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Perinatal depression :chronobiology,sleep related risk factor and light therapy

English title Perinatal depression :chronobiology,sleep related risk factor and light therapy
Applicant Manconi Mauro
Number 160250
Funding scheme Project funding (Div. I-III)
Research institution Neurocentro della Svizzera Italiana Ospedale Civico
Institution of higher education Ente Ospedaliero Cantonale - EOC
Main discipline Mental Disorders, Psychosomatic Diseases
Start/End 01.11.2015 - 31.10.2019
Approved amount 525'000.00
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All Disciplines (2)

Discipline
Mental Disorders, Psychosomatic Diseases
Neurology, Psychiatry

Keywords (3)

pregnancy; depression; sleep

Lay Summary (Italian)

Lead
Il tema psichiatrico del presente studio clinico è quello della depressione perinatale, che affligge circa il 12 % delle donne in gravidanza. Se non adeguatamente trattata, la depressione perinatale puo' avere conseguenze devastanti sulla qualità della vita delle mamme, dei neonati e della famiglia in genere, come l'uso di sostanze dannose, comportamenti di abuso nei confronti dei bambini, divorzio, suicidio e ritardi di sviluppo cognitivo del bambino. La gestione della depressione in gravidanza è particolarmente difficile per due principali motivi: l'assenza di marcatori precoci al fine di identificare le donne con un alto rischio di sviluppare la depressione e l'assenza di farmaci sicuri da impiegare durante la gravidanza e l'allattamento.
Lay summary

Titolo in breve: Progetto "Life-ON"

Introduzione: La prevenzione e il trattamento della depressione perinatale sono due urgenze cliniche ancora irrisolte. Il nostro obiettivo è quello di provare a dare una risposta ad entrambe queste necessità con un'indagine clinica prospettica su di un'ampia coorte di donne gravide, focalizzando in particolare sul sonno. I disturbi del sonno sono molto frequenti durante la gravidanza e possono causare o precipitare disturbi dell'umore.

Soggetti e Obiettivi: In uno studio multicentrico, circa 600 donne in gravidanza saranno osservate sotto il profilo  psichiatrico e del sonno, al fine di individuare possibili marcatori diagnostici precoci di depressione perinatale. In particolare, esploreremo se la presenza di disturbi del sonno in gravidanza può aumentare il rischio di depressione. Per quelle donne che svilupperanno una depressione valuteremo inoltre un trattamento sperimentale con luce brillante, che sappiamo già essere efficace nella depressione stagionale. Parte delle donne non affette da depressione verrà inoltre sottoposta con intento preventivo ad un ciclo di terapia con luce brillante, per verificare se l'esposizione alla luce durante la gravidanza puo' ridurre il rischio di futura depressione. 

Ricadute socio-scientifiche: La fisiopatologia della depressione perinatale è in gran parte sconosciuto, sarebbe un passo scientifico importante quello di identificare possibili marcatori diagnostici precoci e ancor piu' determinante sarebbe la scoperta di un trattamento sicuro ed efficacie che curi e/o prevenga la depressione.  Il progetto ha lo scopo di identificare nuovi fattori di rischio per la depressione perinatale e di testare la terapia con luce brillante in queste donne. 

 

 

 

 

Direct link to Lay Summary Last update: 28.08.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
Polysomnographic features of pregnancy: A systematic review
Garbazza Corrado, Hackethal Sandra, Riccardi Silvia, Cajochen Christian, Cicolin Alessandro, D'Agostino Armando, Cirignotta Fabio, Manconi Mauro (2020), Polysomnographic features of pregnancy: A systematic review, in Sleep Medicine Reviews, 50, 101249-101249.
Management Strategies for Restless Legs Syndrome/Willis-Ekbom Disease During Pregnancy
Garbazza Corrado, Manconi Mauro (2018), Management Strategies for Restless Legs Syndrome/Willis-Ekbom Disease During Pregnancy, in Sleep Medicine Clinics, 13(3), 335-348.
Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the “Life-ON” project
Baiardi Simone (2016), Chronobiology, sleep-related risk factors and light therapy in perinatal depression: the “Life-ON” project, in BMC Psychiatry, 16:374.

Collaboration

Group / person Country
Types of collaboration
Prof. Silvano Scarone, Psychiatric Department Italy (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
Dr. med. Silvia Miano/Neurocenter of Southern Switzerland Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Stephany Fulda/Neurocenter of Southern Switzerland Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Research Infrastructure
Prof. Fabio Cirignotta/Bologna University Italy (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
- Exchange of personnel
Prof. Dr. med. Stephen L. Leib (Neuroinfectious Diseases Laboratory, Institute for Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Dr. med. Nicola Rizzo (Obstretrics & Gynaecology Clinic, University of Bologna, Italy (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
Prof. Dr. med. A. Kaelin (Clinical Trials Unit, Neurocenter of Southern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
Dr. med. Matteo Preve/Clinica Psochiatrica Cantonale Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr. med. Thomas Gyr (Department of Gynaecology, Civic Hospital, EOC, Lugano) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Dr. med. Rafael Traber (Cantonal Psychiatric Clinic, Mendrisio) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel
Prof. Dr. med. Francesco Benedetti/Department of Clinical Neurosciences Italy (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Exchange of personnel

Communication with the public

Communication Title Media Place Year
New media (web, blogs, podcasts, news feeds etc.) Life-ON Website International 2017

Abstract

Introduction: Perinatal depression (PND), i.e. minor and major depressive episodes withonset during pregnancy or within 12 months after delivery, are experienced by 10% to20% of females. Untreated pregnancy-related depression increases the risk of pretermbirth, low birth weight of the infant, smoking and substance use, shortening ofbreast-feeding and can have significant negative effect on the emotional and cognitivedevelopment of the infants. The pathophysiology of PND is currently unknown andpredictors of perinatal depressive symptoms remain poorly understood. Sleep ismarkedly disturbed during pregnancy and the postpartum period with up to 75% ofpregnant women experiencing some form of sleep disruption during pregnancy such aspoor sleep quality or sleep continuity and/or specific sleep disorders such as therestless legs syndrome and sleep disordered breathing. Given that in the generalpopulation, insomnia has been established as a risk factor for the development ofdepression, impaired sleep during the perinatal period could be a critical risk factor forthe development of PND and structured assessment of sleep and sleep disorders couldhelp identify women at risk for developing depression. Treatment of PND andpregnancy-associated sleep disorders poses a complex problem during the perinatalperiod due to concerns about adverse effects of treatments on the fetus and later theinfant during the breast-feeding period. Psychotherapeutic interventions have beenshown to be effective in PND but due to limited availability and logistic issues, such aschildcare arrangements, women with PND might be less likely to participate. Brightlight treatment is a low cost, home-based treatment with established efficacy for othertypes of depression. Its efficacy for PND has so far been evaluated in only a very limitednumber of studies with mixed results that partly may have been due to the universallysmall sample sizes included. Nevertheless, bright light treatment has been shown topositively affect depression, sleep disorders, circadian synchronization and possiblyserotonergic mechanisms implicated in depression, which makes its systematicevaluation for the treatment of PND is especially promising. In summary, PND is aserious concern during the perinatal period and there is a currently an unmet need forthe early and reliable identification of females at risk for PND as well as safe treatmentoptions. These concerns will be directly addressed in the proposed project.Objectives: 1) to systematically explore and characterise risk factors for perinataldepression by prospectively assessing sleep markers, sleep disorders, inflammatorymarkers and other potential markers during the perinatal period (work package (WP)1), 2) to investigated the effectiveness of light therapy in treating perinatal depression(WP2), and 3) to test whether a short term trial of light therapy during pregnancy canprevent postnatal depression (WP3).Experimental design/Methods: WP1: prospective cohort study following 500 pregnantwomen during pregnancy up to 12 months after delivery. Genetic, inflammatory, andsleep markers will be assessed during pregnancy. Sleep, circadian rhythm, and moodwill be assessed every three months during pregnancy and postpartum with the aim toidentify early predictive markers of perinatal depression. WP2: Minor and majordepression will be assessing during pregnancy and postpartum and women withdepressive symptoms will be randomised (1:1) to 6 week treatment with bright light orplacebo dim light to explore effectiveness of bright light therapy during for perinataldepression. WP3: During pregnancy (Month 6), a random sample of subjects will beassigned to 6 weeks bright light therapy to explore whether this treatment can preventthe onset of postpartum depression.Expected Value of the proposed Project: Perinatal depression is one of the mostcommon complications of child bearing. It can have devastating consequences both forthe women and their children and family. This project will improve our understandingof the precursors and risk factors for perinatal depression that can aid in the earlyidentification of women at risk for perinatal depression. Further, results of the plannedrandomised clinical trial of bright light for perinatal depression will establish whetherthis easy and safe, at-home treatment that has been documented to be effective intreating depression outside pregnancy, can be an viable treatment options during theperinatal period. Finally, given its serious, long-term consequences it would bepreferable to prevent postpartum depression rather than treat it once it is establishedand we will explore whether light therapy after delivery can prevent the onset ofpostpartum depression. In summary, the proposed project is expected to significantlycontribute to improved care and treatment of women during and after pregnancy andultimately to the long-term well being of mothers, children and family.
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