Winter Depression: Integrating Mood, Circadian Rhythms, and the Sleep/Wake and Light/Dark Cycles into a Bio-Psycho-Social-Environmental Model

Alfred J. Lewy; Jonathan S. Emens; Jeannie B. Songer; Neelam Sims; Amber L. Laurie; Steven C. Fiala; Allie Buti

doi:10.1016/j.jsmc.2009.02.003

Winter Depression: Integrating Mood, Circadian Rhythms, and the Sleep/Wake and Light/Dark Cycles into a Bio-Psycho-Social-Environmental Model

Alfred J. Lewy, Jonathan S. Emens, Jeannie B. Songer, Neelam Sims, Amber L. Laurie, Steven C. Fiala, Allie Buti

Psychiatry

Research output: Contribution to journal › Review article › peer-review

47 Scopus citations

Abstract

The phase-shift hypothesis (PSH) states that most patients who have seasonal affective disorder become depressed in the winter because of a delay in circadian rhythms with respect to the sleep/wake cycle. According to the PSH, these patients should respond preferentially to the antidepressant effects of bright light exposure when it is scheduled in the morning to provide a corrective phase advance and restore optimum alignment between the circadian rhythms tightly coupled to the endogenous circadian pacemaker and the rhythms that are related to the sleep/wake cycle. Recent support for the PSH has come from studies in which symptom severity was shown to correlate with the degree of circadian misalignment. This article includes a review of resolved and unresolved issues related to circadian rhythms.

Original language	English (US)
Pages (from-to)	285-299
Number of pages	15
Journal	Sleep Medicine Clinics
Volume	4
Issue number	2
DOIs	https://doi.org/10.1016/j.jsmc.2009.02.003
State	Published - Jun 2009

Keywords

Bio-psycho-social-environmental model
Dim light melatonin onset (DLMO)
Light
Melatonin
Phase-angle difference (PAD)
Winter depression (SAD)

ASJC Scopus subject areas

Neuropsychology and Physiological Psychology
Clinical Psychology
Clinical Neurology
Psychiatry and Mental health

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10.1016/j.jsmc.2009.02.003

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title = "Winter Depression: Integrating Mood, Circadian Rhythms, and the Sleep/Wake and Light/Dark Cycles into a Bio-Psycho-Social-Environmental Model",

abstract = "The phase-shift hypothesis (PSH) states that most patients who have seasonal affective disorder become depressed in the winter because of a delay in circadian rhythms with respect to the sleep/wake cycle. According to the PSH, these patients should respond preferentially to the antidepressant effects of bright light exposure when it is scheduled in the morning to provide a corrective phase advance and restore optimum alignment between the circadian rhythms tightly coupled to the endogenous circadian pacemaker and the rhythms that are related to the sleep/wake cycle. Recent support for the PSH has come from studies in which symptom severity was shown to correlate with the degree of circadian misalignment. This article includes a review of resolved and unresolved issues related to circadian rhythms.",

keywords = "Bio-psycho-social-environmental model, Dim light melatonin onset (DLMO), Light, Melatonin, Phase-angle difference (PAD), Winter depression (SAD)",

author = "Lewy, {Alfred J.} and Emens, {Jonathan S.} and Songer, {Jeannie B.} and Neelam Sims and Laurie, {Amber L.} and Fiala, {Steven C.} and Allie Buti",

note = "Funding Information: This work was supported by Grants No. 5R01 HD042125, 5-R01-AG021826-02, and 5R01EY018312 from the National Institutes of Health. A.J.L. also was supported by a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award, and J.S.E. was supported by a National Alliance for Research on Schizophrenia and Depression Junior Investigator Award. ",

year = "2009",

month = jun,

doi = "10.1016/j.jsmc.2009.02.003",

language = "English (US)",

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AU - Lewy, Alfred J.

AU - Emens, Jonathan S.

AU - Songer, Jeannie B.

AU - Sims, Neelam

AU - Laurie, Amber L.

AU - Fiala, Steven C.

AU - Buti, Allie

N1 - Funding Information: This work was supported by Grants No. 5R01 HD042125, 5-R01-AG021826-02, and 5R01EY018312 from the National Institutes of Health. A.J.L. also was supported by a National Alliance for Research on Schizophrenia and Depression Distinguished Investigator Award, and J.S.E. was supported by a National Alliance for Research on Schizophrenia and Depression Junior Investigator Award.

PY - 2009/6

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N2 - The phase-shift hypothesis (PSH) states that most patients who have seasonal affective disorder become depressed in the winter because of a delay in circadian rhythms with respect to the sleep/wake cycle. According to the PSH, these patients should respond preferentially to the antidepressant effects of bright light exposure when it is scheduled in the morning to provide a corrective phase advance and restore optimum alignment between the circadian rhythms tightly coupled to the endogenous circadian pacemaker and the rhythms that are related to the sleep/wake cycle. Recent support for the PSH has come from studies in which symptom severity was shown to correlate with the degree of circadian misalignment. This article includes a review of resolved and unresolved issues related to circadian rhythms.

AB - The phase-shift hypothesis (PSH) states that most patients who have seasonal affective disorder become depressed in the winter because of a delay in circadian rhythms with respect to the sleep/wake cycle. According to the PSH, these patients should respond preferentially to the antidepressant effects of bright light exposure when it is scheduled in the morning to provide a corrective phase advance and restore optimum alignment between the circadian rhythms tightly coupled to the endogenous circadian pacemaker and the rhythms that are related to the sleep/wake cycle. Recent support for the PSH has come from studies in which symptom severity was shown to correlate with the degree of circadian misalignment. This article includes a review of resolved and unresolved issues related to circadian rhythms.

KW - Bio-psycho-social-environmental model

KW - Dim light melatonin onset (DLMO)

KW - Light

KW - Melatonin

KW - Phase-angle difference (PAD)

KW - Winter depression (SAD)

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Winter Depression: Integrating Mood, Circadian Rhythms, and the Sleep/Wake and Light/Dark Cycles into a Bio-Psycho-Social-Environmental Model

Abstract

Keywords

ASJC Scopus subject areas

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