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Background: Approximately 30−40% of depressive patients does not improve or show a partial response. Since biological rhythm involved in the pathogenesis of mood disorders is regarded as a unique characteristic of a person, it opens new opportunities for personalized medicine.

Aim: to evaluate clinical characteristics and treatment effectiveness in depressive patients with different chronotypes.

Materials and methods: In prospective, hospital-based study MADRS was performed weekly (dMADRS), therapeutic response (R) was defined as a 50% or greater decrease from baseline in the score. Chronotype was evaluated using the Morningness−Eveningness Questionnaire (MEQ). Participants completed a questionnaire package: HDRS-21, PSQI, ТОВ, «individual minute». Statistical analysis was performed using Excel for Windows, Statistica 13.0.

Results: All patients (n=100, mean age 48±16 yrs) were divided into groups based on their circadian type: evening types (ETs) had more severe condition; antidepressants (SSRIs; R=72%) were effective given at morning in ETs, at evening (other; R=100%) ― in morning types (MTs) (p<0.00001) with a greater reduction in depressive symptoms (p<0.05). Prescribing drugs with balanced potency were effective in both groups (F=4.62, p=0.032). Cluster analysis on 25 clinical, biological, and therapeutic variables to establish the role of chronotype as a factor important for identifying patients with similar socio-demographic, clinical, and health characteristics was conducted. Cluster 1 achieved a reduction of depression severity (19% MTs; R=81%; 43.4±17.7 yrs; single episode; dMADRS 16.9±2.7; 23% monotherapy). Cluster 3 (80% ETs; R=50%; 40.4±15.2; early onset dMADRS 15.23±2.29; 7% monotherapy) was the most unfavorable prognostic group.

Conclusions: Depressive patients with morning/evening chronotypes have significant differences in clinical presentation, the course of the illness and efficacy of antidepressants. Evening chronotype was found to be associated with poor prognosis. Circadian typology should be considered when choosing the appropriate therapeutic options.

M. Yu. Gerasimchuk

I. M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.

Russian Federation


  1. Дедов И.И., Тюльпаков А.Н., Чехонин В.П., и др. Персонализированная медицина: современное состояние и перспективы // Вестник Российской академии медицинских наук. ― 2012. ― Т.٦٧. ― №12 ― С. 4–12. [Dedov II, Tyul’pakov AN, Chekhonin VP, et al. Personalized medicine: state-of-the-art and prospects. Annals of the Russian academy of medical sciences. 2012;67(12):4–12. (In Russ).] doi: 10.15690/vramn.v67i12.474.
  2. Ушаков И.Б., Богомолов А.В. Информатизация программ персонифицированной адаптационной медицины // Вестник Российской академии медицинских наук. ― 2014. ― Т.69. ― №5–6 ― С. 124–128. [Ushakov IB, Bogomolov AV. Informatization of personalized adaptation medicine programs. Annals of the Russian academy of medical sciences. 2014;69(5–6):124–128. (In Russ).] doi: 10.15690/vramn.v69i5-6.1056.
  3. Чазов Е.И. Защитные системы организма как основа поиска и разработки новых оригинальных лекарственных средств // Вестник Российской академии медицинских наук. ― 2012. ― T.67. ― №5 ― С. 6–7. [Chazov EI. Protective systems of the human organism as a basis of search and development of new original medical drugs. Annals of the Russian academy of medical sciences. 2012;67(5):6–7. (In Russ).] doi: 10.15690/vramn.v67i5.264.
  4. Hampton T. Bench to bedside and back again may be key to clinical breakthroughs. JAMA. 2017;318(1):16–17. doi: 10.1001/jama.2017.7276.
  5. Психиатрия: руководство для врачей / Под ред. Тиганова А.С. ― М.: Издательство «Медицина»; 2012. [Psikhiatriya: rukovodstvo dlya vrachei. Ed by Tiganov A.S. Moscow: Meditsina; 2012. (In Russ).]
  6. Wirz-Justice A. Diurnal variation of depressive symptoms. Dialogues Clin Neurosci. 2008;10(3): 337–343.
  7. Borbély AA, Daan S, Wirz-Justice A, Deboer T. The two-process model of sleep regulation: a reappraisal. J Sleep Res. 2016;25(2):131–143. doi: 10.1111/jsr.12371.
  8. Дедов И.И., Мельниченко Г.А., Липатенкова А.К. Современная нейроэндокринология // Вестник Российской академии медицинских наук. ― 2012. ― Т.٦٧. ― №8 ― С. 7–13. [Dedov II, Mel›nichenko GA, Lipatenkova AK. Modern neuroendocrinology. Annals of the Russian academy of medical sciences. 2012;67(8):7–13. (In Russ).] doi: 10.15690/vramn.v67i8.343.
  9. Герасимчук М.Ю. Депрессия: перспективы дифференцированной психофармакотерапии // Архивъ внутренней медицины. ― 2016. ― №4 ― С. 8–13. [Gerasimchuk MYu. Towards personalized treatment of depression. Archive of internal medicine. 2016;(4):8–13. (In Russ).] doi: 10.20514/2226-6704-2016-6-4-8-13.
  10. Kantermann T, Sung H, Burgess HJ. Comparing the Morningness-Eveningness Questionnaire and Munich ChronoType Questionnaire to the dim light melatonin onset. J Biol Rhythms. 2015;30(5):449–453. doi: 10.1177/0748730415597520.
  11. Carmody TJ, Rush AJ, Bernstein I, et al. The Montgomery Asberg and the Hamilton ratings of depression: a comparison of measures. Eur Neuropsychopharmacol. 2006;16(8):601–611. doi: 10.1016/j.euroneuro.2006.04.008.
  12. Horne JA, Ostberg O. A self-assessment questionnaire to determine Morningness-Eveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97–110.
  13. Alloy LB, Ng TH, Titone MK, Boland EM. Circadian rhythm dysregulation in bipolar spectrum disorders. Curr Psychiatry Rep. 2017;19(4):21. doi: 10.1007/s11920-017-0772-z.
  14. Kryger MH, Roth T, Dement WC, editors. Principles and practice of sleep medicine. St. Louis, MO: Elsevier; 2016.
  15. Melo MC, Abreu RL, Linhares Neto VB, et al. Chronotype and circadian rhythm in bipolar disorder: a systematic review. Sleep Med Rev. 2017;34:46–58. doi: 10.1016/j.smrv.2016.06.007.
  16. Merikanto I, Kronholm E, Peltonen M, et al. Circadian preference links to depression in general adult population. J Affect Disord. 2015;188:143–148. doi: 10.1016/j.jad.2015.08.061.
  17. Lee SJ, Park CS, Kim BJ, et al. Association between morningness and resilience in Korean college students. Chronobiol Int. 2016;33(10):1391–1399. doi: 10.1080/07420528.2016.1220387.
  18. Müller MJ, Cabanel N, Olschinski C, et al. Chronotypes in patients with nonseasonal depressive disorder: distribution, stability and association with clinical variables. Chronobiol Int. 2015;32(10):1343–1351. doi: 10.3109/07420528.2015.1091353.
  19. Au J, Reece J. The relationship between chronotype and depressive symptoms: a meta-analysis. J Affect Disord. 2017;218:93–104. doi: 10.1016/j.jad.2017.04.021.


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