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The mechanisms of action involve modulation of sleep-regulating neurotransmitters and neuroendocrine systems including enhancement of delta wave activity during deep sleep stages, regulation of cortisol and stress hormone rhythms that impact sleep quality, optimization of circadian rhythm signaling for proper sleep-wake cycles, support for melatonin and sleep-promoting pathways, and modulation of pain perception which can interfere with sleep quality

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They also might be receiving other types of treatment such as chemotherapy or radiation therapy before or after the operation

Waiting at least four weeks before judging antidepressant effectiveness is important