- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02053649
Integrated Chronotherapy for Perinatal Depression
May 24, 2019 updated by: Katherine M. Sharkey, Rhode Island Hospital
Perinatal depression is a common and serious mood disorder that increases morbidity and mortality in new mothers and results in poor infant/child outcomes.
Current therapies often fail to produce recovery or are poorly tolerated and many pregnant women seek non-pharmacologic therapy or forgo treatment when non-pharmacologic options are not available.
Expectant and new mothers who suffer from circadian rhythm disruption are at risk for perinatal depression.
This R34 Pilot Effectiveness Studies and Services Research Grant seeks to test whether an Integrated Chronotherapy (IC) intervention can be implemented in an outpatient psychiatry setting to improve treatment outcomes for patients with perinatal depression.
IC is a multicomponent treatment consisting of bright light therapy, sleep phase advance, and sleep stabilization/restriction that targets the Research Domain Criteria (RDoC) constructs of circadian rhythms, sleep-wake behavior, social rhythms, and arousal.
We will assess the feasibility, safety, and acceptability of an IC intervention for perinatal depressin by testing the treatment in expectant mothers diagnosed with major depressive disorder during 3rd trimester of pregnancy.
We will randomize patients to either: (a) usual care (UC, n = 20) or (b) IC+UC (n = 20).
IC+UC will have pregnancy and postpartum components and will be administered via an individualized case formulation approach tailored to each patient.
After a baseline assessment, IC will be prescribed during 5 dedicated clinical visits: three during 3rd trimester of pregnancy and 2 in the postpartum period.
UC will consist of medication administered by a perinatal psychiatrist and/or psychotherapy.
UC will be quantified in both groups to evaluate differences between the IC+UC and UC groups.
Mood will be measured in both groups by blinded clinician interview and patient self-report.
We will assess the safety profile of the IC intervention with evaluation of side effects/adverse events.
Importantly, the study will also examine the putative mechanisms by which IC is hypothesized to work and the "dose" of IC received by patients in the IC+UC group.
All participants will wear wrist actigraphy/light monitors continuously during weeks 28-40 of pregnancy and postpartum weeks 2-6 to assess light exposure and sleep duration and timing.
Circadian phase (measured with salivary dim light melatonin onset) will be measured at baseline during pregnancy (~30 weeks gestation), at 36 weeks gestation, and at postpartum week 6.
This pilot will allow us to refine the IC intervention for future integration into various clinical settings and establish an infrastructue for a larger (R01-scale) trial, including measuring acceptability of IC among UC clinicians and implementing web-based data collection to facilitate data sharing in the planned R01.
Perinatal IC could have major public health impact due to the high prevalence of perinatal depression and its negative effects on mothers and their children.
This project represents a first step toward achieving this goal, as it will provide the pilot data necessary to prepare for a larger scale intervention study focused on providing non-pharmacologic therapies and improving outcomes for women with perinatal depression.
Study Overview
Status
Completed
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
24
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
-
Rhode Island
-
Providence, Rhode Island, United States, 02904
- Miriam Hospital Women's Medicine Collaborative
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years to 40 years (Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
Female
Description
Inclusion Criteria:
- pregnant women with a diagnosis of major depressive disorder at 24-28 weeks gestation
Exclusion Criteria:
- active psychosis or suicidality contraindicating outpatient treatment
- bipolar disorder
- seizure disorder
- self report of frequent migraines/headaches precipitated by bright light or sleep deprivation
- preexisting eye/skin disorders contraindicating light therapy
- use of photosensitizing medications
- primary Axis I diagnosis other than MDD (comorbid phobia, generalized or social anxiety disorder allowed)
- high risk pregnancy (e.g., conditions requiring mandatory bed rest or complex medical regimens that will interfere with study participation or conditions where poor infant outcomes are anticipated)
- starting antidepressants within 4 weeks of enrollment
- current employment as shift worker
- current alcohol or drug use disorders
- women whose infants will not be living in the home or who will have a nighttime caregiver
- Pittsburgh Sleep Quality Inventory (PSQI) < 5 (i.e., those who report no sleep complaints during 3rd trimester of pregnancy and for whom an intervention targeting sleep might not be indicated).
- women who do not speak and read English (because the complexity of translating the research instruments is beyond the scope of this project)
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Usual Care
Usual Care will consist of medication administered by a perinatal psychiatrist and/or psychotherapy
|
UC will consist of medication administered by a perinatal psychiatrist and/or psychotherapy
|
Experimental: Triple Chronotherapy + Usual Care
triple chronotherapy (TC) will consist of bright light therapy, sleep phase advance, and sleep deprivation/restriction
|
UC will consist of medication administered by a perinatal psychiatrist and/or psychotherapy
triple chronotherapy (TC will consist of bright light therapy, sleep phase advance, and sleep deprivation/restriction
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Depression Score
Time Frame: Change in depression score from 28 weeks of pregnancy to 6 weeks postpartum
|
17-item Hamilton Depression score
|
Change in depression score from 28 weeks of pregnancy to 6 weeks postpartum
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Sleep/Circadian Behavior
Time Frame: Change in Sleep/Circadian Rhythms from 28 weeks pregnancy to 6 weeks postpartum
|
sleep will be measured with wrist actigraphy and circadian phase will be measured with melatonin onset
|
Change in Sleep/Circadian Rhythms from 28 weeks pregnancy to 6 weeks postpartum
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Side Effects
Time Frame: Pregnancy weeks 33, 36; postpartum weeks 2, 6, 26
|
Systematic Assessment for Treatment Emergent Effects
|
Pregnancy weeks 33, 36; postpartum weeks 2, 6, 26
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Katherine M Sharkey, MD, PhD, Rhode Island Hospital
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
January 1, 2014
Primary Completion (Actual)
January 15, 2019
Study Completion (Actual)
February 28, 2019
Study Registration Dates
First Submitted
January 30, 2014
First Submitted That Met QC Criteria
January 31, 2014
First Posted (Estimate)
February 4, 2014
Study Record Updates
Last Update Posted (Actual)
May 29, 2019
Last Update Submitted That Met QC Criteria
May 24, 2019
Last Verified
May 1, 2019
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 540053-2
- 1R34MH104377-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Depression
-
ProgenaBiomeRecruitingDepression | Depression, Postpartum | Depression, Anxiety | Depression Moderate | Depression Severe | Clinical Depression | Depression in Remission | Depression, Endogenous | Depression ChronicUnited States
-
Washington University School of MedicineCompletedTreatment Resistant Depression | Late Life Depression | Geriatric Depression | Refractory Depression | Therapy-Resistant DepressionUnited States, Canada
-
Kintsugi Mindful Wellness, Inc.Sonar Strategies; Vituity PsychiatryActive, not recruitingDepression | Depression Moderate | Depression Severe | Depression MildUnited States
-
University GhentUniversiteit Antwerpen; Janssen-Cilag Ltd.RecruitingDepression Moderate | Depression Severe | Depression MildBelgium
-
University of California, San FranciscoRecruitingDepression Moderate | Depression Mild | Depression, TeenUnited States
-
Baylor College of MedicineUniversity of TexasRecruitingDepression | Depression Moderate | Depression Severe | Suicide and Self-harm | Depression in Adolescence | Depression MildUnited States
-
University of Cape TownNational Institute of Mental Health (NIMH)CompletedPostpartum Depression | Clinical Depression | Moderate DepressionSouth Africa
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; National Institute of Mental...CompletedMajor Depressive Disorder | Treatment Resistant Depression | Treatment-Refractory Depression | Late Life Depression | Geriatric DepressionUnited States, Canada
-
Northern Illinois UniversityUniversity Autonoma de Santo DomingoTerminatedDepression Moderate | Depression MildUnited States, Dominican Republic
-
Gerbera Therapeutics, Inc.Not yet recruitingPostpartum Depression | Depression, Postpartum | Postnatal Depression | Post-partum Depression | Post-Natal DepressionUnited States
Clinical Trials on Usual Care
-
Charite University, Berlin, GermanyCompletedMultiple Sclerosis | FatigueGermany
-
Centers for Disease Control and PreventionCompleted
-
Charite University, Berlin, GermanyMammazentrum Hamburg am Krankenhaus Jerusalem, Germany; Dorit und Alexander...Completed
-
European Institute for Evidence Based Osteopathic...Unknown
-
Suzanna ZickUniversity of MichiganTerminatedQuality of Life | Fatigue | Lupus Erythematosus, Systemic | Sleep | Pain, ChronicUnited States
-
The Miriam HospitalNational Institute on Aging (NIA)RecruitingHeart FailureUnited States
-
Lawson Health Research InstituteUnknownDepression | Quality of Life | Sleep | Anxiety | Dry EyeCanada
-
U.S. Wound RegistryRecruitingWounds and Injuries | Diabetic Foot | Leg Ulcer | Skin Ulcer | Diabetes Complications | Diabetic Neuropathies | Lymphedema | Peripheral Arterial Disease | Vasculitis | Venous Insufficiency | Varicose Ulcer | Pressure Ulcer | Pyoderma | Surgical Wound Dehiscence | Amputation StumpUnited States
-
University Hospital, MontpellierCompletedOsteoarthritis | Mindfulness | MBSRFrance
-
Gachon University Gil Oriental Medical HospitalKorea Health Industry Development InstituteCompletedKnee Replacement | AcupunctureKorea, Republic of