Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression

TY - JOUR

T1 - Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression

AU - Martiny, K

AU - Refsgaard, E

AU - Lund, V.

AU - Lunde, M

AU - Thougaard, B

AU - Lindberg, L.

AU - Bech, P

N1 - © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - OBJECTIVE: To investigate the long-term antidepressant effect of a chronotherapeutic intervention.METHOD: In this randomized controlled trial 75 patients with major depression were allocated to fixed duloxetine and either a chronotherapeutic intervention (wake group) with three initial wake therapies, daily bright light therapy, and sleep time stabilization or to a group using daily exercise. Patients were followed 29 weeks. We report the last 20 weeks, a follow-up phase, where medication could be altered. Patients were assessed every 4 weeks. Remission rates were primary outcome.RESULTS: Patients in the wake group had a statistically significant higher remission rate of 61.9% vs. 37.9% in the exercise group at week 29 (OR = 2.6, CL = 1.3-5.6, P = 0.01). This indicated continued improvement compared with the 9 weeks of treatment response (44.8% vs. 23.4%) with maintenance of the large difference between groups. HAM-D17 endpoint scores were statistically lower in the wake group with endpoint scores of 7.5 (SE = 0.9) vs. 10.1 (SE = 0.9) in the exercise group (difference 2.7, CL = 0.5-4.8, P = 0.02).CONCLUSION: In this clinical study patients continued to improve in the follow-up phase and obtained very high remission rates. This is the first study to show adjunct short-term wake therapy and long-term bright light therapy as an effective and feasible method to attain and maintain remission.

AB - OBJECTIVE: To investigate the long-term antidepressant effect of a chronotherapeutic intervention.METHOD: In this randomized controlled trial 75 patients with major depression were allocated to fixed duloxetine and either a chronotherapeutic intervention (wake group) with three initial wake therapies, daily bright light therapy, and sleep time stabilization or to a group using daily exercise. Patients were followed 29 weeks. We report the last 20 weeks, a follow-up phase, where medication could be altered. Patients were assessed every 4 weeks. Remission rates were primary outcome.RESULTS: Patients in the wake group had a statistically significant higher remission rate of 61.9% vs. 37.9% in the exercise group at week 29 (OR = 2.6, CL = 1.3-5.6, P = 0.01). This indicated continued improvement compared with the 9 weeks of treatment response (44.8% vs. 23.4%) with maintenance of the large difference between groups. HAM-D17 endpoint scores were statistically lower in the wake group with endpoint scores of 7.5 (SE = 0.9) vs. 10.1 (SE = 0.9) in the exercise group (difference 2.7, CL = 0.5-4.8, P = 0.02).CONCLUSION: In this clinical study patients continued to improve in the follow-up phase and obtained very high remission rates. This is the first study to show adjunct short-term wake therapy and long-term bright light therapy as an effective and feasible method to attain and maintain remission.

KW - Adult

KW - Aged

KW - Antidepressive Agents

KW - Combined Modality Therapy

KW - Depressive Disorder, Major

KW - Drug Chronotherapy

KW - Duloxetine Hydrochloride

KW - Exercise

KW - Exercise Therapy

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Phototherapy

KW - Self-Assessment

KW - Sleep

KW - Treatment Outcome

U2 - 10.1111/acps.12402

DO - 10.1111/acps.12402

M3 - Journal article

C2 - 25689725

SN - 0001-690X

VL - 131

SP - 446

EP - 457

JO - Acta Psychiatrica Scandinavica

JF - Acta Psychiatrica Scandinavica

IS - 6

ER -