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group (Allison, Grilo, Masheb, & Stunkard, 2005). Depressed mood is a significant marker of NES, but is not present in all cases (Allison et al., 2009). In fact, depressed mood commonly co- occurs in those that suffer with eating disorders in general (Cooper & Fairburn, 1986). Etiology of NES The cause of NES is unknown, but it is hypothesized to develop from a complex interplay of genetic liability (Root et al., 2010; Lundgren, Allison, & Stunkard, 2006), stress (Vander Wal, 2011), and biobehavioral mechanisms (Stunkard, Allison, Lundgren, & O’Reardon, 2009). The serotonin system has been implicated in the development and maintenance of NES in part because of its role in the synthesis of melatonin, a circadian hormone involved in the regulation of the sleep wake cycle (Stunkard et al., 2009), but also because the primary pharmacotherapy for NES (sertraline; Stunkard et al., 2009) works via the serotonin system. A central feature of both the conceptualization of NES and the hypothesized etiology is that, at its core, NES is a disorder of circadian delayed food intake. Whether that is caused by biological or environmental factors or both is still unknown. The literature on circadian rhythm and eating behavior, especially animal models of circadian delayed eating behavior and obesity, are informative in understanding both the etiology of NES and potential treatments. Below is an overview of circadian rhythm and the animal literature which can be used as a model for the development and maintenance of NES in humans. Circadian Rhythms: An Overview Circadian rhythms regulate the sleep and feeding cycle in living organisms, including humans, plants, animals, fungi, and cyanobacteria (Silva, Santo, & Margolis, 2010). Circadian rhythms follow an approximate 24-hour cycle that is typically synchronized, or entrained, with the light/dark cycle. Circadian rhythms can be entrained to other cues, like the intake of food, 10PDF Image | BRIGHT LIGHT THERAPY FOR late NIGHT EATING SYNDRome
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