Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial

Signe Dunker Svendsen; Anne Sofie Aggestrup; Lasse Benn Nørregaard; Philip Løventoft; Anne Præstegaard; Konstantin V. Danilenko; Mads Frost; Ulla Knorr; Ida Hageman; Lars Vedel Kessing; Klaus Martiny

doi:10.1186/s12888-019-2101-z

Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial

Signe Dunker Svendsen, Anne Sofie Aggestrup, Lasse Benn Nørregaard, Philip Løventoft, Anne Præstegaard, Konstantin V. Danilenko, Mads Frost, Ulla Knorr, Ida Hageman, Lars Vedel Kessing, Klaus Martiny

Institut for Klinisk Medicin

6 Citationer (Scopus)

11 Downloads (Pure)

Abstract

Background: The transition phase from inpatient to outpatient care for patients suffering from Major Depressive Disorder represents a vulnerable period associated with a risk of depression worsening and suicide. Our group has recently found that the sleep-wake cycle in discharged depressive patients became irregular and exhibited a drift towards later hours, associated with worsening of depression. In contrast, an advancement of sleep phase has earlier been shown to have an antidepressant effect. Thus, methods to prevent drift of the sleep-wake cycle may be promising interventions to prevent or reduce worsening of depression after discharge. Methods: In this trial, we apply a new treatment intervention, named Circadian Reinforcement Therapy (CRT), to patients discharged from inpatient psychiatric wards. CRT consists of a specialized psychoeducation on the use of regular time signals (zeitgebers): Daylight exposure, exercise, meals, and social contact. The aim is to supply stronger and correctly timed zeitgebers to the circadian system to prevent sleep drift and worsening of depression. The CRT is used in combination with an electronic self-monitoring system, the Monsenso Daybuilder System (MDB). By use of the MDB system, all patients self-monitor their sleep, depression level, and activity (from a Fitbit bracelet) daily. Participants can inspect all their data graphically on the MDB interface and will have clinician contact. The aim is to motivate patients to keep a stable sleep-wake cycle. In all, 130 patients referred to an outpatient service will be included. Depression rating is blinded. Patients will be randomized 1:1 to a Standard group or a CRT group. The intervention period is 4 weeks covering the transition phase from inpatient to outpatient care. The primary outcome is score change in interviewer rated levels of depression on the Hamilton Depression Rating Scale. A subset of patients will be assessed with salivary Dim Light Melatonin Onset (DLMO) as a validator of circadian timing. The trial was initiated in 2016 and will end in 2020. Discussion: If the described intervention is beneficial it could be incorporated into usual care algorithms for depressed patients to facilitate a better and safer transition to outpatient treatment.

Originalsprog	Dansk
Artikelnummer	124
Tidsskrift	BMC Psychiatry
Vol/bind	19
Udgave nummer	1
Sider (fra-til)	1-11
Antal sider	11
ISSN	1471-244X
DOI	https://doi.org/10.1186/s12888-019-2101-z
Status	Udgivet - 25 apr. 2019

Emneord

Chronotherapeutics
Clinician feedback loop
Electronic self-monitoring
Light
Major depressive disorder
Outpatient treatment
Psychoeducation
Sleep

Adgang til dokumentet

10.1186/s12888-019-2101-zLicens: CC BY

s12888-019-2101-zForlagets udgivne version, 1,4 MBLicens: CC BY

Citationsformater

Dunker Svendsen, S., Aggestrup, A. S., Nørregaard, L. B., Løventoft, P., Præstegaard, A., Danilenko, K. V., Frost, M., Knorr, U., Hageman, I., Vedel Kessing, L., & Martiny, K. (2019). Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial. BMC Psychiatry, 19(1), 1-11. [124]. https://doi.org/10.1186/s12888-019-2101-z

Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep : protocol of a randomized controlled trial. / Dunker Svendsen, Signe; Aggestrup, Anne Sofie; Nørregaard, Lasse Benn et al.

I: BMC Psychiatry, Bind 19, Nr. 1, 124, 25.04.2019, s. 1-11.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Dunker Svendsen, S, Aggestrup, AS, Nørregaard, LB, Løventoft, P, Præstegaard, A, Danilenko, KV, Frost, M, Knorr, U , Hageman, I , Vedel Kessing, L & Martiny, K 2019, 'Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial', BMC Psychiatry, bind 19, nr. 1, 124, s. 1-11. https://doi.org/10.1186/s12888-019-2101-z

Dunker Svendsen S, Aggestrup AS, Nørregaard LB, Løventoft P, Præstegaard A, Danilenko KV et al. Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial. BMC Psychiatry. 2019 apr. 25;19(1):1-11. 124. doi: 10.1186/s12888-019-2101-z

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AU - Dunker Svendsen, Signe

AU - Aggestrup, Anne Sofie

AU - Nørregaard, Lasse Benn

AU - Løventoft, Philip

AU - Præstegaard, Anne

AU - Danilenko, Konstantin V.

AU - Frost, Mads

AU - Knorr, Ulla

AU - Hageman, Ida

AU - Vedel Kessing, Lars

AU - Martiny, Klaus

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N2 - Background: The transition phase from inpatient to outpatient care for patients suffering from Major Depressive Disorder represents a vulnerable period associated with a risk of depression worsening and suicide. Our group has recently found that the sleep-wake cycle in discharged depressive patients became irregular and exhibited a drift towards later hours, associated with worsening of depression. In contrast, an advancement of sleep phase has earlier been shown to have an antidepressant effect. Thus, methods to prevent drift of the sleep-wake cycle may be promising interventions to prevent or reduce worsening of depression after discharge. Methods: In this trial, we apply a new treatment intervention, named Circadian Reinforcement Therapy (CRT), to patients discharged from inpatient psychiatric wards. CRT consists of a specialized psychoeducation on the use of regular time signals (zeitgebers): Daylight exposure, exercise, meals, and social contact. The aim is to supply stronger and correctly timed zeitgebers to the circadian system to prevent sleep drift and worsening of depression. The CRT is used in combination with an electronic self-monitoring system, the Monsenso Daybuilder System (MDB). By use of the MDB system, all patients self-monitor their sleep, depression level, and activity (from a Fitbit bracelet) daily. Participants can inspect all their data graphically on the MDB interface and will have clinician contact. The aim is to motivate patients to keep a stable sleep-wake cycle. In all, 130 patients referred to an outpatient service will be included. Depression rating is blinded. Patients will be randomized 1:1 to a Standard group or a CRT group. The intervention period is 4 weeks covering the transition phase from inpatient to outpatient care. The primary outcome is score change in interviewer rated levels of depression on the Hamilton Depression Rating Scale. A subset of patients will be assessed with salivary Dim Light Melatonin Onset (DLMO) as a validator of circadian timing. The trial was initiated in 2016 and will end in 2020. Discussion: If the described intervention is beneficial it could be incorporated into usual care algorithms for depressed patients to facilitate a better and safer transition to outpatient treatment.

AB - Background: The transition phase from inpatient to outpatient care for patients suffering from Major Depressive Disorder represents a vulnerable period associated with a risk of depression worsening and suicide. Our group has recently found that the sleep-wake cycle in discharged depressive patients became irregular and exhibited a drift towards later hours, associated with worsening of depression. In contrast, an advancement of sleep phase has earlier been shown to have an antidepressant effect. Thus, methods to prevent drift of the sleep-wake cycle may be promising interventions to prevent or reduce worsening of depression after discharge. Methods: In this trial, we apply a new treatment intervention, named Circadian Reinforcement Therapy (CRT), to patients discharged from inpatient psychiatric wards. CRT consists of a specialized psychoeducation on the use of regular time signals (zeitgebers): Daylight exposure, exercise, meals, and social contact. The aim is to supply stronger and correctly timed zeitgebers to the circadian system to prevent sleep drift and worsening of depression. The CRT is used in combination with an electronic self-monitoring system, the Monsenso Daybuilder System (MDB). By use of the MDB system, all patients self-monitor their sleep, depression level, and activity (from a Fitbit bracelet) daily. Participants can inspect all their data graphically on the MDB interface and will have clinician contact. The aim is to motivate patients to keep a stable sleep-wake cycle. In all, 130 patients referred to an outpatient service will be included. Depression rating is blinded. Patients will be randomized 1:1 to a Standard group or a CRT group. The intervention period is 4 weeks covering the transition phase from inpatient to outpatient care. The primary outcome is score change in interviewer rated levels of depression on the Hamilton Depression Rating Scale. A subset of patients will be assessed with salivary Dim Light Melatonin Onset (DLMO) as a validator of circadian timing. The trial was initiated in 2016 and will end in 2020. Discussion: If the described intervention is beneficial it could be incorporated into usual care algorithms for depressed patients to facilitate a better and safer transition to outpatient treatment.

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KW - Clinician feedback loop

KW - Electronic self-monitoring

KW - Light

KW - Major depressive disorder

KW - Outpatient treatment

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KW - Sleep

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