Complementary Chronotherapeutics for Pregnancy and Postpartum Depression

针对妊娠和产后抑郁症的补充时间疗法

基本信息

批准号：
8689131
负责人：
BARBARA L PARRY
金额：
$ 55.6万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8689131
关键词：
6-sulfatoxymelatonin Adverse effects Antidepressive Agents Biological Rhythm Breast Feeding Child Child Development Circadian Rhythms Combined Modality Therapy Data Depressed mood Disease Early treatment Family Growth Home environment Impaired health Intervention Investigation Laboratories Light Link Literature Major Depressive Disorder Measures Melatonin Mental Depression Middle Insomnia Mood Disorders Moods Mothers Neurocognitive Pathogenesis Patients Pharmaceutical Preparations Phase Phototherapy Plasma Polysomnography Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women Puerperium Randomized Relapse Safety Sleep Sleep Deprivation Sleep Wake Cycle Testing Therapeutic Time Treatment Efficacy Wakefulness Woman Work actigraphy antepartum depression awake base design improved innovation light treatment pregnant premenstrual dysphoric disorder prevent public health relevance randomized trial reproductive reproductive hormone sleep onset translational approach treatment strategy urinary

6-sulfatoxymelatonin Adverse effects Antidepressive Agents Biological Rhythm Breast Feeding Child Child Development Circadian Rhythms Combined Modality Therapy Data Depressed mood Disease Early treatment Family Growth Home environment Impaired health Intervention Investigation Laboratories Light Link Literature Major Depressive Disorder Measures Melatonin Mental Depression Middle Insomnia Mood Disorders Moods Mothers Neurocognitive Pathogenesis Patients Pharmaceutical Preparations Phase Phototherapy Plasma Polysomnography Postpartum Depression Postpartum Period Postpartum Women Pregnancy Pregnant Women Puerperium Randomized Relapse Safety Sleep Sleep Deprivation Sleep Wake Cycle Testing Therapeutic Time Treatment Efficacy Wakefulness Woman Work actigraphy antepartum depression awake base design improved innovation light treatment pregnant premenstrual dysphoric disorder prevent public health relevance randomized trial reproductive reproductive hormone sleep onset translational approach treatment strategy urinary

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项目摘要

DESCRIPTION (provided by applicant): Pregnant and postpartum major depression (MD) has disabling effects on the mother and her family, and impairs growth and neurocognitive development of the child. Investigation into its pathogenesis, with the ultimate aim of developing new treatment strategies, is needed urgently, particularly given the limited safety and efficacy of treatment options documented in pregnant and in lactating women. In previous work, we demonstrated that pregnant depressed patients (DP) had phase-advanced (shifted-earlier), whereas postpartum DP had phase-delayed (shifted-later) melatonin rhythms compared with normal control (NC) pregnant or postpartum women. In this new application we will test the hypothesis that correcting these underlying circadian rhythm disturbances with a combination of appropriately-timed wake therapy and light treatment achieves antidepressant effects. We expect treatments to act selectively: In pregnant DP with phase- advanced rhythms, we hypothesize that early wake therapy (EWT: wake until 03:00 h, followed by sleep until 07:00 h) plus evening (PM) bright white light (BWL), which phase-delay melatonin rhythms, will improve mood more than late wake therapy (LWT: sleep from 21:00-01:00 h, followed by wake) plus morning (AM) BWL, which phase-advance melatonin rhythms. In contrast, in postpartum DP with phase-delayed rhythms, we hypothesize that LWT plus AM BWL, which phase-advance melatonin rhythms, will improve mood more than EWT plus PM BWL, which phase-delay them. These combined chronobiological treatments are complementary in that wake therapy can hasten and potentiate the antidepressant effects of light treatment that may take up to 10 weeks to show efficacy in pregnant DP, while light treatment can sustain the antidepressant effects of wake therapy that often are lost after subsequent sleep. Although these combined treatments have demonstrated safety and efficacy in other mood disorders, they have not been applied to pregnant and postpartum MD. We will examine the effects of EWT plus PM BWL vs. LWT plus AM BWL on mood, urinary melatonin and the sleep/wake cycle in pregnant and postpartum DP at home. By this translational approach targeted to underlying chronobiological abnormalities, we aim to develop innovative alternative interventions for puerperal MD, potentially transforming treatment approaches for women's mood and other disorders with circadian rhythm disturbances.

描述（由申请人提供）：孕妇和产后重度抑郁症（MD）对母亲及其家人具有致残的影响，并损害儿童的成长和神经认知的发展。迫切需要对其发病机理进行调查，以制定新的治疗策略的最终目的，特别是考虑到有限的安全性和有效性孕妇和哺乳期妇女记录的治疗方案。在先前的工作中，我们证明了怀孕的抑郁症患者（DP）具有相增长（移位较高），而产后DP与正常对照（NC）孕妇或产后妇女相比，（替代者）褪黑激素节奏（转移）褪黑激素节奏。在这一新应用中，我们将测试以下假设：纠正这些基本的昼夜节律干扰，结合适当定时的唤醒疗法和轻度治疗可实现抗抑郁作用。 We expect treatments to act selectively: In pregnant DP with phase- advanced rhythms, we hypothesize that early wake therapy (EWT: wake until 03:00 h, followed by sleep until 07:00 h) plus evening (PM) bright white light (BWL), which phase-delay melatonin rhythms, will improve mood more than late wake therapy (LWT: sleep from 21:00-01:00 h, followed by wake) plus morning （AM）BWL，哪个相吸收褪黑激素节奏。相比之下，在具有相位延迟的节奏的产后DP中，我们假设LWT Plus Am BWL（相吸收褪黑激素节奏）将使情绪比EWT PLUS PM BWL高于EWT PM BWL，而PM BWL（这些相位延迟）。这些结合的时间生物学治疗是互补的，因为唤醒疗法可以加速和增强轻型治疗的抗抑郁作用，可能需要长达10周的时间才能在怀孕的DP中表现出疗效，而轻度治疗可以维持尾流疗法的抗抑郁作用，而后期睡眠后通常会丢失。尽管这些联合治疗表现出在其他情绪障碍中的安全性和功效，但尚未应用于孕妇和产后MD。我们将研究EWT加上PM BWL与LWT Plus AM BWL对心情，尿褪黑激素和睡眠/唤醒周期对孕妇和产后DP的影响。通过这种针对生物生物学异常的转化方法，我们旨在开发针对Puerperal MD的创新替代性干预措施，可能会改变女性情绪和其他昼夜节律障碍的疾病的治疗方法。