Study on the Changes in Circadian Rhythm Before and After Treatment and the Influencing Factors in Patients with Depression

Abstract

Objective

To investigate the circadian rhythms of patients with major depressive disorder (MDD) pre-treatment and post-treatment to analyse possible influencing factors.

Methods

In this study, we recruited 154 patients in the acute phase of MDD from 10 psychiatric centers in the province. The patients were divided into a morning chronotype group (16–41 points), an intermediate chronotype group (42–58 points) and an evening chronotype group (59–86 points), according to the total scores obtained from the morningness–eveningness questionnaire (MEQ). They were treated randomly with antidepressants, either selective serotonin reuptake inhibitors or agomelatine, for 12 weeks and were evaluated using the MEQ, the 17-item Hamilton Depression Rating Scale (HAMD-17), the Hamilton anxiety scale, the Snaith–Hamilton pleasure scale (SHAPS), the multidimensional fatigue inventory (MFI-20) and the Pittsburgh sleep quality index at the baseline and then at 2, 4, 8 and 12 weeks. The results were analysed by Logistic regression analysis and repeated-measures analysis of variance.

Results

The baseline detection rates for the evening, intermediate and morning types were 14.93%, 56.5% and 28.57%, respectively. HAMD-17 scores were significantly lower at weeks 2, 4, 8, and 12 after treatment in patients with different concurrent phenotypes compared with those before treatment (P<0.05). There were significant differences in gender, age, body mass index, whether depression was first-episode, type of medication, baseline-MEQ and baseline-SHAPS in the chronotype change group compared with the post-treatment chronotype unchanged group (p<0.05). Logistic regression analysis showed that medication type (P=0.047), baseline MEQ (P=0.001) and baseline SHAPS (P=0.001) were risk factors for improvement in circadian rhythm after treatment for depression.

Conclusion

Circadian rhythm disturbances can be adjusted to a normal pattern with effective antidepressant therapy. The medication type, baseline MEQ and baseline SHAPS scores were the influencing factors for the recovery of circadian rhythm disorders.

Keywords:

• major depressive disorder
• morningness–eveningness questionnaire
• circadian rhythm
• chronotype
• antidepressant

Abbreviations

MDD, major depressive disorder; MEQ, morningness-eveningness questionnaire; HAMD-17, 17-item Hamilton depression rating scale; MFI-20, multidimensional fatigue inventory; TCAS, treatment of depression are tricyclic antidepressants; MAOIs, monoamine oxidase inhibitors; SSRIs, selective serotonin reuptake inhibitors; CGI-S, clinical global impression severity scale; ALT, alanine aminotransferase; HAMA, Hamilton anxiety scale; SHAPS, Snaith–Hamilton pleasure scale; PSQI, Pittsburgh sleep quality index; AST, aspartate aminotransferase.

Data Sharing Statement

All data generated or analyzed during this study are included in this published article.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of Huzhou Third Municipal Hospital. All patients signed an informed consent form for inclusion in the study.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2018KY789); Nonprofit Applied Research Project of Huzhou Science and Technology Bureau (2017GY50, 2021GYB16).