Bright Light Therapy Efficacy for Depressive Symptoms Following Cardiac Surgery or Acute Coronary Syndrome: Pilot Trial

NCT ID: NCT02621567

Last Updated: 2018-03-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

15 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-01-31

Study Completion Date

2017-10-20

Brief Summary

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Bright Light Therapy Efficacy for Depressive Symptoms Following Cardiac Surgery or Acute Coronary Syndrome: Pilot Trial (BEAM-P) is a randomized controlled trial (RCT) that seeks to assess the feasibility of conducting a full trial which would assess the efficacy of Bright Light Therapy (BLT) for improving depressive symptoms post-cardiac surgery or acute coronary syndrome.

Detailed Description

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Overall Study Objective

The Bright Light Therapy Efficacy for Depressive Symptoms Following Cardiac Surgery or Acute Coronary Syndrome: Pilot Trial (BEAM-P) is a randomized controlled trial (RCT) that seeks to assess the feasibility of conducting a full trial which would assess the efficacy of Bright Light Therapy (BLT) for improving depressive symptoms post-cardiac surgery or acute coronary syndrome (ACS).

Specific Objectives

To assess the feasibility of conducting a full trial, including assessment of recruitment rate, retention rate, adherence, process time, and potential additional data values that should be measured.

Rationale

More than 50,000 Canadians undergo coronary artery bypass grafting (the most common cardiac surgery) each year and over 100,000 are hospitalized for an ACS. Of these patients, at least 15-20% experience depression. Depressed cardiac patients have a nearly 20% increased risk of all-cause mortality, increased risk of cardiac death, and increased risk of experiencing future cardiovascular events. Addressing depression and depressive symptoms in cardiac surgery and ACS patients is therefore crucial. BLT could represent a simple, safe, and cost-effective method of reducing depressive symptoms following cardiac surgery or ACS. BLT has been shown to decrease depressive symptoms in individuals with both seasonal affective disorder and non-seasonal depression in the general population, as well as in a few specific patient populations. However, the efficacy of BLT for reducing depressive symptoms post-cardiac surgery or ACS is unknown. The full BEAM Trial will be the first to study the effects of BLT in this patient population. Since BLT has not yet been investigated in cardiac patients, the feasibility of conducting a large trial of BLT in this population must be determined in order to avoid potential pitfalls and enhance the chances of success of a full trial.

Methods

We will conduct an RCT with a treatment period of 4 weeks and 12 week follow-up post-cardiac surgery or ACS. A total of 38 cardiac surgery or ACS participants will be randomized 1:1 to one of two treatment arms: 1) BLT (10,000 lux light intensity) or 2) Dim light (control group; 500 lux light intensity). Study personnel and participants will be blinded as to treatment allocation. Permutated block randomization will help ensure a balance of known and unknown confounders. Informed consent will be obtained in person from all individuals. Participants in both groups will begin using the lamps in-hospital and will continue the treatment at home for the remainder of the 4 weeks post-surgery or ACS. At baseline and day of discharge, participants will complete the Patient Health Questionnaire 9 (PHQ-9), Depression Anxiety Stress Scale short version (DASS-21), and Short Form (36) Health Survey (SF-36) questionnaires in order to determine index levels of depressive symptomology (PHQ-9, DASS-21) and health-related quality of life (SF-36). A case report form, to collect demographic and clinical information, will also be completed at baseline and day of discharge. There will be a clinic visit at week 4, when patients will return their lamp and complete questionnaires, and study personnel will complete a case report form to monitor treatment adherence. At week 12, participants will have the option to complete their questionnaires online or by mail. To compensate participants for expenses incurred due to participation (parking, childcare, opportunity costs, etc.), they will receive $25 at week 4, and a $20 prepaid VISA card after completing the questionnaires at week 12.

Significance

BLT may be a simple, cost-effective, and safe method of decreasing the severity of depression and depressive symptoms in patients following cardiac surgery or ACS. Even a small reduction in depressive symptoms could have a significant effect on the occurrence of cardiovascular events, cardiac death, and all-cause mortality in this high-risk population. The full BEAM Trial will provide regulators, health care professionals, and patients with important new information about the efficacy of BLT to decrease symptoms of depression in this population. Conducting the BEAM-P study will help ensure the success of carrying out the full BEAM Trial.

Conditions

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Depressive Symptoms Post Cardiac Surgery or Post Acute Coronary Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Bright Light Therapy Group

Participants in this group will receive bright light therapy lamps and will be instructed to use them for 30 minutes every morning within an hour of waking up, everyday for 4 weeks.

Group Type EXPERIMENTAL

Bright Light Therapy Lamp

Intervention Type DEVICE

TRAVelite Desk Lamp manufactured by Northern Light Technologies, located in Montreal, Quebec. The light is emitted from a lamp. The florescent tubes in the box are covered with a diffusing screen to ensure even distribution of light and protection from ultraviolet light. These lamps also have a stand which enables users to place the box horizontally or vertically on most surfaces. These lamps emit light of intensity 10,000 lux.

Dim Light Group

Participants in this group will receive modified dim lamps and will be instructed to use them for 30 minutes every morning within an hour of waking up, everyday for 4 weeks.

Group Type PLACEBO_COMPARATOR

Modified Dim Lamp

Intervention Type DEVICE

TRAVelite Desk Lamp manufactured by Northern Light Technologies, located in Montreal, Quebec. The light is emitted from a lamp. The florescent tubes in the box are covered with a diffusing screen to ensure even distribution of light and protection from ultraviolet light. These lamps also have a stand which enables users to place the box horizontally or vertically on most surfaces. These lamps have been modified to emit light of intensity 500 lux.

Interventions

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Bright Light Therapy Lamp

TRAVelite Desk Lamp manufactured by Northern Light Technologies, located in Montreal, Quebec. The light is emitted from a lamp. The florescent tubes in the box are covered with a diffusing screen to ensure even distribution of light and protection from ultraviolet light. These lamps also have a stand which enables users to place the box horizontally or vertically on most surfaces. These lamps emit light of intensity 10,000 lux.

Intervention Type DEVICE

Modified Dim Lamp

TRAVelite Desk Lamp manufactured by Northern Light Technologies, located in Montreal, Quebec. The light is emitted from a lamp. The florescent tubes in the box are covered with a diffusing screen to ensure even distribution of light and protection from ultraviolet light. These lamps also have a stand which enables users to place the box horizontally or vertically on most surfaces. These lamps have been modified to emit light of intensity 500 lux.

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Undergoing cardiac surgery or hospitalized for an acute coronary syndrome;
* Age ≥ 18 years;
* Score of ≥ 8 on the Patient Health Questionnaire-9;
* Able to understand and to provide informed consent in English or French; and
* Likely to be available for follow-up.

Exclusion Criteria

* Pregnant or lactating females;
* Medical condition with a prognosis \< 12 weeks;
* History of bipolar disorder, SAD, psychosis, or dementia;
* Medical condition contraindicating use of BLT (ocular or retinal pathology: glaucoma, cataracts, retinal detachment, retinopathy, diabetes);
* Medical condition that increases photosensitivity (e.g. systemic lupus erythematosus, rosacea, psoriasis, albinism);
* Current use of medication that increases photosensitivity (e.g. St John's Wort, lithium, melatonin, tetracycline, Accutane, Benzoyl peroxide, Retin-A);
* Less than one month following previous BLT;
* Light induced epilepsy or migraines; or
* Suicidal ideation.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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McGill University

OTHER

Sponsor Role lead

Responsible Party

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Mark Eisenberg

Professor of Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mark J Eisenberg

Role: PRINCIPAL_INVESTIGATOR

McGill University, Jewish General Hospital

Locations

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Jewish General Hospital

Montreal, Quebec, Canada

Site Status

Countries

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Canada

References

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Huffman JC, Celano CM, Beach SR, Motiwala SR, Januzzi JL. Depression and cardiac disease: epidemiology, mechanisms, and diagnosis. Cardiovasc Psychiatry Neurol. 2013;2013:695925. doi: 10.1155/2013/695925. Epub 2013 Apr 7.

Reference Type BACKGROUND
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Tully PJ, Baker RA. Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review. J Geriatr Cardiol. 2012 Jun;9(2):197-208. doi: 10.3724/SP.J.1263.2011.12221.

Reference Type BACKGROUND
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Pincus HA, Pettit AR. The societal costs of chronic major depression. J Clin Psychiatry. 2001;62 Suppl 6:5-9.

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Stewart WF, Ricci JA, Chee E, Hahn SR, Morganstein D. Cost of lost productive work time among US workers with depression. JAMA. 2003 Jun 18;289(23):3135-44. doi: 10.1001/jama.289.23.3135.

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Blumenthal JA. Depression and coronary heart disease: association and implications for treatment. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S48-53. doi: 10.3949/ccjm.75.suppl_2.s48.

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Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation. 1995 Feb 15;91(4):999-1005. doi: 10.1161/01.cir.91.4.999.

Reference Type BACKGROUND
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Bush DE, Ziegelstein RC, Tayback M, Richter D, Stevens S, Zahalsky H, Fauerbach JA. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001 Aug 15;88(4):337-41. doi: 10.1016/s0002-9149(01)01675-7.

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Golden RN, Gaynes BN, Ekstrom RD, Hamer RM, Jacobsen FM, Suppes T, Wisner KL, Nemeroff CB. The efficacy of light therapy in the treatment of mood disorders: a review and meta-analysis of the evidence. Am J Psychiatry. 2005 Apr;162(4):656-62. doi: 10.1176/appi.ajp.162.4.656.

Reference Type BACKGROUND
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Lieverse R, Van Someren EJ, Nielen MM, Uitdehaag BM, Smit JH, Hoogendijk WJ. Bright light treatment in elderly patients with nonseasonal major depressive disorder: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2011 Jan;68(1):61-70. doi: 10.1001/archgenpsychiatry.2010.183.

Reference Type BACKGROUND
PMID: 21199966 (View on PubMed)

Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database Syst Rev. 2004;2004(2):CD004050. doi: 10.1002/14651858.CD004050.pub2.

Reference Type BACKGROUND
PMID: 15106233 (View on PubMed)

Kripke DF. Light treatment for nonseasonal depression: speed, efficacy, and combined treatment. J Affect Disord. 1998 May;49(2):109-17. doi: 10.1016/s0165-0327(98)00005-6.

Reference Type BACKGROUND
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Niederhofer H, von Klitzing K. Bright light treatment as mono-therapy of non-seasonal depression for 28 adolescents. Int J Psychiatry Clin Pract. 2012 Sep;16(3):233-7. doi: 10.3109/13651501.2011.625123. Epub 2012 Jul 19.

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Wirz-Justice A, Bader A, Frisch U, Stieglitz RD, Alder J, Bitzer J, Hosli I, Jazbec S, Benedetti F, Terman M, Wisner KL, Riecher-Rossler A. A randomized, double-blind, placebo-controlled study of light therapy for antepartum depression. J Clin Psychiatry. 2011 Jul;72(7):986-93. doi: 10.4088/JCP.10m06188blu. Epub 2011 Apr 5.

Reference Type BACKGROUND
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Baxendale S, O'Sullivan J, Heaney D. Bright light therapy for symptoms of anxiety and depression in focal epilepsy: randomised controlled trial. Br J Psychiatry. 2013 May;202(5):352-6. doi: 10.1192/bjp.bp.112.122119. Epub 2013 Mar 21.

Reference Type BACKGROUND
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Kripke DF, Mullaney DJ, Klauber MR, Risch SC, Gillin JC. Controlled trial of bright light for nonseasonal major depressive disorders. Biol Psychiatry. 1992 Jan 15;31(2):119-34. doi: 10.1016/0006-3223(92)90199-a.

Reference Type BACKGROUND
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Terman M, Terman JS. Light therapy for seasonal and nonseasonal depression: efficacy, protocol, safety, and side effects. CNS Spectr. 2005 Aug;10(8):647-63; quiz 672. doi: 10.1017/s1092852900019611.

Reference Type BACKGROUND
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Shirani A, St Louis EK. Illuminating rationale and uses for light therapy. J Clin Sleep Med. 2009 Apr 15;5(2):155-63.

Reference Type BACKGROUND
PMID: 19968050 (View on PubMed)

Rastad C, Ulfberg J, Lindberg P. Improvement in Fatigue, Sleepiness, and Health-Related Quality of Life with Bright Light Treatment in Persons with Seasonal Affective Disorder and Subsyndromal SAD. Depress Res Treat. 2011;2011:543906. doi: 10.1155/2011/543906. Epub 2011 Jun 13.

Reference Type BACKGROUND
PMID: 21747994 (View on PubMed)

Reeves GM, Nijjar GV, Langenberg P, Johnson MA, Khabazghazvini B, Sleemi A, Vaswani D, Lapidus M, Manalai P, Tariq M, Acharya M, Cabassa J, Snitker S, Postolache TT. Improvement in depression scores after 1 hour of light therapy treatment in patients with seasonal affective disorder. J Nerv Ment Dis. 2012 Jan;200(1):51-5. doi: 10.1097/NMD.0b013e31823e56ca.

Reference Type BACKGROUND
PMID: 22210362 (View on PubMed)

Naus T, Burger A, Malkoc A, Molendijk M, Haffmans J. Is there a difference in clinical efficacy of bright light therapy for different types of depression? A pilot study. J Affect Disord. 2013 Dec;151(3):1135-7. doi: 10.1016/j.jad.2013.07.017. Epub 2013 Aug 7.

Reference Type BACKGROUND
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Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ. 2012 Feb 21;184(3):E191-6. doi: 10.1503/cmaj.110829. Epub 2011 Dec 19.

Reference Type BACKGROUND
PMID: 22184363 (View on PubMed)

Other Identifiers

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15-125

Identifier Type: -

Identifier Source: org_study_id

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