冬季抑郁症的轻疗成功的个性化时序键

纽约，纽约 - 与一个人的生物时钟同步光疗加倍其作为冬季抑郁症治疗的有效性，哥伦比亚大学研究人员已经证明。在1月15日发表的一项研究中，一般精神病学档案，博士团队。迈克尔和九源苏格兰在42例季节性情感障碍（悲伤）之前和之后测量了42例患者的血浆褪黑激素模式。使用为此目的制造的专用高强度灯箱，每天施用30分钟。每天早晚或晚上，每年患者的精确治疗时间是相对于针刺腺体的每晚褪黑素产生的每晚褪黑素产生的镜头，这在大脑中深处。此前，研究人员已经假设了悲伤的人们在冬天遭受了昼夜昼夜节律的延迟。但冠长发现，患者的褪黑激素循环可以早期，晚期或之间发生。“你不能得出结论，这些患者作为一群群体遭受昼夜阶段的延迟，导致他们的抑郁症，”哥伦比亚医师和外科医生临床心理学教授迈克尔·星座Terman博士指导冬季抑郁症计划，于1984年成立于纽约州精神病学院（NYSPI）。相反，他解释说：“人们在褪黑激素发作后，人们太早睡着了，他们的生物钟需要早先转移以进行纠正。” While morning light treatment pushes internal clocks forward, evening treatment pushed them back. Patients whose clocks were pushed forward the farthest in the study experienced the strongest response to therapy. The researchers found that treatment timed 8.5 hours after melatonin onset was by far the most effective at pushing the clock forward and relieving depression. "Melatonin onset varies by up to four hours between individuals and serves as an anchor point to specify the optimum time of light administration," Dr. Terman says. "If treatment is appropriately early in circadian time, it is twice as effective as later in the morning or in the evening. The contrast in remission rates is dramatic -- approximately 80 percent vs. 35 percent -- and the lower rate can be suspected to be nothing more than a placebo effect." Currently, melatonin onset is measured by testing saliva samples taken throughout the evening. Although this assay is still only available as a research tool, doctors and patients can estimate the optimum time for light therapy by closely examining the depressed patient's sleeping pattern. The Termans found that regardless of the amount of sleep, its midpoint falls about six hours after melatonin onset. "We can rewrite the prescription for timing light therapy in relation to habitual sleep: The best response occurs when light is taken promptly upon waking 2.5 to 3.5 hours after the midpoint of the depressed patient's sleep cycle," Dr. Terman says. "Short sleepers will use the lights around the time of normal waking, while longer sleepers will need to wake up earlier." Dr. Terman notes that the implications of these findings go beyond SAD treatment. The effectiveness of many drugs -- for example, antihypertensives, antiasthmatics, and chemotherapy agents -- vary with the time of day. "The importance for medicine as a whole is that you have to anchor your manipulations to the individual patient's circadian phase, not to a standard external clock time," he says. This "inside out" approach stands in stark contrast to dosing schedules that neglect the patient's oscillating state. The research by the Termans is supported by the National Institute of Mental Health. Information about clinical trials is available athttp://www.light-and-ion-therape.org.。

来源：Terman JS，Terman M，Lo ES，Cooper TB。早晨照射管理和治疗反应的昼夜昼夜时期在冬天凹陷。2001年拱门精神病学; 58：69-75。

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