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The circadian rhythm sleep disorders define the clinical conditions where sleep and ndash;wake rhythm is disrupted despite optimum environmental and social conditions. They occur as a result of the changes in endogenous circadian hours or non-compatibility of environmental factors or social life with endogenous circadian rhythm. The sleep and ndash;wake rhythm is disrupted continuously or in repeating phases depending on lack of balance between internal and external cycles. This condition leads to functional impairments which cause insomnia, excessive sleepiness or both in people. Application of detailed sleep anamnesis and sleep diary with actigraphy record, if possible, will be sufficient for diagnosis. The treatment aims to align endogenous circadian rhythm with environmental conditions. The purpose of this article is to review pathology, clinical characteristics, diagnosis and treatment of circadian rhythm disorder. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2016; 8(2): 178-189]

The aim was to assess the combination therapy of nitric oxide synthase inhibitors and melatonin, since they had been separately shown to be as efficacious as conventional antidepressant drugs in pre-clinical antidepressant screening procedures.The Porsolt swim test was conducted to resemble the symptornatolog of major depressive disorder and an open-filed locomotor activity was also used.N(G)-nitro-L-arginine (L-NNA) at 3 mg/kg slightly, but not significantly, reduced the duration of immobility, and increasing the dose to 10 mg/kg was sufficient to attain a significant reduction. On the other hand, the maximal dose of L-NNA (30 mg/kg) was without effect, although a non-significant small increase was observed. The results obtained with L-NNA were in accorldance with a U-shape effect. While 3 mg/kg melatonin was ineffective, a statistically significant decrease in the duration of immobility was determined at the dose of 10 mg/kg. While the combination of ineffective doses (3 mg/kg, each) of L-NNA and melatonin revealed no further inhibition in the duration of immobility, the most effective doses (10 mg/kg, each) caused a more pronounced reduction when compared with those of each drug alone. None of the drugs used in the present study had any effects on locomotor activity over the dose range applied.The combination therapy with L-NNA and melatonin seems to have an additive effect and may be considered as a feasible candidate in attenuating the symptoms of major depressive disorder.