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Circadian rhythms: Their role and dysfunction in affective disorder

ith high-tech medicine, and for this reason are often not taken seriously.

Clinical implications

In clinical practice there is still rather widespread ignorance about circadian sleep disturbances and chronotherapeutics in spite of the significant evidence base. How can wider dissemination of chronotherapeutics be achieved?

First, enterprising doctors should try them out. Only with first-hand experience does the reality of efficacy and response emerge.

Second, the techniques should be taught in medical school and during residency since it is the younger generation that is most open to change and use of cogent alternatives to medication. The nonprofit, multilingual patients' website and clinicians' website of the Center for Environmental Therapeutics (CET) illustrate some first attempts to meet this Phase 3 educational challenge.

Third, through its societies, the field of chronotherapeutics needs to advocate recognition for reimbursement.

In the treatment of affective disorders, chronotherapeutics offer a new synthesis of non-pharmacologic interventions designed to accelerate remission in patients with depression and bipolar disorder. Combining chronotherapeutics with concomitant or follow-up medication shows great promise.

Given the urgent need for new strategies to treat patients with residual depressive symptoms, clinical trials of wake therapy and/or adjuvant light therapy, coupled with follow-up studies of long-term recurrence, are of high priority.


Circadian dysfunction can have drastic consequences on brain functions. Increasing evidence suggests that disrupted temporal organisation impairs behaviour, cognition, and affect (Benca et al., 2009).

Disruption of circadian clock genes impairs sleep-wake cycle and behavioural rhythms, which may be implicated in mental disorders. Several different psychiatric dis

Contact: Sonja Mak
European College of Neuropsychopharmacology

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