Is it possible to change the chronotype? A prospective study in hospitalized patients with non-seasonal depression

Sleep Med. 2025 Apr 30;132:106546. doi: 10.1016/j.sleep.2025.106546. Online ahead of print.

ABSTRACT

BACKGROUND: This study aimed to investigate the prospective change of chronotype in hospitalized patients with non-seasonal major depressive episode.

METHODS: A total of 114 adult psychiatric inpatients were recruited. Assessments were conducted upon admission and repeated upon discharge from the hospital, which included a structural clinical interview of depressive symptoms (17-HDS), the Morningness-Eveningness Questionnaire (MEQ), self-rated measures for insomnia, suicidality and biological rhythm, and morning urinary 6-sulfatoxymelatonin (aMT6s). The morning affect factor (MA) was extracted from the MEQ item 4,5,7 and the sub-score of the rest of the items was denoted as the timing-preference factor (TF). Changes of the MEQ metrics and clinical outcomes among the chronotypes were compared by ANOVA and linear mixed models. The associations between the prospective changes of MA, TF and aMT6s with depression severity were assessed by repeated measures correlations (r_m).

RESULTS: Baseline evening-types had the greatest advance in sleep timings and 47 % changed to an earlier chronotype. Clinical measures improved in all groups with no significant chronotype∗time interaction. MA improved with time and showed significant correlation with the change in depression severity (r_m = -0.37, p < 0.005). Despite an advancement of behavioral sleep timings and improvement of depression, TF and aMT6s levels did not change with time nor correlated with depression severity.

CONCLUSIONS: The improvement of morning affect contributed to the change of chronotype in depression. In-patient psychiatric treatment with early ward routines advanced the sleep-wake schedule but did not change the individual timing preference. Adjunctive chronobiological treatment should be considered for those with persistent vulnerability to circadian misalignment.

PMID:40328186 | DOI:10.1016/j.sleep.2025.106546