Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Antidepressant Drugs | Research article

Circadian rhythm and sleep alterations in older people with lifetime depression: a case-control study

Authors: Camilla M. Hoyos, Christopher Gordon, Zoe Terpening, Louisa Norrie, Simon J. G. Lewis, Ian B. Hickie, Sharon L. Naismith

Published in: BMC Psychiatry | Issue 1/2020

Login to get access

Abstract

Background

Depression is common in older people and is associated with underlying brain change increasing the risk of dementia. Sleep disturbance is frequently reported by those with lifetime depression, however whether circadian misalignment also exists is unclear. We aimed to examine circadian rhythms and sleep associations in older patients with and without lifetime depression.

Methods

Thirty-four older people meeting DSM-IV criteria for lifetime major depression (mean age = 63.9 years), and 30 healthy controls (mean age = 65.7 years) were recruited. Participants underwent 2-weeks of actigraphy followed by a 3-night protocol including dim light melatonin onset (DLMO) assessment and overnight polysomnography (PSG) for sleep architecture. DLMO and phase angle of entrainment were computed.

Results

Compared to controls, participants with depression had a significantly longer phase angle of entrainment (6.82 h ± 1.45 vs. 5.87 h ± 1.60, p = 0.02, Cohens-d = 0.62). A small to moderate yet non-significant difference in DLMO times, with earlier DLMO (34 ± 27 min) observed in depression (20:36 ± 1:48 vs. 21:10 ± 1:48, p = 0.22, Cohens-d = 0.32). Individuals with depression had longer sleep latency and latency to rapid eye movement sleep than controls (all p < 0.05).

Conclusion

Circadian advancement and alterations to the timing of sleep and REM onset are evident in older people with lifetime major depression, despite having only mild residual symptoms. Further research examining the prognostic significance of these changes is warranted as well as chronotherapeutic treatment studies.
Literature
1.
Australian Institute of Health and Welfare. Australia’s health 2008. Canberra: Australian Institute of Health and Welfare; 2008.
2.
Katon WJ, Lin E, Russo J, Unutzer J. Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry. 2003;60(9):897–903.PubMedCrossRef
3.
Naismith SL, Hickie IB, Turner K, Little CL, Winter V, Ward PB, Wilhelm K, Mitchell P, Parker G. Neuropsychological performance in patients with depression is associated with clinical, etiological and genetic risk factors. J Clin Exp Neuropsychol. 2003;25(6):866–77.PubMedCrossRef
4.
Naismith S, Hickie I, Longley W, Scott E. How well do self-reported and objectively measured cognitive deficits predict disability in major depression? BMC Psychiatry. 2007;7:32.PubMedPubMedCentralCrossRef
5.
Steffens DC, Potter GG, McQuoid DR, MacFall JR, Payne ME, Burke JR, Plassman BL, Welsh-Bohmer KA. Longitudinal magnetic resonance imaging vascular changes, apolipoprotein E genotype, and development of dementia in the neurocognitive outcomes of depression in the elderly study. Am J Geriatr Psychiatry. 2007;15(10):839–49.PubMedCrossRef
6.
Hickie I, Scott E, Wilhelm K, Brodaty H. Subcortical hyperintensities on magnetic resonance imaging in patients with severe depression--a longitudinal evaluation. Biol Psychiatry. 1997;42(5):367–74.PubMedCrossRef
7.
Lyness JM, Yu Q, Tang W, Tu X, Conwell Y. Risks for depression onset in primary care elderly patients: potential targets for preventive interventions. Am J Psychiatry. 2009;166(12):1375–83.PubMedPubMedCentralCrossRef
8.
Yaffe K, Blackwell T, Gore R, Sands L, Reus V, Browner WS. Depressive symptoms and cognitive decline in nondemented elderly women: a prospective study. Arch Gen Psychiatry. 1999;56(5):425–30.PubMedCrossRef
9.
Ritchie K, Carriere I, Ritchie CW, Berr C, Artero S, Ancelin ML. Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors. Br Med J. 2010;341.
10.
Pigeon WR, Hegel M, Unutzer J, Fan MY, Sateia MJ, Lyness JM, Phillips C, Perlis ML. Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort? Sleep. 2008;31(4):481–8.PubMedPubMedCentralCrossRef
11.
Mallon L, Broman J-E, Hetta J. Relationship between insomnia, depression, and mortality: a 12-year follow-up of older adults in the community. Int Psychogeriatr. 2000;12(03):295–306.PubMedCrossRef
12.
Perlis ML, Smith LJ, Lyness JM, Matteson SR, Pigeon WR, Jungquist CR, Tu X. Insomnia as a risk factor for onset of depression in the elderly. Behav Sleep Med. 2006;4:104–13.PubMedCrossRef
13.
Cho H, Lavretsky H, Olmstead R, Levin M, Oxman M, Irwin M. Sleep disturbance and depression recurrence in community-dwelling older adults: a prospective study. Am J Psychiatr. 2008;165(12):1543–50.PubMedCrossRef
14.
Costa IC, Carvalho HN, Fernandes L. Aging, circadian rhythms and depressive disorders: a review. Am J Neurodegener Dis. 2013;2(4):228–46.
15.
16.
Buysse DJ. Insomnia, depression and aging. Assessing sleep and mood interactions in older adults. Geriatrics. 2004;59(2):47–51.PubMed
17.
Lauer CJ, Riemann D, Wiegand M, Berger M. From early to late adulthood. Changes in EEG sleep of depressed patients and healthy volunteers. Biol Psychiatry. 1991;29(10):979–93.PubMedCrossRef
18.
Naismith SL, Lewis SJ, Rogers NL. Sleep-wake changes and cognition in neurodegenerative disease. Prog Brain Res. 2011;190:21–52.PubMedCrossRef
19.
Sunderajan P, Gaynes BN, Wisniewski SR, Miyahara S, Fava M, Akingbala F, DeVeaugh-Geiss J, Rush AJ, Trivedi MH. Insomnia in patients with depression: a STAR*D report. CNS Spectr. 2010;15(6):394–404.PubMedCrossRef
20.
Dew MA, Reynolds CF 3rd, Buysse DJ, Houck PR, Hoch CC, Monk TH, Kupfer DJ. Electroencephalographic sleep profiles during depression. Effects of episode duration and other clinical and psychosocial factors in older adults. Arch Gen Psychiatry. 1996;53(2):148–56.PubMedCrossRef
21.
Dridi D, Zouiten A, Ben Mansour H. Depression: chronophysiology and chronotherapy. Biol Rhythm Res. 2014;45(1):77–91.CrossRef
22.
Palagini L, Baglioni C, Ciapparelli A, Gemignani A, Riemann D. REM sleep dysregulation in depression: state of the art. Sleep Med Rev. 2013;17(5):377–90.PubMedCrossRef
23.
Dew MA, Reynolds CF 3rd, Houck PR, Hall M, Buysse DJ, Frank E, Kupfer DJ. Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry. 1997;54(11):1016–24.PubMedCrossRef
24.
Hickie IB, Rogers NL. Novel melatonin-based therapies: potential advances in the treatment of major depression. Lancet. 2011;378(9791):621–31.PubMedCrossRef
25.
Srinivasan V, Smits M, Spence W, Lowe AD, Kayumov L, Pandi-Perumal SR, Parry B, Cardinali DP. Melatonin in mood disorders. World J Biol Psychiatry. 2006;7(3):138–51.PubMedCrossRef
26.
Branchey L, Weinberg U, Branchey M, Linkowski P, Mendlewicz J. Simultaneous study of 24-hour patterns of melatonin and cortisol secretion in depressed patients. Neuropsychobiology. 1982;8(5):225–32.PubMedCrossRef
27.
Claustrat B, Chazot G, Brun J, Jordan D, Sassolas G. A chronobiological study of melatonin and cortisol secretion in depressed subjects: plasma melatonin, a biochemical marker in major depression. Biol Psychiatry. 1984;19(8):1215–28.PubMed
28.
Parry BL, Newton RP. Chronobiological basis of female-specific mood disorders. Neuropsychopharmacology. 2001;25(5 Suppl):S102–8.PubMedCrossRef
29.
Wehr TA, Rosenthal NE, Sack DA, Gillin JC. Antidepressant effects of sleep deprivation in bright and dim light. Acta Psychiatr Scand. 1985;72(2):161–5.PubMedCrossRef
30.
Lewy A. Circadian phase sleep and mood disorders. Philadelphia: Lipincott Williams and Wilkins 1880-1893; 2002.
31.
Naismith SL, Hermens DF, Ip TK, Bolitho S, Scott E, Rogers NL, Hickie IB. Circadian profiles in young people during the early stages of affective disorder. Transl Psychiatry. 2012;2:e123.PubMedPubMedCentralCrossRef
32.
Robillard R, Naismith SL, Smith KL, Rogers NL, White D, Terpening Z, Ip TK, Hermens DF, Whitwell B, Scott EM, et al. Sleep-wake cycle in young and older persons with a lifetime history of mood disorders. PLoS One. 2014;9(2):e87763.PubMedPubMedCentralCrossRef
33.
Hickie IB, Naismith SL, Norrie LM, Scott EM. Managing depression across the life cycle: new strategies for clinicians and their patients. Intern Med J. 2009;39(11):720–7.PubMedCrossRef
34.
Folstein MF, Folstein SE, PR MH. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRef
35.
Miller MD, Towers A. Manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). Pittsburgh: University of Pittsburgh; 1991.
36.
First MB, Spitzer RL, Gibson M, Williams JB. Structured clinical interview for DSM-IV Axis I disorders, patient Ed, SCID I/P. Washington, DC: American Psychiatric Association; 1996.
37.
38.
Naismith SL, Hickie IB, Terpening Z, Rajaratnam SW, Hodges JR, Bolitho S, Rogers NL, Lewis SJG. Circadian misalignment and sleep disruption in mild cognitive impairment. J Alzheimers Dis. 2014;38(4):857–66.PubMedCrossRef
39.
Klerman EB, Gershengorn HB, Duffy JF, Kronauer RE. Comparisons of the variability of three markers of the human circadian pacemaker. J Biol Rhythm. 2002;17(2):181–93.CrossRef
40.
Burgess HJ, Eastman CI. The dim light melatonin onset following fixed and free sleep schedules. J Sleep Res. 2005;14(3):229–37.PubMedCrossRef
41.
Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.PubMedCrossRef
42.
Naismith SL, Rogers NL, Lewis SJ, Terpening Z, Ip T, Diamond K, Norrie L, Hickie IB. Sleep disturbance relates to neuropsychological functioning in late-life depression. J Affect Disord. 2011;132(1–2):139–45.PubMedCrossRef
43.
Rechtschaffen K. A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. In: Rechtschaffen A, Kales A, editors. . Bethesda: U. S. National Institute of Neurological Diseases and Blindness, Neurological Information Network; 1968.
44.
Webb WB, Dreblow LM. A modified method for scoring slow wave sleep of older subjects. Sleep. 1982;5(2):195–9.PubMedCrossRef
45.
Wehr TA, Wirz-Justice A, Goodwin FK, Duncan W, Gillin JC. Phase advance of the circadian sleep-wake cycle as an antidepressant. Science. 1979;206(4419):710–3.PubMedCrossRef
46.
Nair NP, Hariharasubramanian N, Pilapil C. Circadian rhythm of plasma melatonin in endogenous depression. Prog Neuro-Psychopharmacol Biol Psychiatry. 1984;8(4–6):715–8.CrossRef
47.
Millet B, Touitou Y, Poirier MF, Bourdel MC, Hantouche E, Bogdan A, Olie JP. Plasma melatonin and cortisol in patients with obsessive-compulsive disorder: relationship with axillary temperature, physical activity, and clinical symptoms. Biol Psychiatry. 1998;44(9):874–81.PubMedCrossRef
48.
Novakova M, Prasko J, Latalova K, Sladek M, Sumova A. The circadian system of patients with bipolar disorder differs in episodes of mania and depression. Bipolar Disord. 2015;17(3):303–14.PubMedCrossRef
49.
Duffy JF, Dijk DJ, Klerman EB, Czeisler CA. Later endogenous circadian temperature nadir relative to an earlier wake time in older people. Am J Phys. 1998;275(5 Pt 2):R1478–87.
50.
Weitzman ED, Moline ML, Czeisler CA, Zimmerman JC. Chronobiology of aging: temperature, sleep-wake rhythms and entrainment. Neurobiol Aging. 1982;3(4):299–309.PubMedCrossRef
51.
Robillard R, Carpenter JS, Rogers NL, Fares S, Grierson AB, Hermens DF, Naismith SL, Mullin SJ, Feilds KL, Glozier N, et al. Circadian rhythms and psychiatric profiles in young adults with unipolar depressive disorders. Transl Psychiatry. 2018;8(1):213.PubMedPubMedCentralCrossRef
52.
Crasson M, Kjiri S, Colin A, Kjiri K, L'Hermite-Baleriaux M, Ansseau M, Legros JJ. Serum melatonin and urinary 6-sulfatoxymelatonin in major depression. Psychoneuroendocrinology. 2004;29(1):1–12.PubMedCrossRef
53.
Kripke DF, Youngstedt SD, Rex KM, Klauber MR, Elliott JA. Melatonin excretion with affect disorders over age 60. Psychiatry Res. 2003;118(1):47–54.PubMedCrossRef
54.
Emens J, Lewy A, Kinzie JM, Arntz D, Rough J. Circadian misalignment in major depressive disorder. Psychiatry Res. 2009;168(3):259–61.PubMedCrossRef
55.
Morin LP. Serotonin and the regulation of mammalian circadian rhythmicity. Ann Med. 1999;31(1):12–33.PubMedCrossRef
56.
Carvalho LA, Gorenstein C, Moreno R, Pariante C, Markus RP. Effect of antidepressants on melatonin metabolite in depressed patients. J Psychopharmacol. 2009;23(3):315–21.PubMedCrossRef
57.
McGlashan EM, Nandam LS, Vidafar P, Mansfield DR, Rajaratnam SMW, Cain SW. The SSRI citalopram increases the sensitivity of the human circadian system to light in an acute dose. Psychopharmacology. 2018;235(11):3201–9.PubMedCrossRef
58.
Naismith SL, Rogers NL, Lewis SJ, Diamond K, Terpening Z, Norrie L, Hickie IB. Sleep disturbance in mild cognitive impairment: differential effects of current and remitted depression. Acta Neuropsychiatr. 2011;23(4):167–72.PubMedCrossRef
59.
Naismith SL, Norrie L, Lewis SJ, Rogers NL, Scott EM, Hickie IB. Does sleep disturbance mediate neuropsychological functioning in older people with depression? J Affect Disord. 2009;116(1–2):139–43.PubMedCrossRef
60.
McKinnon AC, Hickie IB, Scott J, Duffy SL, Norrie L, Terpening Z, Grunstein RR, Lagopoulos J, Batchelor J, Lewis SJG, et al. Current sleep disturbance in older people with a lifetime history of depression is associated with increased connectivity in the default mode network. J Affect Disord. 2018;229:85–94.PubMedCrossRef
61.
Schulz H, Lund R. Sleep onset REM episodes are associated with circadian parameters of body temperature. A study in depressed patients and normal controls. Biol Psychiatry. 1983;18(12):1411–26.PubMed
62.
63.
Difrancesco S, Lamers F, Riese H, Merikangas KR, Beekman ATF, van Hemert AM, Schoevers RA, Penninx B. Sleep, circadian rhythm, and physical activity patterns in depressive and anxiety disorders: a 2-week ambulatory assessment study. Depress Anxiety. 2019;36(10):975–86.PubMedPubMedCentralCrossRef
64.
Robillard R, Carpenter JS, Feilds KL, Hermens DF, White D, Naismith SL, Bartlett D, Whitwell B, Southan J, Scott EM, et al. Parallel changes in mood and melatonin rhythm following an adjunctive multimodal Chronobiological intervention with Agomelatine in people with depression: a proof of concept open label study. Front Psychiatry. 2018;9:624.PubMedPubMedCentralCrossRef
65.
66.
Metadata
Title
Circadian rhythm and sleep alterations in older people with lifetime depression: a case-control study
Authors
Camilla M. Hoyos
Christopher Gordon
Zoe Terpening
Louisa Norrie
Simon J. G. Lewis
Ian B. Hickie
Sharon L. Naismith
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02606-z

Other articles of this Issue 1/2020

BMC Psychiatry 1/2020 Go to the issue

Research article

Potential metabolic monitoring indicators of suicide attempts in first episode and drug naive young patients with major depressive disorder: a cross-sectional study

Research article

Impacts of stigma and discrimination in the workplace on people living with psychosis

Research article

Exploring mediators of the recovery process over time among mental health service users, using a mixed model regression analysis based on cluster RCT data

Case report

Comprehensive phenotyping of neuropsychiatric traits in a multiplex 3q29 deletion family: a case report

Research article

The association between serotonin-related gene polymorphisms and susceptibility and early sertraline response in patients with panic disorder

Research article

Unrecognized geriatric depression in the emergency Department of a Teaching Hospital in Nepal: prevalence, contributing factors, and metric properties of 5 item geriatric depression scale in this population