Circadian depression: A mood disorder phenotype
Open accessAbstract
Major mood syndromes are among the most common and disabling mental disorders. However, a lack of clear delineation of their underlying pathophysiological mechanisms is a major barrier to prevention and optimised treatments. Dysfunction of the 24-h circadian system is a candidate mechanism that has genetic, behavioural, and neurobiological links to mood syndromes. Here, we outline evidence for a new clinical phenotype, which we have called 'circadian depression'. We propose that key clinical characteristics of circadian depression include disrupted 24-h sleep-wake cycles, reduced motor activity, low subjective energy, and weight gain. The illness course includes early age-of-onset, phenomena suggestive of bipolarity (defined by bidirectional associations between objective motor and subjective energy/mood states), poor response to conventional antidepressant medications, and concurrent cardiometabolic and inflammatory disturbances. Identifying this phenotype could be clinically valuable, as circadian-targeted strategies show promise for reducing depressive symptoms and stabilising illness course. Further investigation of underlying circadian disturbances in mood syndromes is needed to evaluate the clinical utility of this phenotype and guide the optimal use of circadian-targeted interventions.
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Recent proposals of a 'circadian type' of depression might support the use of pathophysiology‐targeted, stand‐alone interventions.
“Recent proposals of a ‘circadian type’ of depression might support the use of pathophysiology‐targeted, stand‐alone interventions [19].”
From Essential Information About Chronobiology and Chronotherapy for the Optimal Care of People With Bipolar Disorders: An Expert Consensus (2026) · cites this paper as [19]
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Circadian disruption and human health
Fishbein, A. B., Knutson, K. L., & Zee, P. C. (2021) · Journal of Clinical Investigation · doi:10.1172/jci148286 · Cited by 468 · see citing works
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Self-citationCrouse, J. J., Ho, N., Scott, J., Parker, R., Park, S. H., Couvy-Duchesne, B., Mitchell, B. L., Byrne, E. M., Hermens, D. F., Medland, S. E., et al. (2022) · European Psychiatry · doi:10.1192/j.eurpsy.2022.23 · Cited by 14 · see citing works
Self-citationAssociation between polarity of first episode and solar insolation in bipolar I disorder
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One-year actigraphy study of sleep and rest-activity rhythms as markers of relapse in depression
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Crouse, J. J., Loblay, V., Jorm, A., Wong, T. R., de Haan, Z., Gorban, C., Shin, M., Tonini, E., Aiken, C., Alloy, L. B., et al. (2026) · Bipolar Disorders · doi:10.1111/bdi.70141 · Cited by 3 · see citing works
Self-citation
- Authors
- Carpenter, J. S., Crouse, J. J., Scott, E. M., Naismith, S. L., Wilson, C., Scott, J., Merikangas, K. R., & Hickie, I. B.
- Affiliations
- The University of Sydney (AU)
- National Institute of Mental Health (US)
- Corresponding author
- Hickie, Ian B.
- ORCID
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2021-07
- Volume
- 126
- Pages
- 79-101
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W3135465928
- Cited by
- 114
- References
- 403
- Citations by year
- 2026: 20 · 2025: 25 · 2024: 27 · 2023: 17 · 2022: 14 · 2021: 11
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institutes of Health
- National Institute of Mental Health (Z01MH002804)
- Topics
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- circadian rhythm disruption, mood disorders, sleep-wake cycle, motor activity, weight gain, bipolarity, antidepressant resistance, inflammation
- MeSH terms
- Bipolar Disorder, Circadian Rhythm, Depression, Humans, Phenotype, Sleep, Mood Disorders
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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