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Circadian Phase in Bipolar Depression: Is it Delayed and Does it Normalize With Remission?

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01784341
Recruitment Status : Completed
First Posted : February 5, 2013
Last Update Posted : March 28, 2017
Information provided by (Responsible Party):
John Gottlieb, Northwestern University

Brief Summary:
The overall aim of this project is to compare sleep patterns and melatonin profiles in individuals with bipolar disorder during depression and after remission. The hypothesis is that sleep time, rest-activity cycles and melatonin onset will be delayed during depression and become less delayed after remission.

Condition or disease
Bipolar Disorder

Detailed Description:

Bipolar disorder is a prevalent, disabling, and chronic mood disorder characterized by depressive symptoms that alternate with hypomanic, manic or mixed states. The depressive phase of this illness predominates and is associated with cognitive, occupational and social impairment, psychiatric comorbidity, and increased mortality from suicide and general medical problems. Clarification of the pathophysiology of this illness is important to improve treatment effectiveness.

Various lines of evidence suggest that circadian factors play a role in the onset and maintenance of bipolar depression. Rhythmic clinical disturbances are found in the altered sleep-wake cycle, diurnal mood shifts, rest-activity changes, seasonal features, the cyclic pattern of relapse and remission and the polarity inversions that define this disorder. Chronotherapeutic treatments that act by modifying circadian phase have been shown to be effective in ameliorating the depressive symptoms of this illness. In addition to this circumstantial evidence, there is some more direct data implicating circadian dysfunction in bipolar depression. Genetic studies have documented associations between various circadian genes and bipolar illness. Actigraphic studies of activity levels have demonstrated illness-remission differences and phase advances in manic states. Though these latter studies employ more direct assessment methodologies, there are few articles that have attempted to investigate circadian processes in bipolar depression with the use of the core clock processes. These basic clock rhythms include core body temperature, cortisol levels and dim light melatonin onset. Because these physiological oscillations are less influenced by behavior and less prone to masking, they more accurately reflect the intrinsic timing of the central pacemaker.

This study will use dim light melatonin onset and actigraphy to assess the status and changes in circadian phase between states of bipolar depression and their remission. Using a case control methodology, adult subjects will be evaluated during, and after remission from the depressive phase of bipolar disorder.

General Aim

The overall aim of this project is to compare the timing of dim-light melatonin onset and actigraphy-based activity patterns in adult patients with bipolar disorder in depressed vs remitted states. These markers will enable characterization of changes in circadian phase between illness and recovery. A case control design will enable the use of small sample sizes capable of identifying statistically significant changes in the timing of circadian rhythms in the two states of interest.


It is predicted that the dim light melatonin onset and activity profile will be delayed in the depressed vs. the euthymic state of bipolar disorder. It is further anticipated that this phase delay will lessen when bipolar subjects achieve remission from their depression.

Last, it is predicted that the circadian phase of the dim light melatonin onset and the activity profile will correlate, both being delayed in the depressive phase, and less delayed in euthymia.

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Study Type : Observational [Patient Registry]
Actual Enrollment : 10 participants
Observational Model: Case-Control
Time Perspective: Prospective
Target Follow-Up Duration: 6 Months
Official Title: Circadian Phase in Bipolar Depression: Is it Delayed and Does it Normalize With Remission?
Study Start Date : August 2011
Actual Primary Completion Date : December 2016
Actual Study Completion Date : December 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Bipolar Disorder

Primary Outcome Measures :
  1. Change in Dim Light Melatonin Onset from Depression to Remission [ Time Frame: Collected at end of first and second weeks of actigraphy. ]
    Subjects will be instructed in the procedures used for home-based, self-collection of saliva samples. The protocol developed by Sit and colleagues at the University of Pittsburgh (attached), will be used. This involves obtaining ten saliva samples, one every 30 minutes, over a 4.5 hour period. This protocol contains instructions about ambient lighting, posture, exercise, eating, and use of the oral swabs and collection kits.

Secondary Outcome Measures :
  1. Change in Sleep Schedule from Depression to Remission [ Time Frame: One week after initial enrollment and one week after remission of depression. ]
    Wrist actigraphy and sleep logs will be collected for a one week period to estimate the subjects average sleep schedule.

Biospecimen Retention:   Samples Without DNA
Saliva Samples

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Adults between 18 and 55 who are currently diagnosed with Bipolar Disorder.

Inclusion Criteria:

  • Ages between 18 and 55
  • Bipolar Disorder Type I or II, with current major depression.
  • Currently receiving active treatment from a psychiatrist for bipolar disorder

Exclusion Criteria:

  • Recent history of, or current Diagnostic and Statistical Manual IV, Text Revision criteria for alcohol or substance abuse/dependence disorders
  • circadian rhythm sleep disorders or sleep apnea
  • current stimulant use
  • any recent or planned transmeridian travel across more than two time zones
  • recent, current, or planned shift work schedules
  • pregnancy or plan to become pregnant
  • a Young Mania Rating Scale Score of greater than or equal to seven
  • received in the past two weeks or plan to receive bright light therapy, dawn simulation, sleep deprivation, or other forms of chronotherapy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01784341

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United States, Illinois
Northwestern University
Chicago, Illinois, United States, 60611
Sponsors and Collaborators
Northwestern University
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Principal Investigator: John Gottlieb, MD Northwestern University

Additional Information:

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Responsible Party: John Gottlieb, Assistant Clinical Professor of Psychiatry, Northwestern University Identifier: NCT01784341    
Other Study ID Numbers: 47709
First Posted: February 5, 2013    Key Record Dates
Last Update Posted: March 28, 2017
Last Verified: March 2017
Keywords provided by John Gottlieb, Northwestern University:
Bipolar, Circadian, Melatonin
Additional relevant MeSH terms:
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Bipolar Disorder
Behavioral Symptoms
Bipolar and Related Disorders
Mental Disorders