Circadian depression: A mood disorder phenotype

Joanne S Carpenter; Jacob J Crouse; Elizabeth M Scott; Sharon L Naismith; Chloe Wilson; Jan Scott; Kathleen R Merikangas; Ian B Hickie

doi:10.1016/j.neubiorev.2021.02.045

Circadian depression: A mood disorder phenotype

Neurosci Biobehav Rev. 2021 Jul:126:79-101. doi: 10.1016/j.neubiorev.2021.02.045. Epub 2021 Mar 6.

Authors

Joanne S Carpenter¹, Jacob J Crouse¹, Elizabeth M Scott², Sharon L Naismith³, Chloe Wilson¹, Jan Scott⁴, Kathleen R Merikangas⁵, Ian B Hickie⁶

Affiliations

¹ Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia.
² Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia; School of Medicine, University of Notre Dame, Sydney, Australia.
³ Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia; Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia; School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
⁴ Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia; Academic Psychiatry, Institute of Neuroscience, Newcastle University, UK; Diderot University, Sorbonne City, Paris, France; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
⁵ Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA.
⁶ Youth Mental Health and Technology Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia. Electronic address: ian.hickie@sydney.edu.au.

PMID: 33689801
DOI: 10.1016/j.neubiorev.2021.02.045

Abstract

Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.

Keywords: Bipolar disorder; Circadian rhythms; Depression; Mood disorders; Sleep-wake cycles.

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Bipolar Disorder*
Circadian Rhythm
Depression
Humans
Mood Disorders
Phenotype
Sleep

Grants and funding

Z01 MH002804/ImNIH/Intramural NIH HHS/United States