Sleepless and depressed: Could this CBT-based approach help young night owls struggling with clinical depression?

Dealing with a young patient who struggles with clinical depression and sleepless nights? A cognitive behavioural change-based approach called transdiagnostic sleep and circadian intervention for youth—or TranS-C for short—appears to hold promise for night owls diagnosed with major depressive disorder.What’s TranS-C?Transdiagnostic sleep and circadian intervention for youth is a hybrid of four interventions: cognitive behaviour therapy for insomnia, interpersonal and social rhythm therapy, chronotherapy and motivational interviewing. The approach focuses on teaching young patients skills meant to advance circadian rhythm and bedtime, delay wake time, improve sleep efficiency, extend total sleep time and improve sleep quality.Depression and insomnia in youthIt’s not uncommon for teens to say up late into the night. But among young people with depression, 80% report late-night sleep patterns, according to researchers at the University of California, San Francisco, whose study on circadian biology and sleep-wake behaviour was published recently in the Journal of Child Psychology and Psychiatry.In their report, the study authors looked to establish the “misalignment between biological circadian timing and sleep-wake behaviour” as a potential driver for the severity of depression among youth with “evening circadian preference” and major depressive disorder. A secondary goal was to explore ways of measuring this misalignment, with a view to using this metric in interventions to alleviate the severity of depression.Read: A pacemaker for the brain helped a woman with crippling depression. It may soon be available to moreThe study: 42 participants, two approachesResearchers looked at data for 42 participants who had been part of a larger clinical trial with 176 subjects. In the secondary study, 24 of the 42 participants received TranS-C intervention while 18 had psychoeducational sessions, which focused on leading a healthy lifestyle, with sleep mentioned only briefly as a key contributing factor. Assessors were not informed of these treatment assignments.All participants—who each received a 45-minute TranS-C or psychoeducational session each week for eight weeks—were asked to keep sleep diaries and to wear a device, called an Actigraph, that measured sleep quality. Researchers also measured for their circadian preference (morning versus evening, for example) as well as for depression using the interview-based Children’s Depression Rating Scale and for dim light melatonin onset—the gold standard index of the endogenous circadian phase—using the serial saliva sampling method before and after treatment. At the same time, researchers tracked participants’ use of medications.FindingsWhen the study commenced, all participants scored at least 40 on the Children’s Depression Rating Scale, indicating clinically significant depression. After six months the group receiving TranS-C reported an average depression rating of 21.67—a score of 28 or lower indicates remission—compared to 32.5 for the group receiving healthy lifestyle psychoeducation.These results were consistent for at least 12 months. By the end of the year, the TranS-C group scored 24.97 while the other group came in at 32.75.In examining the relationship between the participants’ depression and sleep behaviors, the researchers found that the TranS-C group had significantly longer wake times post-treatment compared to the psychoeducation group. This indicated more alignment between the endogenous circadian phase and wake-up time, concluded the researchers.After 12 months, the researchers found that longer wake times from pre- to post-treatment were associated with lower depression scores.Read: Study shows significant risk of major drug-drug interactions in outpatient childrenSleep on thisWhile the study showed a significant effect on the severity of depression at the six- and 12-month follow ups, the researchers did not find a significant impact on depression severity immediately after each TranS-C session. Future studies should investigate how soon after treatment depression improvements may occur, they concluded.Read: Brain wave-powered tech allows Canadian kids ‘trapped in their own bodies’ to play

Sleepless and depressed: Could this CBT-based approach help young night owls struggling with clinical depression?

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