Improved Sleep Habits for Adolescent Depression

(MoDA Trial)

Overseen By Amanda Johnson

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: University of Oregon

Must not be taking: Neuroleptics, Psoralen, Antiarrhythmics, others

Disqualifiers: Alcohol/substance use disorder, Narcolepsy, Bipolar, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

Duration: 8 weeks

150 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you must stop taking your current medications, but it mentions that you should not begin or end a prescribed medication within 2 months of the study, and there should be no changes in medication dosing during the study. If you use melatonin, you must stop using it for the duration of the study.

What data supports the effectiveness of the treatment for improved sleep habits in adolescent depression?

Research shows that cognitive-behavioral sleep interventions can improve sleep quality and reduce depression symptoms in adolescents. A study found that combining sleep-focused cognitive behavioral therapy with depression treatment led to better sleep and faster recovery from depression. ^{1 2 3 4 5}

Is improving sleep habits safe for adolescents?

The research does not provide specific safety data for improving sleep habits in adolescents, but it generally suggests that addressing sleep issues can be beneficial for mood and depression without indicating any safety concerns. ^{2 3 4 6 7}

How does the treatment for improved sleep habits differ from other treatments for adolescent depression?

This treatment is unique because it focuses on improving sleep through interventions like bright light therapy, melatonin, and cognitive-behavioral therapy for insomnia (CBT-I), which can help alleviate depression symptoms by addressing sleep issues that often precede depression. ^{1 2 3 4 8}

What is the purpose of this trial?

This research will use biobehavioral approaches to generate understanding about the linkages between sleep duration and timing, stressful life events, and depressive symptoms in adolescents, with a long-term aim of developing effective preventative interventions.

Research Team

Melynda D Casement, PhD

Principal Investigator

University of Oregon

Eligibility Criteria

Adolescents aged 14-19, currently in high school with fluent English skills. They must have experienced significant stress (score >4 on STRAIN) and exhibit certain sleep patterns: either short/late or long/early as per the Munich Chronotype Questionnaire. Participants should also show depressive symptoms but not have severe psychiatric disorders, substance abuse issues, or conditions that conflict with study procedures.

Inclusion Criteria

I either sleep less than 7 hours and go to bed after 10:30 PM, or I sleep 7 hours or more and go to bed by 10:30 PM.

Lifetime stressful event frequency ≥ 2 on the Stress and Adversity Inventory (STRAIN) Screener

I am a high school student.

Exclusion Criteria

Current sleep disorders other than insomnia, delayed sleep phase, or hypersomnia, determined by the Structured Clinical Interview for DSM-5 Sleep Disorders

Urgent suicide risk, defined by moderate/severe risk as per Columbia Suicide Severity Rating (CSSR) Community Card, and clinician determination that current risk requires immediate action, precluding engagement in study

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for current moderate to severe alcohol/substance use disorder (≥4 symptoms)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo sleep manipulation with either the 'Lark Routine' or 'Owl Routine' to evaluate changes in reward- and stress-related brain function

8 weeks

Weekly visits for monitoring and assessments

Follow-up

Participants are monitored for changes in depressive symptoms and anhedonia after the treatment phase

4 weeks

2 visits (in-person)

Treatment Details

Interventions

• Regular sleep duration and timing
• Sleep extension and advance

Trial Overview The trial is exploring how changing sleep patterns can affect depression and lack of pleasure (anhedonia) in teenagers. It involves adjusting their sleep to be longer and earlier or maintaining regular sleep duration/timing while examining brain function related to stress and reward.

Participant Groups

Group I: Sleep extension and advance "Lark Routine" Experimental Treatment 1 Intervention

Participants go to bed 90 minutes earlier than their typical average bedtime to extend sleep duration and advance sleep timing

Group II: Regular sleep duration and timing "Owl Routine" Active Control 1 Intervention

Participants go to bed at their typical average bedtime

Who Is Running the Clinical Trial?

University of Oregon

Lead Sponsor

Trials

91

Recruited

46,700+

Oregon Research Institute

Collaborator

Trials

87

Recruited

62,600+

University of Pittsburgh

Collaborator

Trials

1,820

Recruited

16,360,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

Emerging evidence indicates that sleep difficulties in adolescents may precede the onset of depression, suggesting a complex relationship where sleep issues can contribute to the development of depressive symptoms.

The review highlights various contributors to sleep problems in adolescents, such as delayed circadian rhythms and restricted sleep duration, and recommends evidence-based interventions like bright light therapy and cognitive-behavioral techniques to improve sleep and alleviate depression symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sleep's role in the development and resolution of adolescent depression. Gradisar, M., Kahn, M., Micic, G., et al.[2022]

In a study involving 41 youth aged 12-20, combining cognitive behavioral therapy for insomnia (CBT-I) with standard depression treatment (CBT-D) led to significant improvements in sleep and depression outcomes, including a 99-minute increase in total sleep time by week 12.

The experimental group receiving CBT-I showed faster recovery rates and a higher percentage of participants recovering from depression compared to those receiving only sleep hygiene control, indicating that addressing sleep issues can enhance depression treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral treatment of insomnia and depression in adolescents: A pilot randomized trial. Clarke, G., McGlinchey, EL., Hein, K., et al.[2018]

In a study involving 23 adolescents with major depressive disorder and 23 normal controls, those with depression exhibited significantly shorter REM sleep latencies, indicating a potential disruption in their sleep patterns (P = 0.005).

Additionally, the depressed adolescents had longer sleep latencies compared to the controls (P = 0.04), suggesting that they took longer to fall asleep, which may be an important factor in understanding sleep disturbances associated with adolescent depression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

REM latency in endogenously depressed adolescents. Kutcher, S., Williamson, P., Marton, P., et al.[2019]

In a study involving 10 adolescents with major depression and 10 controls, no significant differences in sleep patterns were found between the two groups, suggesting that sleep disturbances seen in adults with depression may not be present in adolescents.

The findings indicate that abnormalities in REM sleep characteristics, such as latency and density, which are common in adult depression, do not appear to affect adolescents, highlighting potential developmental differences in how depression manifests in younger individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Polysomnographic findings in adolescents with major depression. Khan, AU., Todd, S.[2019]

Adolescent cognitive-behavioral sleep interventions significantly improved subjective total sleep time by about 29.5 minutes and reduced sleep onset latency by approximately 21.4 minutes, indicating their efficacy in enhancing sleep quality among adolescents.

The interventions also led to improvements in global sleep quality, daytime sleepiness, and symptoms of depression and anxiety, suggesting a broader positive impact on mental health, although more high-quality randomized controlled trials are needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Systematic Review and Meta-analysis of Adolescent Cognitive-Behavioral Sleep Interventions. Blake, MJ., Sheeber, LB., Youssef, GJ., et al.[2020]

About 46% of Swedish adolescents sleep less than the recommended eight hours on weekdays, with this number rising to 68% among those with clinically relevant depression, indicating a strong link between insufficient sleep and depression.

Shorter weekday sleep duration, poor sleep quality, and a late chronotype are significant predictors of depression in adolescents, suggesting that interventions like later school start times could help improve mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents. Lemke, T., Hökby, S., Wasserman, D., et al.[2023]

A study involving 55 adolescents with chronic sleep reduction showed that gradual sleep extension, combined with sleep hygiene advice, significantly improved sleep duration and quality, leading to earlier bedtimes and reduced insomnia symptoms.

Participants in the sleep extension group also experienced a notable decrease in depressive symptoms, suggesting that improving sleep can positively impact mood in adolescents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial. Dewald-Kaufmann, JF., Oort, FJ., Meijer, AM.[2015]

The authors propose that addressing insomnia through cognitive behavioral therapy could enhance the effectiveness of traditional depression treatments in youth, as sleep issues are linked to higher depression risk and can hinder treatment success.

This approach is based on existing research and aims to improve the modest response and remission rates seen in current youth depression treatments, highlighting the importance of sleep in mental health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The complex role of sleep in adolescent depression. Clarke, G., Harvey, AG.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Sleep's role in the development and resolution of adolescent depression. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Cognitive-behavioral treatment of insomnia and depression in adolescents: A pilot randomized trial. [2018]

3. England pubmed.ncbi.nlm.nih.gov

REM latency in endogenously depressed adolescents. [2019]

4. Ireland pubmed.ncbi.nlm.nih.gov

Polysomnographic findings in adolescents with major depression. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Systematic Review and Meta-analysis of Adolescent Cognitive-Behavioral Sleep Interventions. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents. [2023]

7. England pubmed.ncbi.nlm.nih.gov

The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: a randomized controlled trial. [2015]

8. United States pubmed.ncbi.nlm.nih.gov

The complex role of sleep in adolescent depression. [2021]