in sleep disturbances, including all age groups, failed to document significant and clinically meaningful effects of exogenous melatonin on sleep quality, efficiency and latency. However, in clinical trials involving elderly insomniacs and AD patients suffering from sleep disturbances exogenous melatonin has repeatedly been found to be effective in improving sleep. The results indicate that exogenous melatonin is more effective to promote sleep in the presence of a diminished production of endogenous melatonin. A MT1/MT2 receptor analog of melatonin (ramelteon) has recently been introduced as a new type of hypnotics with no evidence of abuse or dependence.
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Affiliation(s)
- S R Pandi-Perumal
- Comprehensive Center for Sleep Medicine; Department of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, 1176 - 5th Avenue, 6th Floor, NY 10029, USA
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45
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Sumaya IC, Masana MI, Dubocovich ML. The antidepressant-like effect of the melatonin receptor ligand luzindole in mice during forced swimming requires expression of MT2 but not MT1 melatonin receptors. J Pineal Res 2005; 39:170-7. [PMID: 16098095 DOI: 10.1111/j.1600-079x.2005.00233.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We previously reported an antidepressant-like effect in C3H/HeN mice during the forced swimming test (FST) following treatment with the MT1/MT2 melatonin receptor ligand, luzindole. This study investigated the role melatonin receptors (MT1 and/or MT2) may play in the effect of luzindole in the FST using C3H/HeN mice with a genetic deletion of either MT1 (MT1KO) or MT2 (MT2KO) melatonin receptors. In the light phase (ZT 9-11), luzindole (30 mg/kg, i.p.) significantly decreased immobility during swimming in both wild type (WT) (135.6 +/- 25.3 s, n = 7) and MT(1)KO (132.6 +/- 13.3 s, n = 8) as compared with vehicle-treated mice (WT: 207.1 +/- 6.0 s, n = 7; MT1KO: 209.5 +/- 6.2 s, n = 8) (P < 0.001). In the dark phase (ZT 20-22), luzindole also decreased time of immobility in both WT (89.5 +/- 13.9 s, n = 8) and MT1KO (66.5 +/- 6.4 s, n = 8) mice as compared with the vehicle treated (WT: 193.8 +/- 3.5, n = 6; MT1KO: 176.6 +/- 6.2 s, n = 8) (P < 0.001). Genetic disruption of the MT1 gene did not alter the diurnal rhythm of serum melatonin in MT1KO mice (ZT 9-11: 1.3 +/- 0.6 pg/mL, n = 7; ZT 20-22: 10.3 +/- 1.1 pg/mL, n = 8) as compared with WT (ZT 9-11: 1.4 +/- 0.7 pg/mL; ZT 20-22: 10.6 pg/mL). Swimming did not alter the serum melatonin diurnal rhythm in WT and MT1KO mice. Decreases in immobility of WT and MT1KO mice by luzindole treatment were not affected by gender or age (3 months versus 8 months). In contrast, luzindole did not decrease immobility during the FST in MT2KO mice. We conclude that the antidepressant-like effect of luzindole may be mediated through blockade of MT2 rather than MT1 melatonin receptors.
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MESH Headings
- Animals
- Antidepressive Agents/pharmacology
- Ligands
- Melatonin/blood
- Mice
- Mice, Inbred C3H
- Mice, Knockout
- Receptor, Melatonin, MT1/biosynthesis
- Receptor, Melatonin, MT1/genetics
- Receptor, Melatonin, MT1/physiology
- Receptor, Melatonin, MT2/biosynthesis
- Receptor, Melatonin, MT2/genetics
- Receptor, Melatonin, MT2/physiology
- Swimming/physiology
- Tryptamines/metabolism
- Tryptamines/pharmacology
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Affiliation(s)
- I C Sumaya
- Department of Molecular Pharmacology and Biological Chemistry, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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46
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Jean-Louis G, Kripke D, Cohen C, Zizi F, Wolintz A. Associations of ambient illumination with mood: contribution of ophthalmic dysfunctions. Physiol Behav 2005; 84:479-87. [PMID: 15763587 DOI: 10.1016/j.physbeh.2005.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 12/29/2004] [Accepted: 01/24/2005] [Indexed: 11/18/2022]
Abstract
Evidence suggests that ocular pathology could reduce light-stimulated neuronal signaling to the suprachiasmatic nuclei. This study investigated associations of ambient illumination with moods, while considering the contribution of ophthalmic dysfunctions. Seventy Black (59%) and White (41%) Americans participated in the study. Their average age was 68.27+/-5.97 years; 73% were women. Baseline data included: physical health, mood, and sociodemographics. Ophthalmic factors including visual acuity, visual field defects, intraocular pressure, vertical and horizontal cup-to-disk ratios, and nerve-fiber-layer thickness were assessed at SUNY Downstate's eye clinic. The following week, participants wore the Actiwatch-L at home to monitor ambient illumination and sleep. Cosine analyses were performed on the logarithm of measured illumination, yielding the mesor and acrophase of daily illumination exposure. Sleep was estimated with an automatic scoring algorithm. Of the sample, 25% reported visual impairment and 85% reported good to excellent health; 27% were visually impaired according to American criteria. Partial correlation analyses showed an inverse correlation of daily illumination levels to depressed mood [r(p)=-0.33, P<0.05], when age, sex, ethnicity, income, BMI, diabetes, hypertension, respiratory disease, and habitual sleep duration were controlled. With further control for ophthalmic factors, the magnitude and significance of the correlation diminished [r(p)=-0.26, NS]. Individuals receiving daily illumination later in the day reported more depressed moods [r(p)=0.36, P<0.01]; of note, this correlation was not significant after control for the covariates [r(p)=0.18, NS]. Regression analysis indicated that the ophthalmic factors explained 13% of the variance in depression. Our results show that both the level and timing of ambient illumination are associated with mood. Furthermore, they suggest that visual impairment has a mediating effect on the associations of ambient illumination with depression, supporting the notion that ocular pathology lessens the efficacy of daily illumination in promoting positive moods.
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Affiliation(s)
- G Jean-Louis
- Department of Psychiatry and Ophthalmology, SUNY Downstate Medical Center, 450 Clarkson Avenue (P.O. Box 58), Brooklyn, NY 11203-2098, United States.
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Palmer CR, Kripke DF, Savage HC, Cindrich LA, Loving RT, Elliott JA. Efficacy of enhanced evening light for advanced sleep phase syndrome. Behav Sleep Med 2005; 1:213-26. [PMID: 15602801 DOI: 10.1207/s15402010bsm0104_4] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study tested whether a newly designed enhanced evening light therapy was well tolerated and effective in relieving symptoms of Advanced, Sleep Phase Syndrome (ASPS). Participants with self-reported ASPS symptoms were 47 older adults (21 men and 26 women, age 60-86). After baseline, participants underwent 28 consecutive days of either dim or enhanced intensity light treatment for 2-3 hr in the evening. Enhanced evening light (approximately 265 lux) exposure was no more effective than a placebo dim light (approximately 2 lux) at alleviating advanced sleep phase as measured by actigraphically recorded sleep and urinary 6-sulphatoxymelatonin (aMT6s) excretion patterns. Participants receiving the enhanced light reported subjective benefit and a significant delay in sleep onset as compared to the placebo. Although compliance was good and the new enhanced evening light therapy design was well tolerated, the benefits were statistically equivocal.
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Affiliation(s)
- Christopher R Palmer
- Department of Psychiatry, Sam and Rose Stein Institute for Research on Aging,University of California, San Diego, La Jolla 92093-0667, USA
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48
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Yoon IY, Kripke DF, Elliott JA, Langer RD. Naps and circadian rhythms in postmenopausal women. J Gerontol A Biol Sci Med Sci 2004; 59:844-8. [PMID: 15345736 DOI: 10.1093/gerona/59.8.m844] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Napping patterns and relationships among naps, circadian rhythms, and nocturnal sleep were evaluated in postmenopausal women. Naps and nocturnal sleep were compared between depressed women and healthy volunteers. METHODS The study included 436 postmenopausal women between the ages of 50 and 81 years. Psychiatric interviews were conducted using the Structured Clinical Interview for DSM-IV Axis I Disorders. Each participant wore a wrist-activity monitor and kept a daily sleep log at home for 1 week. The major urinary melatonin metabolite (6-sulfatoxymelatonin [aMT6s]) was measured for two 24-hour periods at home. RESULTS There was no significant difference in naps and nocturnal sleep patterns between depressed participants (n = 30) and those with no history of mental disorder (n = 222). Three peaks occurred in the timing of napping: approximately 1 hour before bedtime, 8 to 9 hours after wake-up time, and 2 hours after waking, in descending order of magnitude. Significant inverse correlations were observed between evening nap duration and both wake-up time and aMT6s acrophase. The onset time of aMT6s excretion was advanced by 32 minutes in evening nappers. CONCLUSIONS Evening napping, a characteristic of these postmenopausal women, may be related to an advance of circadian rhythms in this age group. Relationships between evening napping and earlier wake-up time may be a common manifestation of advanced circadian rhythms or may be a homeostatic effect.
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Affiliation(s)
- In-Young Yoon
- Department of Psychiatry, 0667, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0667, USA
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Youngstedt SD, Leung A, Kripke DF, Langer RD. Association of morning illumination and window covering with mood and sleep among post-menopausal women. Sleep Biol Rhythms 2004; 2:174-183. [PMID: 25374475 DOI: 10.1111/j.1479-8425.2004.00139.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The antidepressant and sleep-promoting effects of light exposure might be useful for treating age-related mood and sleep disorders. In view of recent evidence suggesting beneficial effects of morning light, this study examined the associations of mood and sleep with morning light exposure, 24 h environmental illumination, and the degree to which the volunteers' bedroom windows were covered in the morning. We examined 459 postmenopausal women participating an ancillary study of the Women's Health Initiative conducted at the University of California, San Diego Clinical Center, San Diego, CA, USA. At baseline, volunteers completed a 4-week sleep-recall questionnaire. Volunteers were then assessed for 5-7 days in their home environments with actigraphic wrist monitors. During home recording, self-reported mood was assessed. Morning illumination during the first 4 h after arising, 24-h illumination mesor (cosine-fitted mean), and illumination acrophase (cosine-fitted peak time) were calculated. Sleep was scored each night using validated wrist actigraphic methods. A sleep diary was completed each morning. During two 24-h periods, urine was collected approximately every 2 h during wakefulness and following any voidings during the sleep period. Cosine-fitting established the acrophase of urinary 6-sulfatoxymelatonin (aMT6s) excretion. Morning illumination and 24-h illumination were modestly associated with better mood and sleep. Associations of light with mood and sleep were consistently greater for subjects whose body clocks were delayed relative to the group median. Less morning window covering in the subjects' bedrooms was associated with more morning light and less depressed mood. The results suggest that both morning and 24-h light exposure may be beneficial for older adults.
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Affiliation(s)
- Shawn D Youngstedt
- Department of Exercise Science, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC ; Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - Amy Leung
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - Daniel F Kripke
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - Robert D Langer
- Department of Family and Preventive Medicine, University of California, San Diego, CA, USA
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50
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Kripke DF, Jean-Louis G, Elliott JA, Klauber MR, Rex KM, Tuunainen A, Langer RD. Ethnicity, sleep, mood, and illumination in postmenopausal women. BMC Psychiatry 2004; 4:8. [PMID: 15070419 PMCID: PMC400740 DOI: 10.1186/1471-244x-4-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2003] [Accepted: 04/07/2004] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study examined how ethnic differences in sleep and depression were related to environmental illumination and circadian rhythms. METHODS In an ancillary study to the Women's Health Initiative, 459 postmenopausal women were recorded for one week in their homes, using wrist monitors. Sleep and illumination experience were estimated. Depression was self-rated with a brief adjective check list. Affective diagnoses were made using the SCID interview. Sleep disordered breathing was monitored with home pulse oximetry. RESULTS Hispanic and African-American women slept less than European-American women, according to both objective recordings and their own sleep logs. Non-European-American women had more blood oxygen desaturations during sleep, which accounted for 26% of sleep duration variance associated with ethnicity. Hispanic women were much more depressed. Hispanic, African-American and Native-American women experienced less daily illumination. Less daily illumination experience was associated with poorer global functioning, longer but more disturbed sleep, and more depression. CONCLUSIONS Curtailed sleep and poor mood were related to ethnicity. Sleep disordered breathing was a factor in the curtailed sleep of minority women. Less illumination was experienced by non-European-American women, but illumination accounted for little of the contrasts between ethnic groups in sleep and mood. Social factors may be involved.
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Affiliation(s)
- Daniel F Kripke
- Departments of Psychiatry, University of California, San Diego, CA, USA
| | | | - Jeffrey A Elliott
- Departments of Psychiatry, University of California, San Diego, CA, USA
| | - Melville R Klauber
- Family and Preventive Medicine and The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
| | - Katharine M Rex
- Departments of Psychiatry, University of California, San Diego, CA, USA
| | - Arja Tuunainen
- Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Robert D Langer
- Family and Preventive Medicine and The Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, CA, USA
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