Effects of Restricted Time in Bed on Antidepressant Treatment Response

Abstract

Objective Antidepressant response onset is delayed in individuals with major depressive disorder (MDD). This study compared remission rates and time to remission onset for antidepressant medication delivered adjunctive to nightly time in bed (TIB) restriction of 6 hours (6h TIB) or 8 hours (8h TIB) for the initial two weeks. Method Sixty-eight adults with DSM-IV diagnosed MDD (25.4 ± 6.6 years of age, 34 women) were recruited from September 2009 to December 2012 in an academic medical center. Participants received 8 weeks of open-label fluoxetine 20–40 mg and were randomized to one of three TIB conditions for the first two weeks: 8h TIB (n=19); 6h TIB with a 2-hour bedtime delay (Late Bedtime, n=24); or 6h TIB with a 2-hour rise time advance (Early Risetime, n=25). Clinicians blinded to TIB condition rated symptom severity weekly. HAMD-17 rated symptom severity, remission rates, and remission onset were the primary outcomes. Results Mixed effects models indicated lower depression severity for the 8h TIB compared to the 6h TIB group overall (F=2.1, df=8, 226.9, p< .05), with 63.2% of 8h TIB compared to 32.6% of 6h TIB subjects remitting by Week 8 (X2(1) = 4.9, p < .05). Remission onset occurred earlier for the 8h TIB group (hazard ratio = 0.43, 95% CI 0.20 – 0.91, p < .03), with no differences between 6h TIB conditions. Conclusions and Relevance Two consecutive weeks of nightly 6h TIB does not accelerate or improve antidepressant response. Further research is needed to determine whether adequate sleep opportunity is important to antidepressant treatment response.

Relationships between circadian measures, depression, and response to antidepressant treatment: A preliminary investigation

“…It was hypothesized that participants assigned to the Early Rise time condition would report the greatest symptom improvement relative to those assigned to the Late Bedtime or 8h TIB conditions. Contrary to hypotheses, participants assigned to the 8h TIB group had lower depression severity, greater remission rates, and earlier onset of remission relative to both 6h TIB groups (Arnedt et al, 2016). …”

“…The parent trial was an 8-week randomized, controlled trial with 68 participants (Arnedt et al, 2016). All participants in the parent trial completed the dim light melatonin saliva sample collection procedure (except for the last 5 participants, who did not complete the procedure due to financial considerations); however, due to financial constraints, for this secondary analysis, saliva samples were assayed for melatonin in a subsample of 30 participants randomly selected from parent trial.…”

“…Participants underwent overnight polysomnography in the laboratory for the first 3 nights of the study (respectively, screening/adaptation (8h TIB), Baseline (8h TIB), and first experimental night (6h or 8h TIB)) and again for 2 consecutive nights at the end of the experimental phase ((the final experimental night (6h or 8h TIB) and an 8h TIB recovery night; Week 2); polysomnography results are reported in the parent trial (Arnedt et al, 2016). On the final experimental night, participants again completed a saliva sample collection protocol in dim light to assess melatonin levels (for more detail, see Measures below).…”

“…In partial deprivation, an advanced wake time (i.e., wakefulness during the second half of the night) is generally more effective than a delayed bedtime (i.e., wakefulness during the first half of the night (Sack et al, 1988)). Our group recently completed a randomized controlled trial designed to compare depression remission rates and time to depression remission for two weeks of 6 hours’ time in bed (6h TIB) to 8h TIB delivered adjunctive to fluoxetine in adults with MDD (Arnedt et al, 2016). Participants completed the 2-week TIB condition protocol at home and were assigned to 8h TIB, 6h TIB with delay of bedtime (Late Bedtime), or 6h TIB with advance of rise time (Early Rise time).…”

Sleep, circadian rhythm, and physical activity patterns in depressive and anxiety disorders: A 2‐week ambulatory assessment study

“…The dose‐response relationships provide further evidence for the ecological validity of actigraphy. Although, recent clinical trials have employed actigraphy to monitor activation therapy (Averill et al, ) and sleep deprivation (Arnedt et al, ) as adjunctive treatments to usual care, or as a tool to complement behavioral activation (Chum et al, ), more research is needed to clarify whether actigraphy may be used to monitor treatment outcomes of such interventions.…”