Temporal organization as a therapeutic target

Abstract

Biological functions occur at many different frequencies, and each has its healthy and pathological ranges, patterns, and properties. Physiology, biochemistry, and behavior are not only organized at the morphological level in cells and organs, but separated or coordinated in time for minimal interference and optimal function. One of the most important temporal frameworks is that of the 24-hour day-night cycle, and its change in day length with season. Robust circadian rhythms are important for mental and physical well-being. Though rhythms have been long neglected as irrelevant (in spite of the high prevalence of sleep disorders in nearly every psychiatric illness), we now have tools to document rhythm disruption and, through better understanding of underlying molecular and physiological mechanisms, to develop therapeutic applications. Light as the major synchronizing agent of the biological clock is becoming a treatment option not only for winter depression but other, nonseasonal forms, as well as an adjunct in optimizing sleep-wake cycles, daytime alertness, cognition, and mood in many neuropsychiatric illnesses. Melatonin is the signal of darkness and promotes sleep onset. Manipulation of sleep (wake therapy, phase advance) has yielded the most rapid, nonpharmacological antidepressant effect known, and combinations (with light, medication) provide long-lasting response. Thus, by analogy, new molecules to augment synchronization or mimic changes occuring during night-time wakefulness may yield novel treatments. This issue on biological rhythms contains articles on a variety of different frequencies not included in the usual definition of chronobiology, but which open up interesting approaches to time and illness.