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Curr Psychiatry Rep. 2009 Dec;11(6):459-65.

Circadian misalignment in mood disturbances.

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  • 1Oregon Health & Science University, 3181 Southwest Sam Jackson Road, Portland, OR 97239, USA.


Recent refinements in methodology allow chronobiological researchers to answer the following questions: is there circadian misalignment in sleep and mood disturbances, and, if so, is it of the phase-advance or phase-delay type? Measurement of the dim light melatonin onset-to-midsleep interval, or phase-angle difference, in sleep and mood disorders should answer these questions. Although the phase-advance hypothesis of affective disorders was formulated three decades ago, recent studies suggest that many, if not all, mood disturbances have a circadian misalignment component of the phase-delay type, operationally defined as a delay in the dim light melatonin onset relative to the sleep/wake cycle. Phase-delayed disorders can be treated with bright light in the morning and/or low-dose melatonin in the afternoon/evening. Phase-advanced disorders can be treated with bright light in the evening and/or low-dose melatonin in the morning.

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