Mechanisms of Depression and Anhedonia in Adolescents: Linking Sleep to Reward- and Stress-Related Brain Function

Depression in Adolescence Clinical Trial

— MoDA  

Official title:

Mechanisms of Depression and Anhedonia in Adolescents: Linking Sleep Duration and Timing to Reward- and Stress-Related Brain Function

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05691439
• Other study ID #: 217730
• Secondary ID: R01MH126109
• Status: Recruiting
• Phase: N/A
• Start date: March 27, 2023
• Est. completion date: December 31, 2026

Study information

• Verified date: January 2024
• Source: University of Oregon
• Contact: Amy Konyn, PhD
• Phone: 541-346-0392
• Email: akonyn[@]uoregon.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This research will use biobehavioral approaches to generate understanding about the linkages between sleep duration and timing, stressful life events, and depressive symptoms in adolescents, with a long-term aim of developing effective preventative interventions.

Description:

The last decade witnessed a steady growth from 8% to 14% in the prevalence of adolescents suffering from major depressive episode within the past year, and depression is expected to be the leading cause of global disability by 2030. The increase in depression incidence and disability is also related to increases in suicidality in adolescents, and the depressive symptom of anhedonia predicts suicidality above and beyond depression diagnosis. The high degree of morbidity and mortality associated with depression and anhedonia in adolescence makes this a key developmental period for research and intervention. Risk for depression and anhedonia is elevated in adolescents with insufficient sleep duration, late sleep timing, or elevated exposure to stressors. Alarmingly, only 30% of adolescents regularly obtain the recommended hours of sleep, and sleep timing is at its latest during mid- to late-adolescence. Adolescents also report high levels of stress related to work- and time-demands, and most will experience at least one major adverse life event before adulthood. Short/late sleep and stressors may also cause disruptions in reward- and stress-related brain function (e.g., medial prefrontal cortex response to monetary reward, autonomic and endocrine function during stressors), which are key biobehavioral mechanisms of depression and anhedonia. Short/late sleep habits are prime targets for depression intervention in adolescents; however, there is insufficient causal evidence that improving sleep opportunity and/or timing will alter the biobehavioral mechanisms of depression. The overall objective of this R01 is to evaluate a biobehavioral model whereby sufficient sleep duration and/or early sleep timing can reduce depressive symptoms and anhedonia by promoting reward- and stress-related brain function in adolescents. The long-term goal of this research is to leverage sleep and circadian function to promote mental health. A series of studies by the PI and Co-Is indicate that short sleep, late sleep, and stressful life events independently predict reward- and stress-related brain function and depressive symptoms in adolescents. However, these studies do not evaluate the interactive effects of sleep/circadian function and stressful life events, or use experimental designs. More recent research by the PI and Co-Is uses sleep-circadian manipulation to target reward- and stress-related brain function and improve mental health in adolescents. Building from this research, this R01 will test the central hypothesis that extending and/or advancing sleep will alter reward- and stress-related brain function, and decrease depressive symptoms and anhedonia, in adolescents with short and late sleep. This proposal is consistent with the National Institute of Mental Health (NIMH) Strategic Objective to identify clinically meaningful biomarkers and behavioral indicators of mental health.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 150
• Est. completion date: December 31, 2026
• Est. primary completion date: December 31, 2026
• Accepts healthy volunteers: No
• Gender: All
• Age group: 14 Years to 18 Years

Eligibility

Inclusion Criteria:

1. 14-18 years of age

2. Currently in high school

3. short and late sleep (weekday sleep duration = 7 h and bedtime = 22:30 (10:30 pm); n=100) or long and early sleep (weekday sleep duration = 7 hours and bedtime = 22:30 (10:30 pm); n=50), indexed by the Munich Chronotype Questionnaire

4. Lifetime stressful event frequency = 2 on the Stress and Adversity Inventory (STRAIN) Screener

5. Depressive symptom severity t-score greater than or equal to 45 on the Patient Reported Outcomes (PROMIS) Depression scale

6. English language fluency

Exclusion Criteria:

1. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for current moderate to severe alcohol/substance use disorder (=4 symptoms);

2. Current sleep disorders other than insomnia, delayed sleep phase, or hypersomnia, determined by the Structured Clinical Interview for DSM-5 Sleep Disorders;

3. Lifetime diagnosis of bipolar or schizophrenia spectrum disorder;

4. Urgent suicide risk, defined by moderate/severe risk as per Columbia Suicide Severity Rating (CSSR) Community Card, and clinician determination that current risk requires immediate action, precluding engagement in study;

5. Certain medical conditions (e.g., serious neurological disorder, heart failure or serious heart trouble, history of unconsciousness > 5 minutes);

6. Conditions that are contraindicated for functional magnetic resonance imaging (fMRI; e.g., ferrous metal in the body);

7. Positive screen for participant-reported eye disease, epilepsy, or photosensitizing medications that are contraindicated during the manipulation condition when bright light is administered (e.g., psychiatric neuroleptic drugs [e.g., phenothiazine], psoralen drugs, antiarrhythmic drugs [e.g., amiodarone], antimalarial and antirheumatic drugs, porphyrin drugs used in photodynamic treatment of skin diseases);

8. Use of melatonin if participant is not willing to discontinue use for the duration of the study. We will schedule around (i.e., delay appointments as needed) to avoid the timeframe of the

following events:

1. travel across two or more time zones within the month prior to the overnight study visits;

2. beginning or ending a prescribed medication within 2 months of the observational study;

3. prescribed medication dose changes within the timeframe calculated as 5x the drug's half-life [the time to reach pharmacokinetic steady-state] before the initiation of the observational or experimental studies;

4. anticipated change in prescribed medications or medication dosing during the observational or experimental studies. Participants with positive breathalyzer screen (blood alcohol level > .02) will be rescheduled for an alternative overnight visit date. Participants excluded for suicide risk may become eligible for the study when the risk has dissipated. We will reschedule participants who have current symptoms of an airborne infectious illness (e.g., COVID).

Related Conditions & MeSH terms

• Anhedonia
• Depression
• Depression in Adolescence
• Depressive Disorder

Intervention

Behavioral:
• Sleep extension and advance
Participants in the sleep extension and advance condition will maintain a stable sleep schedule that extends sleep duration and advances bedtime by 90 min relative to weekday bedtime. This chronotherapeutic manipulation will include blocking phase-delaying light in the evening using goggles with orange lenses ("blue blockers") beginning 2 h prior to bedtime, and 30 min of 506 lux blue-green light exposure in the morning beginning at rise time using bright light goggles (ReTimer Pty Ltd., Australia). Schedule and chronotherapy adherence will be reinforced using motivational techniques (e.g., securing motivation, preplanning, problem-solving), requiring participants to text the study coordinator and complete morning assessments at rise time, and monetary incentives.
• Regular sleep duration and timing
Participants in the regular sleep duration and timing condition will keep a stable sleep schedule that matches their typical weekday sleep opportunity and timing. Schedule adherence will be reinforced using motivational techniques (e.g., securing motivation, preplanning, problem-solving), requiring participants to text the study coordinator and complete morning assessments at rise time, and monetary incentives.

Locations

Country	Name	City	State
United States	University of Oregon	Eugene	Oregon

Sponsors (4)

Lead Sponsor	Collaborator
University of Oregon	National Institute of Mental Health (NIMH), Oregon Research Institute, University of Pittsburgh

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Depression Scale - Short Form (8-item)	The Patient-Reported Outcomes Measurement Information System (PROMIS) scale for Depression (8-item short form) will be administered at baseline, after each 2-week interval of intensive monitoring, and at follow-up, in reference to the past 7 days. The measure uses 5-point Likert scales, with scores ranging from 8 to 40 and higher scores indicating higher depression and lower scores indicating better outcome. Raw scores are converted to standardized T-scores using conversion tables published on the PROMIS website (nihpromis.org). T-scores of 50 represent the mean of the standardized sample.	2 months
Primary	Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Positive Affect Scale - Short Form (8-item)	The Patient-Reported Outcomes Measurement Information System (PROMIS)scale for Positive Affect (8-item short form) will be administered at baseline, after each 2-week interval of intensive monitoring, and at follow-up, in reference to the past 7 days. The measure uses 5-point Likert scales, with scores ranging from 8 to 40 and higher scores indicating higher positive affect and better outcome. Raw scores are converted to standardized T-scores using conversion tables published on the PROMIS website (nihpromis.org). T-scores of 50 represent the mean of the standardized sample.	2 months
Primary	Dimensional Anhedonia Rating Scale (DARS)	The Dimensional Anhedonia Rating Scale (DARS) will be used to assess state anhedonia related to 4 domains: hobbies, food/drink, social activities, and sensory experience. The 17-item measure assesses hedonic experiences "right now" using 4-point Likert scales. The DARS has high reliability and good convergent and divergent validity. The DARS scores range from 0 to 68, with higher scores indicating lower anhedonia and better outcome.	2 months
Primary	Reward-related brain function	Functional magnetic resonance imaging (fMRI) during the Monetary Incentive Delay (MID) task will be used to measure blood oxygen level dependent (BOLD) regional response and functional connectivity related to anticipation and receipt of monetary rewards. This task reliably elicits activation in neural reward circuitry and is sensitive to depression and sleep/circadian factors.	2 weeks
Primary	Stress-related brain function	Stress-related brain function will be indexed using autonomic and neuroendocrine measures taken before and during the Trier Social Stress Task (TSST). The TSST is a lab-based social-evaluative threat task that reliably elicits subjective stress and increases in the stress-hormone cortisol.	2 weeks