Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital

Circadian reinforcement therapy in combination with electronic self-monitoring to facilitate a safe post-discharge period of patients with depression by stabilizing sleep: protocol of a randomized controlled trial

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


  1. Alzheimer's disease related biomarkers in bipolar disorder - A longitudinal one-year case-control study

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Reduced prefrontal cortex response to own vs. unknown emotional infant faces in mothers with bipolar disorder

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Incomplete systematic review and meta-analysis on statin use and depression risk - A commentary

    Publikation: Bidrag til tidsskriftLetterForskningpeer review

Vis graf over relationer

Background: The transition phase from inpatient to outpatient care for patients suffering from Major Depressive Disorder represents a vulnerable period associated with a risk of depression worsening and suicide. Our group has recently found that the sleep-wake cycle in discharged depressive patients became irregular and exhibited a drift towards later hours, associated with worsening of depression. In contrast, an advancement of sleep phase has earlier been shown to have an antidepressant effect. Thus, methods to prevent drift of the sleep-wake cycle may be promising interventions to prevent or reduce worsening of depression after discharge. Methods: In this trial, we apply a new treatment intervention, named Circadian Reinforcement Therapy (CRT), to patients discharged from inpatient psychiatric wards. CRT consists of a specialized psychoeducation on the use of regular time signals (zeitgebers): Daylight exposure, exercise, meals, and social contact. The aim is to supply stronger and correctly timed zeitgebers to the circadian system to prevent sleep drift and worsening of depression. The CRT is used in combination with an electronic self-monitoring system, the Monsenso Daybuilder System (MDB). By use of the MDB system, all patients self-monitor their sleep, depression level, and activity (from a Fitbit bracelet) daily. Participants can inspect all their data graphically on the MDB interface and will have clinician contact. The aim is to motivate patients to keep a stable sleep-wake cycle. In all, 130 patients referred to an outpatient service will be included. Depression rating is blinded. Patients will be randomized 1:1 to a Standard group or a CRT group. The intervention period is 4 weeks covering the transition phase from inpatient to outpatient care. The primary outcome is score change in interviewer rated levels of depression on the Hamilton Depression Rating Scale. A subset of patients will be assessed with salivary Dim Light Melatonin Onset (DLMO) as a validator of circadian timing. The trial was initiated in 2016 and will end in 2020. Discussion: If the described intervention is beneficial it could be incorporated into usual care algorithms for depressed patients to facilitate a better and safer transition to outpatient treatment.

TidsskriftBMC Psychiatry
Udgave nummer1
Sider (fra-til)124
StatusUdgivet - 25 apr. 2019

ID: 58077863