Depressive symptoms associated with changes in circadian rhythms. Concordance in perception between doctor and patient, clinical impact and its response to current antidepressant drugs.

This is a descriptive, transversal and multicenter study using self-administered surveys concurrently to collect the opinions of two groups (psychiatrists and patients) and discuss their disagreements. The scope of study are hospital services, outpatient centers, individual professional consultation and other assistance system, public or private, which provides psychiatric care in Spain. Participated in this study 319 psychiatrists and 957 patients with the diagnosis of depression, stratified by autonomous communities. The populations they are intended to infer the results of this study were all patients diagnosed with depression and antidepressant treatment, and the group of specialists in psychiatry responsible for clinical monitoring at the national level. In the study sample, depressive symptoms related to circadian rhythms are very common: they are perceived by more than 65% of patients surveyed, except the «early morning awakening insomnia» (54%) and «fatigue, anergy and unresponsiveness» (37%). In general, and endorsing the study hypothesis, the prevalence of almost all analyzed depressive symptoms is significantly underestimated by psychiatrists about the perception of the patients themselves. Only the presence of «fatigue, anergy and unresponsiveness» is more often observed by professionals than by patients, perhaps by nature be of particular somatic symptoms that may suggest to the clinician to rule out underlying organic pathology. In light of the results presented it is concluded that disturbances in circadian rhythms are core aspects of depression and frequent cause of key symptoms and residual symptoms of patients in treatment. These disorders appear to be underestimated by professionals and only partially solved with existing antidepressant drugs.