Etiology, pathogenesis, and treatment of seasonal and non-seasonal mood disorders: possible role of circadian rhythm abnormalities related to developmental alcohol exposure.

Developmental alcohol exposure adversely influences the developing brain. Alcohol exposure during rapid brain growth causes cell loss, alters connections between brain regions, and lowers the production of biological substances responsible for the communication among neurons. It is reasonable to suggest that alcohol may adversely affect the development of suprachiasmatic nuclei (SCN), the master circadian pacemaker. Multiple research reports suggest that abnormalities in circadian rhythms are involved in the etiopathogenesis of seasonal affective disorder (SAD), a syndrome in which depression develops during autumn or winter and remits the following spring or summer. Several lines of evidence suggest that changes in the circadian system are also involved in the development of nonseasonal mood disorders, such as major depression and bipolar disorder. Thus, developmental alcohol exposure produces subtle abnormalities in circadian rhythms that may contribute to the development of seasonal and nonseasonal mood disorders. Pharmacological, psychological, and light treatments of mood disorders have multiple effects on circadian function. The state of the circadian system may affect a response to treatment. Circadian rhythms have been reported for neurotransmitters, receptors, enzymes, and the second messenger system in the brain that are involved in the effects of treatments. Some of these rhythms have amplitudes as large as several 100%. Effects of many psychotropic medications depend on the time of administration in relation to body rhythmicity. Therefore, subtle circadian rhythm abnormalities related to developmental alcohol exposure may affect treatment response in patients with mood disorders.