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Review
. 2021 Sep;8(9):813-823.
doi: 10.1016/S2215-0366(21)00034-1.

Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention

Jacob J Crouse  1 , Joanne S Carpenter  2 , Yun Ju C Song  2 , Samuel J Hockey  2 , Sharon L Naismith  3 , Ronald R Grunstein  4 , Elizabeth M Scott  5 , Kathleen R Merikangas  6 , Jan Scott  7 , Ian B Hickie  2
Affiliations
Review

Circadian rhythm sleep-wake disturbances and depression in young people: implications for prevention and early intervention

Jacob J Crouse et al. Lancet Psychiatry. 2021 Sep.

Abstract

A rate-limiting step in the prevention and early intervention of depressive disorders in young people is our insufficient understanding of causal mechanisms. One plausible pathophysiological pathway is disturbance in the 24 h sleep-wake cycle and the underlying circadian system. Abnormalities in circadian rhythms are well documented in adults with various depressive disorders and have been linked to core clinical features, including unstable mood, daytime fatigue, non-restorative sleep, reduced motor activity, somatic symptoms, and appetite and weight change. In this Review, we summarise four areas of research: basic circadian biology and animal models of circadian disturbances; developmental changes in circadian rhythms during adolescence and implications for the emergence of adolescent-onset depressive syndromes; community and clinical studies linking 24 h sleep-wake cycle disturbances and depressive disorders; and clinical trials of circadian-based treatments. We present recommendations based on a highly personalised, early intervention model for circadian-linked depression in young people.

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Conflict of interest statement

Declaration of interests EMS is the medical director of the Young Adult Mental Health Unit, St Vincent's Hospital, Darlinghurst, Australia, discipline leader of Adult Mental Health, School of Medicine, University of Notre Dame, Sydney Australia, and a consultant psychiatrist. She has received honoraria for educational seminars related to the clinical management of depressive disorders that were supported by Servier Laboratories and Eli Lilly. She has participated in a national advisory board for the antidepressant compound Pristiq, manufactured by Pfizer. She was the national coordinator of an antidepressant trial that was sponsored by Servier Laboratories. IBH reports grants from the Australian National Health and Medical Research Council; personal fees from the Australian National Mental Health Commission and InnoWell; non-financial support from the Australian National Mental Health Commission (National Mental Health Research Strategy), Australian Department of Health, Million Minds Advisory Panel, Psychosis Australia Trust, and Medibank Clinical Reference Group, outside the submitted work. IBH was an inaugural commissioner on Australia's National Mental Health Commission (ie, 2012–18). He is the co-director of Health and Policy at the Brain and Mind Centre, University of Sydney, Sydney, Australia. The Brain and Mind Centre operates early intervention youth services at Camperdown under contract to Headspace. IBH has previously led community-based and pharmaceutical industry-supported (ie, Wyeth, Eli Lilly, Servier Laboratories, Pfizer, AstraZeneca) projects that were focused on the identification and improved management of anxiety and depression. He has led investigator-initiated studies into the antidepressant and linked circadian effects of agomelatine. These studies were supported by Servier Laboratories, the manufacturer of agomelatine. He was a member of the Medical Advisory Panel for Medibank Private until October, 2017, a board member of the Psychosis Australia Trust, and a member of Veterans Mental Health Clinical Reference group. He is the chief scientific advisor to, and a 5% equity shareholder in, InnoWell. InnoWell was formed by the University of Sydney (45% equity) and PwC (Australia; 45% equity) to deliver the AUS$30 million Australian Government-funded Project Synergy (ie, 2017–20; a 3-year programme for the transformation of mental health services) and to lead transformation of mental health services internationally through innovative technologies. InnoWell operates as a software-as-a-service provider and is not a developer of any other linked technologies. It licenses the use of its platform to health service organisations and does not provide services direct to the public. JJC, JSC, YJCS, SJH, SLN, RRG, KRM, and JS declare no competing interests.

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