Sunday October 23, 2011
CIRCADIAN rhythm disorders driven by changes in the sleep-wake cycle has been identified as one of the major causes of depression, the fourth most disabling disease in Malaysia, affecting up to 10% of the population.
Misdiagnosis and/or sub-optimal treatment of depression and the relatively little attention paid to changes to circadian rhythms that control physical, mental and behavioural patterns that follow roughly a 24-hour cycle is further hampering treatment of this malady.
“Up to 82% of depressed patients remain untreated due to social stigma, misdiagnosis, and under-treatment. More depressed patients are seen by primary care doctors than by actual psychiatrists, and a majority of them are not diagnosed. The remaining 18% receive antidepressant medications, but only 10% are adequately treated,” noted Prof Dr Mohamad Hussain Habil, past president of the Asean Federation for Psychiatry and Mental Health (AFPMH) at a media workshop organised by Servier Malaysia on “Circadian Rhythms and Depression” in conjunction with Mental Health Month.
“Hence, it is extremely important to develop a better understanding of the correlation between circadian rhythm disorders and depression to improve the recognition and management of the disease.
“Depression is one of the more common reasons for people to visit their general practitioner, and better diagnosis as well as greater focus on circadian rhythm disruption presents an effective platform for treating mood disorders,” he added.
Circadian rhythm disorders are disruptions in a person’s “internal body clock” that regulates biological processes such as brain wave activity, hormone production, cell regeneration and other biological activities linked to this cycle. Circadian rhythms can change sleep-wake cycles, hormone release, body temperature and other important bodily functions.
The regular rhythm of night and day regulates our lives and associated with this are regular changes in core body temperature, hormonal levels, heart rate, renal output and gut motility. Features of depression indicative of circadian rhythm disturbance include early awakening, a feeling of low mood in the morning, changes in sleep patterns, changes in temperature, and hormonal activity.
According to Prof Dr Azhar Md Zain, consultant psychiatrist at the Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, circadian rhythm disruption has been found amongst patients with major depression, and although these changes are thought to be a contributing factor to the depression, it is also possible that they may arise as a consequence of the depression.