title: Maintained superiority of chronotherapeutics vs. exercise in a 20-week randomized follow-up trial in major depression.
abstract: OBJECTIVE
  To investigate the long-term antidepressant effect of a chronotherapeutic intervention.
  
  
  METHODS
  In this randomized controlled trial 75 patients with major depression were allocated to fixed duloxetine and either a chronotherapeutic intervention (wake group) with three initial wake therapies, daily bright light therapy, and sleep time stabilization or to a group using daily exercise. Patients were followed 29 weeks. We report the last 20 weeks, a follow-up phase, where medication could be altered. Patients were assessed every 4 weeks. Remission rates were primary outcome.
  
  
  RESULTS
  Patients in the wake group had a statistically significant higher remission rate of 61.9% vs. 37.9% in the exercise group at week 29 (OR = 2.6, CL = 1.3-5.6, P = 0.01). This indicated continued improvement compared with the 9 weeks of treatment response (44.8% vs. 23.4%) with maintenance of the large difference between groups. HAM-D17 endpoint scores were statistically lower in the wake group with endpoint scores of 7.5 (SE = 0.9) vs. 10.1 (SE = 0.9) in the exercise group (difference 2.7, CL = 0.5-4.8, P = 0.02).
  
  
  CONCLUSIONS
  In this clinical study patients continued to improve in the follow-up phase and obtained very high remission rates. This is the first study to show adjunct short-term wake therapy and long-term bright light therapy as an effective and feasible method to attain and maintain remission.
authors.affiliation: Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: K
authors.initials: K
authors.lastname: Martiny
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerod, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Refsgaard
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerod, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Lund
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerod, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Lunde
authors.affiliation: Physiotherapy, Child and Adolescent Psychiatric Centre, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: B
authors.initials: B
authors.lastname: Thougaard
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerod, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Lindberg
authors.affiliation: Psychiatric Research Unit, Mental Health Centre North Zealand, Copenhagen University Hospital, Hillerod, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Bech
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D055870:Drug Chronotherapy; D000068736:Duloxetine Hydrochloride / Q000008:administration & dosage*; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010789:Phototherapy / Q000379:methods*; D012647:Self-Assessment; D012890:Sleep / Q000502:physiology; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000068736:Duloxetine Hydrochloride
keywords: chronotherapy; depressive disorder; light therapy; randomized controlled trial; sleep; sleep deprivation