Treatment of Depression-Related Circadian Rhythm Sleep-Wake Disorder (CRSWD) With Melatonin Receptor Agonist Ramelteon: A Case Report

Insomnia, also called sleeplessness, is a sleep disorder with very diverse sleep problems and is classified into seven categories. Circadian rhythm sleep-wake disorder (CRSWD) is a type of insomnia characterized by the misalignment of the body's circadian clock with the external 24-hour environmental cycle. CRSWD encompasses seven subtypes, among which delayed sleep-wake phase disorder (DSWPD) is prominently recognized for its impact on sleep patterns. Sleep disturbances, particularly insomnia, are prevalent in depressed patients, often serving as a primary symptom that prompts clinical consultation. CRSWD frequently leads to significant social dysfunction, often making it impossible for students to attend school and difficult for working adults to find employment. Effective treatments for CRSWD include bright light therapy, cognitive-behavioral therapy for insomnia (CBT-I), and melatonin receptor agonists, particularly for certain CRSWD subtypes. In this case report, the melatonin receptor agonist ramelteon was administered to a high school student with DSWPD and comorbid depression, resulting in the successful management of symptoms. Following treatment, the patient resumed high school, pursued a university education, and secured employment post-graduation. These findings indicate that ramelteon may be a promising treatment option for CRSWD in patients with comorbid depression, warranting further clinical investigation.