Clocking in

Time of article published Sep 2, 2011

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Lindsay Ord

Scientists have discovered a link between disturbed circadian rhythms and depression and it could all be down to re-setting the body’s internal clock which makes us sleep at night and be awake in the day.

Circadian rhythms are physical, mental and behavioural changes that follow a 24-hour cycle. Our master biological clock in the brain governs our circadian rhythms or biorhythms, which are affected by environmental signals such as eating and drinking patterns, social interactions and stress, among others. They are also responsible for the regulation functions such as body temperature, hormone release, variations in mood, energy and alertness.

Recent research has linked the dysfunction of biorhythms to the symptoms of depression, including disturbed sleep-wake cycles, daytime mood swings and changes in the intensity of the depressed mood. In fact, research has shown that the more “out of synch” a patient's circadian rhythms are, the more severe their depression.

Current treatments of depression generally focus on controlling the brain’s chemical pathways and increasing the activity and availability of these chemicals or neurotransmitters. But a drug that re-synchronises the body’s circadian rhythms is on the way and will be in South Africa in the next few months.

Psychiatrist Dr Franco Colin says nobody should underestimate the severity of depression, which he describes as an “illness of the brain”, one that is severe, recurrent and disrupts the patient’s life.

“Depression is serious and it can become chronic,” he said at a briefing in Johannesburg last week.

“People who have depression are three times more likely to die if they have a heart attack than those who do not have depression. It is a ‘whole body’ disease. Depression also damages the brain on a physical level, increases cardiovascular risk, impairs the immune system and affects relationships. If you were to leave depression untreated for 40 or 50 years, you would end up in an Alzheimer’s-like state.”

The new drug, agomelatine, has been widely prescribed in Europe for several years and tested on a small number of patients in South Africa, with success.

It has the potential to establish a new approach to the treatment of the condition, says Colin.

Psychiatrist Dr Rykie Liebenberg says she has prescribed the drug to several patients with success, and a big plus is that there are fewer side effects than with many of the current drugs in use to treat depression.

“Adherence to treatment is often a problem and patients stop taking medication because they cannot bear the side effects like nausea, weight gain, sexual dysfunction and disrupted sleep patterns. Patients report few side effects with this drug.”

Another plus is that patients have reported an improvement in symptoms, as early as in one week in some symptoms. You can take it in conjunction with other therapies too, under guidance of your doctor.

Liebenberg points out that depression will only occur in genetically predisposed people and that is also why not everybody who is stressed or bereaved will become clinically depressed.

Agomelatine is suitable for all depressed patients, not just the ones with sleep disturbances. Many rhythms are disturbed in depression – energy, libido, appetite, diurnal mood variation, to name a few – and sleep is only one of them.

Colin stresses that drug therapy is only one component in the treatment of depression and a holistic approach needs to be taken. Other treatments include psychotherapy, family and couples therapy, occupational rehabilitation (helping the patient get back to work), supplements (folic acid has been shown to increase effectiveness of anti-depressants) and in some cases electro-convulsive therapy.”

Forget what you saw in the Jack Nicolson movie One Flew Over the Cuckoo's Nest.

“Treatments today are far more refined and, when used correctly, for the right patient, it is a good therapy,” he says.


What is deperession

Depression is a “whole-body” illness, involving your body, mood and thoughts.

It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. It is not the same as a temporary blue mood, a sign of personal weakness or a condition that can be willed or wished away.

People with a depression cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months or years. The appropriate treatment can help most sufferers.



Not everyone who is depressed experiences every symptom listed. Some people experience a few symptoms, some people experience many. Also, the severity varies between individuals.

Symptoms include:

* Persistent sad, or “empty” mood.

* Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex.

* Feelings of hopelessness.

* Feelings of guilt, worthlessness, helplessness and self-reproach.

* Insomnia or hypersomnia, early morning awakening, or oversleeping.

* Appetite and/or weight loss or overeating and weight gain.

* Decreased energy and feeling run down.

* Increased use of alcohol and drugs, may be associated but not a criteria for diagnosis.

* Thoughts of death or suicide; suicide attempts.

* Restlessness, irritability, hostility.

* Difficulty concentrating, remembering, making decisions.

* Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, chronic pain.

* Deterioration of social relationships.


Depression by numbers

The average age of onset is 45, with women of childbearing age outnumbering men by two to one. After menopause the incidence in men and women is the same.

The average number of depressive episodes experienced by sufferers over a lifetime is four. Studies show that people with depression spend one-fifth of their lives in a depressed state. One in three people recover with current treatment and one in eight will have a lifetime of chronic depression.

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