[Depression and circadian rhythm]

Adverse changes in circadian rhythms are an integral part of the clinical features of endogenous depression, and particularly of seasonal depression. Alongside twenty-four variations in the major symptoms, these forms of depression can be characterised psychometrically, physiologically and biologically. The most classical adverse changes are amplitude modifications, fluctuations and periodicity of the hormonal secretory rhythms. Pathophysiological and psychopathological models have been proposed to combat these abnormalities. The leading models include free course, phase advance (or instability) and hypnic models, or those based on disturbances of the internal clock. The main psychopathological models are those of endokinesis and psychosocial desynchronisation. The therapeutic applications of the pathophysiological models use manipulation of the wake-sleep cycle, phototherapy and melatonin and its derivatives : those of the psychopathological models used time-space management and development of resynchronisation capacities. The question determining whether these adverse changes are a cause or effect of depressive behaviour is unresolved.