Virtual Darkness as Additive Treatment in Mania (VATMAN)

Virtual Darkness as Additive Treatment in Mania- a Randomized Controlled Trial

In this randomized controlled study we will investigate the effect of blue-blocking goggles or screens (virtual darkness therapy) on manic symptoms in bipolar disorder compared to placebo. This 3-armed study includes 2 patient-groups and a non-bipolar control-group. The main hypothesis is that virtual darkness therapy is effective as additive treatment in mania.Other hypotheses are that virtual darkness therapy has significant effects on sleep, motor activity, circadian rhythm and mood also in the non-bipolar control-group.

Study Overview

• Status: Completed
• Conditions: Bipolar Disorder; Mania
• Intervention / Treatment: Device: Blue-blocking goggles/screens; Device: Clear-lensed goggles

Detailed Description

Recent discoveries in neurophysiology has shown that "virtual darkness" is achievable by blocking blue wavelengths of light (Phelps, 2007). A newly discovered retinal photoreceptor called the Intrinsically photoresponsive retinal ganglion-cell (IpRGC) whose fibers directly synapses with the suprachiasmatic nucleus (SCN), responds only to a narrow band of wavelengths with highest sensitivity between 446 and 484 nm (Brainard et al., 2001; Berson 2007). Amber tinted goggles preserve normal nocturnal melatonin levels in light environments, which means that blocking of the blue wavelengths is perceived as virtual darkness to the SCN (Kayumov, 2005; Sasseville, 2006).

In this randomized controlled study we will investigate the effect of blue-blocking goggles or screens (virtual darkness therapy) on manic symptoms in bipolar disorder compared to placebo. The general feasibility of the method both in research and treatment will be evaluated. This is a multi-site study covering Helse Fonna Local Health Authority's catchment area wich serves a population of 120000 adults. This 3-armed study includes 2 patient-groups and a non-bipolar control-group. The main hypothesis is that virtual darkness therapy is effective as additive treatment in mania.Other hypotheses are that virtual darkness therapy has significant effects on sleep, motor activity, circadian rhythm and mood also in the non-bipolar control-group. The study may contribute to develop a supplement to the current treatment in mania and may also generate new hypotheses about the underlying pathophysiological mechanisms in bipolar disorder.

• Study Type: Interventional
• Enrollment (Actual): 69
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Norway
  • Haugesund, Norway, 5521
    • Haugesund Hospital and Haugaland District Psychiatric Hospital
  • Valen, Norway, 5451
    • Valen Hospital and Folgfonn District Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

PATIENT GROUPS

Inclusion Criteria:

• Inpatients
• Diagnosis of DSM IV-TR of Bipolar I or Bipolar II disorder with current manic episode as verified by the semistructured interview MINI plus
• Ability to comply with the protocol
• Willingness to participate in the study
• Delayed written informed consent at discharge

Exclusion Criteria:

• Inability to comply with the protocol
• Severe retinal damage, cataract or corneal damage on both eyes
• Daily use of NSAIDS
• Daily use of betablockers
• Daily use of calcium-antagonists

NON-BIPOLAR CONTROLS

Inclusion Criteria:

• Written informed consent

Exclusion Criteria:

• Working night shift
• Diagnosed with bipolar disorder or single manic episode
• Severe retinal damage, cataract or corneal damage on both eyes
• Daily use of alcohol
• Daily use of benzodiazepines
• Daily use of NSAIDS
• Daily use of betablockers
• Daily use of calcium-antagonists

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Patient-group blue-blockers; N= 21 Blue-blocking goggles/screens from 6 p.m. to 08 a.m. in addition to treatment as usual (TAU). The goggles may be taken of when going to bed and turning of the light. For consenting patients who are unable to use goggles according to the protocol blue-blocking screens covering light-sources will be used.	Device: Blue-blocking goggles/screens; Goggles with amber tinted lenses, all model's transmittance spectra are identical. Goggles and screens are tested at Department of Physics and Technology, University of Bergen. Patients and non-bipolar controls choose model for best comfort.; Other Names: Goggles from LowBlueLights.com, several different designs; Screens from Ganta Trading 047 Orange-red
Placebo Comparator: Patient group clear-lensed goggles; N= 21 (Patient group) clear-lensed goggles from 06 p.m. to 08 a.m. in addition to TAU.	Device: Clear-lensed goggles; Clear lensed safety eyewear. Patients may choose model for best comfort.; Other Names: Uvex Genesis; Cocraft Safety Glasses 40-7362; 3M Refine 300 PC AS/AF
Experimental: Non-bipolar control-group blue-blockers; N= 42 For baseline day 1-7: Actiwatch Spectrum worn at the wrist of dominant hand, day 8-14 continued wearing of Actiwatch spectrum + blue-blocking goggles from 6 p.m. to 08 a.m. In addition to selfreport forms described in the outcome section self report forms Horne-Ostberg Morningness-Eveningness Questionaire (HOMEQ)and Seasonal Pattern Assessment Questionaire (SPAQ).	Device: Blue-blocking goggles/screens; Goggles with amber tinted lenses, all model's transmittance spectra are identical. Goggles and screens are tested at Department of Physics and Technology, University of Bergen. Patients and non-bipolar controls choose model for best comfort.; Other Names: Goggles from LowBlueLights.com, several different designs; Screens from Ganta Trading 047 Orange-red

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Young Mania Rating Scale (YMRS) score	The YMRS-score is assessed daily at 12 a.m. for 7 days	Change from baseline in YMRS score after 7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in motor activity measured by use of actigraphy, Actiwatch Spectrum device	Patient-groups wear Actiwatch Spectrum for 7 days. Non-bipolar controls wear Actiwatch Spectrum for 14 days (day 1-7 for baseline, day 8-14 with intervention)	Change in motor activity over 7 days ( patients) or 14 days ( non-bipolar controls) .

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
For the non-bipolar control-group: self report forms Mood Visual Analog Scale, Positive And Negative Affect Schedule and Sleep Diary		14 days
Self-report form for patient's experience.	Self report form developed for the trial for patients experience with the intervention, wearing of Actiwatch Spectrum and general participation in the trial, and section for other comments.	At discharge
Self report form for non-bipolar controls on experience with intervention	3 questions: 1)Did you notice any change during the intervention? 2)If yes in question 1)When did you first notice any change? 3)If yes in question 1)Describe the experience in own words	At end of intervention, day 14

Collaborators and Investigators

• Sponsor: Helse Fonna
• Collaborators: University of Bergen; Helse Vest; Moodnet
• Investigators: Study Director: Anders Lund, PhD, University of Bergen, Moodnet

Publications and helpful links

General Publications

• Sasseville A, Paquet N, Sevigny J, Hebert M. Blue blocker glasses impede the capacity of bright light to suppress melatonin production. J Pineal Res. 2006 Aug;41(1):73-8. doi: 10.1111/j.1600-079X.2006.00332.x.
• Berson DM. Phototransduction in ganglion-cell photoreceptors. Pflugers Arch. 2007 Aug;454(5):849-55. doi: 10.1007/s00424-007-0242-2. Epub 2007 Mar 10.
• Brainard GC, Hanifin JP, Greeson JM, Byrne B, Glickman G, Gerner E, Rollag MD. Action spectrum for melatonin regulation in humans: evidence for a novel circadian photoreceptor. J Neurosci. 2001 Aug 15;21(16):6405-12. doi: 10.1523/JNEUROSCI.21-16-06405.2001.
• Phelps J. Dark therapy for bipolar disorder using amber lenses for blue light blockade. Med Hypotheses. 2008;70(2):224-9. doi: 10.1016/j.mehy.2007.05.026. Epub 2007 Jul 16.
• Kayumov L, Casper RF, Hawa RJ, Perelman B, Chung SA, Sokalsky S, Shapiro CM. Blocking low-wavelength light prevents nocturnal melatonin suppression with no adverse effect on performance during simulated shift work. J Clin Endocrinol Metab. 2005 May;90(5):2755-61. doi: 10.1210/jc.2004-2062. Epub 2005 Feb 15.

Study record dates

Study Major Dates

• Study Start: February 1, 2012
• Primary Completion (Actual): February 1, 2015
• Study Completion (Actual): March 1, 2015

Study Registration Dates

• First Submitted: March 22, 2013
• First Submitted That Met QC Criteria: March 22, 2013
• First Posted (Estimate): March 26, 2013

Study Record Updates

• Last Update Posted (Estimate): March 19, 2015
• Last Update Submitted That Met QC Criteria: March 18, 2015
• Last Verified: March 1, 2015

More Information

Terms related to this study

• Keywords: Randomized controlled trial; Mania; Bipolar disorder; Actigraphy; Blue-blockers; Virtual darkness therapy
• Additional Relevant MeSH Terms: Mental Disorders; Nervous System Diseases; Neurologic Manifestations; Neurobehavioral Manifestations; Bipolar and Related Disorders; Bipolar Disorder; Mania
• Other Study ID Numbers: 911678; 2011/1668 (Other Identifier: Regional Ethics Committee North)