title: Effects of Restricted Time in Bed on Antidepressant Treatment Response: A Randomized Controlled Trial.
abstract: OBJECTIVE
  Antidepressant response onset is delayed in individuals with major depressive disorder (MDD). This study compared remission rates and time to remission onset for antidepressant medication delivered adjunctively to nightly time in bed (TIB) restriction of 6 hours or 8 hours for the initial 2 weeks.
  
  
  METHODS
  Sixty-eight adults with DSM-IV-diagnosed MDD (mean ± SD age = 25.4 ± 6.6 years, 34 women) were recruited from September 2009 to December 2012 in an academic medical center. Participants received 8 weeks of open-label fluoxetine 20-40 mg and were randomized to 1 of 3 TIB conditions for the first 2 weeks: 8-hour TIB (n = 19); 6-hour TIB with a 2-hour bedtime delay (late bedtime, n = 24); or 6-hour TIB with a 2-hour rise time advance (early rise time, n = 25). Clinicians blinded to TIB condition rated symptom severity weekly. Symptom severity, remission rates, and remission onset as rated by the 17-item Hamilton Depression Rating Scale were the primary outcomes.
  
  
  RESULTS
  Mixed effects models indicated lower depression severity for the 8-hour TIB compared to the 6-hour TIB group overall (F₈, ₂₂₆.₉ = 2.1, P < .05), with 63.2% of 8-hour TIB compared to 32.6% of 6-hour TIB subjects remitting by week 8 (χ²₁ = 4.9, P < .05). Remission onset occurred earlier for the 8-hour TIB group (hazard ratio = 0.43; 95% CI, 0.20-0.91; P < .03), with no differences between 6-hour TIB conditions.
  
  
  CONCLUSIONS
  Two consecutive weeks of nightly 6-hour TIB does not accelerate or improve antidepressant response. Further research is needed to determine whether adequate sleep opportunity is important to antidepressant treatment response.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01545843.
authors.affiliation: Associate Professor of Psychiatry and Neurology, Sleep and Circadian Research Laboratory, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI 48109-2700. tarnedt@umich.edu.|Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: J Todd
authors.initials: JT
authors.lastname: Arnedt
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Swanson
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Dopp
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Holli S
authors.initials: HS
authors.lastname: Bertram
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Ann J
authors.initials: AJ
authors.lastname: Mooney
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Huntley
authors.affiliation: Sleep and Circadian Research Laboratory, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Hoffmann
authors.affiliation: When this work was done, Dr Armitage was a faculty member at the University of Michigan.
authors.forename: Roseanne
authors.initials: R
authors.lastname: Armitage
mesh_terms: D056044:Actigraphy; D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D017286:Polysomnography; D012892:Sleep Deprivation / Q000503:physiopathology* / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine