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Randomized Controlled Trial
. 2023 Dec;64(12):1652-1664.
doi: 10.1111/jcpp.13880. Epub 2023 Aug 17.

Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms

Lauren D Asarnow  1 , Adriane Soehner  2 , Emily Dolsen  1   3   4 , Lulu Dong  5 , Allison G Harvey  6
Affiliations
Randomized Controlled Trial

Report from a randomized control trial: improved alignment between circadian biology and sleep-wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms

Lauren D Asarnow et al. J Child Psychol Psychiatry. 2023 Dec.

Abstract

Study objectives: An evening circadian preference is common among adolescents. It is characterized by a behavioral predilection for later sleep and wake timing and is associated with higher rates of Major Depressive Disorder (MDD). The present study aims to (a) test the effectiveness of a cognitive behavioral sleep intervention (Transdiagnostic Sleep and Circadian Intervention; TranS-C) in a sample of adolescents with an evening circadian preference and clinically significant depressive symptoms and (b) evaluate improved alignment between circadian biology and sleep-wake behavior as a potential mechanism in the relationship between sleep and depression symptom improvement.

Methods: Adolescents with an evening circadian preference and clinically significant depressive symptoms were randomized to receive TranS-C (n = 24) or a psychoeducation condition (PE; n = 18). Alignment between circadian biology and sleep-wake behavior was measured using objective biological measurement. Measures of sleep and circadian rhythm were taken at pre- and posttreatment, and depression symptoms were measured at pre- and posttreatment and 6- and 12-month follow-up.

Results: Mixed effects modeling revealed that compared with an active control condition, TranS-C resulted in a significant reduction in MDD severity at 12-month follow-up. A MacArthur mediation analysis conducted to explore alignment between circadian biology and sleep-wake behavior as a mediator of depression severity reduction through 12-month follow-up revealed a significant interaction between change in alignment between circadian biology and sleep-wake behavior and treatment arm, indicating that improved alignment between circadian biology and sleep-wake behavior at posttreatment was associated with improvements in depression outcomes at 12-month follow-up under the treatment condition.

Conclusions: These results provide novel evidence for improved alignment between circadian biology and sleep-wake behavior as a specific mechanism of depression improvement, provide key clues into the complex relationship between sleep and depression, and have significant clinical implications for adolescents with depression.

Keywords: Depression; adolescents; circadian alignment; dim light melatonin onset; evening circadian preference; sleep intervention.

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Conflict of interest statement

Conflict of interest statement: See Acknowledgements for full disclosures.

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References

    1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. Jun 2005;62(6):593–602. doi:10.1001/archpsyc.62.6.593 - DOI - PubMed
    1. SAMHSA. 2015 National Survey on Drug Use and Health. 2015. https://www.samhsa.gov/samhsa-data-outcomes-quality/major-data-collectio...
    1. Lewinsohn PM, Clarke GN, Seeley JR, Rohde P. Major depression in community adolescents: age at onset, episode duration, and time to recurrence. Journal of the American Academy of Child & Adolescent Psychiatry. 1994;33(6):809–818. - PubMed
    1. Fergusson DM, Woodward LJ. Mental health, educational, and social role outcomes of adolescents with depression. Archives of general psychiatry. 2002;59(3):225–231. - PubMed
    1. Kennard B, Silva S, Vitiello B, et al. Remission and residual symptoms after acute treatment of adolescents with major depressive disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(12):1404–1411. - PubMed

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