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Seasonal Affective Disorder and Visual Impairment

Primary Purpose

Seasonal Affective Disorder, Visual Impairment

Status
Completed
Phase
Not Applicable
Locations
Denmark
Study Type
Interventional
Intervention
light therapy
Sponsored by
Psychiatric Centre Rigshospitalet
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Seasonal Affective Disorder focused on measuring pupillometry, light therapy, visual impairment, melatonin, ipRGC

Eligibility Criteria

18 Years - 80 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

Seasonal affective disorder. Visual impairment (Snellen visual acuity < 6/18) or visual field reduction (MD<10).

Exclusion Criteria:

Alcohol or drug abuse. Current or planned pregnancy. Other neuropsychiatric disorder. Antidepressant medication. Regular use of melatonin.

Sites / Locations

  • Mental Health Center Copenhagen

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

SAD

non-SAD

Arm Description

Persons with visual impairment and SAD are assessed by clinical interview, depression rating, diurnal saliva melatonin and cortisol and chromatic pupillometry during symptomatic winter phase and asymptomatic summer phase. Winter assessment is followed by a 6 week light therapy protocol ending with assessment of depression severity and repeated pupillometry.

Control participants with similar visual impairment but without SAD/sSAD are assessed by clinical interview, depression rating, diurnal saliva melatonin and cortisol and chromatic pupillometry in winter and summer.

Outcomes

Primary Outcome Measures

treatment response
Reduction in depression severity on the Structured interview guide for the Hamilton Depression Rating Scale - Seasonal affective disorder version (25 items version total score with range 0-78. Results from Hamilton Rating Scale for Depression 17 items (range 0-52) and the 8 item atypical symptom subscale (range 0-26) are reported. Higher scores indicate higher severity.
saliva melatonin concentration
Differences in melatonin secretion as indicated by area under curve (AUC) between SAD and non-SAD (summer and winter).

Secondary Outcome Measures

PIPR - light therapy
Correlation between treatment response and ipRGC function as measured by the sustained (10-20 seconds) post-illumination pupillary contraction following blue light stimulation

Full Information

First Posted
January 11, 2018
Last Updated
September 15, 2020
Sponsor
Psychiatric Centre Rigshospitalet
Collaborators
Glostrup University Hospital, Copenhagen
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1. Study Identification

Unique Protocol Identification Number
NCT03403959
Brief Title
Seasonal Affective Disorder and Visual Impairment
Official Title
The Neurobiology of Seasonal Affective Disorder: Exploring the High Prevalence in Severe Visual Impairment
Study Type
Interventional

2. Study Status

Record Verification Date
September 2020
Overall Recruitment Status
Completed
Study Start Date
December 1, 2017 (Actual)
Primary Completion Date
March 12, 2020 (Actual)
Study Completion Date
March 12, 2020 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Psychiatric Centre Rigshospitalet
Collaborators
Glostrup University Hospital, Copenhagen

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
As a subtype of major depressive disorder, seasonal affective disorder (SAD) or winter depression causes severe reductions in both quality of life and productivity and results in high morbidity and frequent sick leave (1). SAD is a prevalent disorder with rates as high as 3-5% in central European countries and 8-10% in Scandinavian countries. In our recent screening survey among persons with severe visual impairment or blindness (visual acuity < 6/60), we found a strikingly high prevalence of SAD of 17 % compared to 8% in the fully sighted control group. Persons with maintained light perception had a highly increased SAD prevalence of 18 % whereas no light perception (NLP) respondents had an SAD prevalence of 13 %. Light is unquestionably of great importance in the development and treatment of SAD. It is suggested that a reduced retinal sensitivity to light leads to sub-threshold light input to the brain and consequently to the development of SAD. The novel retinal non-visual photoreceptors, the intrinsically photosensitive retinal ganglion cells (ipRGCs), are involved in the regulation of circadian rhythm and mood and their function are in part independent of the function of the classical rod and cone photoreceptors which form the basis of conscious visual perception. Function of the ipRGCs can be assessed by chromatic pupillometry where the sustained pupillary contractions following blue light stimulation (PIPR) is the main outcome. In persons with SAD without eye disorder the function of the ipRGCs is reduced. We here wish to investigate associations between ipRGC function and SAD symptoms, circadian profile and treatment response to light therapy in persons with visual impairment. Persons with visual impairment (SAD and non-SAD) are assessed for ipRGC function with chromatic pupillometry, for seasonal mood variation by interview and questionnaire and for diurnal melatonin secretion by saliva analysis summer and winter. In winter SAD participants are treated with daily morning bright light for 6 weeks. Reduction in depression scores and tolerability is recorded.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Seasonal Affective Disorder, Visual Impairment
Keywords
pupillometry, light therapy, visual impairment, melatonin, ipRGC

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
The study combines two models: a case/control study with observational outcomes where all cases are consequently included in a non-randomized interventional study
Masking
Outcomes Assessor
Masking Description
The outcomes assessor and the participant is unaware of ipRGC function prior to and during treatment
Allocation
Non-Randomized
Enrollment
18 (Actual)

8. Arms, Groups, and Interventions

Arm Title
SAD
Arm Type
Experimental
Arm Description
Persons with visual impairment and SAD are assessed by clinical interview, depression rating, diurnal saliva melatonin and cortisol and chromatic pupillometry during symptomatic winter phase and asymptomatic summer phase. Winter assessment is followed by a 6 week light therapy protocol ending with assessment of depression severity and repeated pupillometry.
Arm Title
non-SAD
Arm Type
No Intervention
Arm Description
Control participants with similar visual impairment but without SAD/sSAD are assessed by clinical interview, depression rating, diurnal saliva melatonin and cortisol and chromatic pupillometry in winter and summer.
Intervention Type
Device
Intervention Name(s)
light therapy
Intervention Description
6 weeks morning treatment with bright light therapy in own home.
Primary Outcome Measure Information:
Title
treatment response
Description
Reduction in depression severity on the Structured interview guide for the Hamilton Depression Rating Scale - Seasonal affective disorder version (25 items version total score with range 0-78. Results from Hamilton Rating Scale for Depression 17 items (range 0-52) and the 8 item atypical symptom subscale (range 0-26) are reported. Higher scores indicate higher severity.
Time Frame
6 weeks
Title
saliva melatonin concentration
Description
Differences in melatonin secretion as indicated by area under curve (AUC) between SAD and non-SAD (summer and winter).
Time Frame
6 months
Secondary Outcome Measure Information:
Title
PIPR - light therapy
Description
Correlation between treatment response and ipRGC function as measured by the sustained (10-20 seconds) post-illumination pupillary contraction following blue light stimulation
Time Frame
6 weeks
Other Pre-specified Outcome Measures:
Title
feasibility of light therapy
Description
side effects and tolerability of light therapy
Time Frame
6 weeks
Title
Late sustained post-illumination pupillary response to blue light
Description
Difference in late PIPR (10-30 seconds post-illumination) following high intensity blue light between SAD and non-SAD and between seasons
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
80 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Seasonal affective disorder. Visual impairment (Snellen visual acuity < 6/18) or visual field reduction (MD<10). Exclusion Criteria: Alcohol or drug abuse. Current or planned pregnancy. Other neuropsychiatric disorder. Antidepressant medication. Regular use of melatonin.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Helle Ø Madsen, MD
Organizational Affiliation
Mental Health Center Copenhagen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mental Health Center Copenhagen
City
Copenhagen Ø
ZIP/Postal Code
2100
Country
Denmark

12. IPD Sharing Statement

Plan to Share IPD
No

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Seasonal Affective Disorder and Visual Impairment

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