Adolescent depression: Study protocol for a randomized, controlled, double-blind multicenter parallel group trial of Bright Light Therapy in a naturalistic inpatient setting (DeLight)

Abstract

BackgroundDepressive disorders are among the most prominent health problems in youth. Even with the best available pharmacological and non-pharmacological treatments, remission rates are low. Without early treatment, depression in youth is associated with a high risk of symptom progression, chronicity, co-morbidity, and suicidal behavior. Thus, adolescent depression is a prime candidate for innovation in treatment. In depressive adults, meta-analytic evidence has proven that bright light therapy (BLT) is a potent low-threshold intervention, promising due to easy application, low side effects, and optimized compliance. In adolescents, studies with small samples show promising effects. This randomized controlled trial will examine the effectiveness of BLT in youth inpatients.Methods/designIn this randomized, controlled, double-blind multicenter parallel group trial, morning BLT is applied for four weeks in addition to treatment as usual (TAU) for depressed youth inpatients (daily morning exposure to bright light via light-emitting glasses, 10,000 lx, for 30 min) and will be compared to a control condition (placebo light treatment, red light, identical light glasses). The primary objective is to assess whether BLT reduces symptoms of depression in youth with greater effect compared to placebo light therapy. Secondary objectives are to examine the impact of BLT on responder status, application of antidepressant medication, and further depression-related symptoms (sleep, activity, quality of life, satisfaction with health, general psychopathology, alertness, and circadian function). N = 224 patients will be recruited in a naturalistic inpatient setting. A follow-up will be carried out after three and six months.DiscussionThe study aims to discuss and evaluate BLT as an additive method supporting standardized clinical procedures dealing with severe to moderate depressive symptoms in youth.Trial registrationGerman Clinical Trials Register, DRKS00013188. Registered on November 30, 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2949-0) contains supplementary material, which is available to authorized users.

Are one-year changes in adherence to the 24-hour movement guidelines associated with depressive symptoms among youth?

“…Once considered a core symptom or comorbidity of depressive disorders, some now identify sleep problems as both a prodromal manifestation and an independent risk factor for subsequent episodes, predicting the occurrence and outcome of depressive disorders [78]. In fact, given the inadequacy of treatments for youth depression [79], sleep therapy has been suggested as an intervention for adolescent MDD [80]. In addition to symptom management, further consideration from a population prevention standpoint is warranted, particularly given the proportion of youth sleeping less than 8 h/night.…”

Light therapy with boxes or glasses to counteract effects of acute sleep deprivation

“…The Luminette® (CE marking BE07/71114) is a pair of glasses equipped with LT and developed more recently 16,30,49 . The glasses contain diodes emitting a blue-enriched white light reflecting to the retina at 2,000 Lux via a holographic system in order to ensure correct penetration into the eye without impeding vision.…”

Let there be blue-depleted light: in-patient dark therapy, circadian rhythms and length of stay

“…Evidence suggests that morning sunlight and/or BLT may be particularly useful for treating bipolar depression and/or reducing hospital LOS (Benedetti 2001), but a recent meta-analysis suggests that findings are inconsistent regarding any specific benefit for bipolar compared with unipolar depression (Takeshima 2020). Research is ongoing on the use of BLT for atypical depression, but there is emerging evidence of its utility in treatmentresistant disorders (Kragh 2018) and its use with adolescent in-patients (Holtmann 2018;).…”