Abstract
BackgroundMajor depression and type 2 diabetes often co-occur. Novel treatment strategies for depression in type 2 diabetes patients are warranted, as depression in type 2 diabetes patients is associated with poor prognosis and treatment results. Major depression and concurrent sleep disorders have been related to disturbances of the biological clock. The biological clock is also involved in regulation of glucose metabolism by modulating peripheral insulin sensitivity. Light therapy has been shown to be an effective antidepressant that ‘resets’ the biological clock. We here describe the protocol of a study that evaluates the hypothesis that light therapy improves mood as well as insulin sensitivity in patients with a major depressive episode and type 2 diabetes.Methods/designThis study is a randomised, double-blind, parallel-arm trial in 98 participants with type 2 diabetes and a major depressive episode, according to DSM-IV criteria. We will assess whether light therapy improves depressive symptoms and insulin sensitivity, our primary outcome measures, and additionally investigate whether these effects are mediated by restoration of the circadian rhythmicity, as measured by sleep and hypothalamic-pituitary-adrenal axis activity. Participants will be randomly allocated to a bright white-yellowish light condition or dim green light condition. Participants will undergo light therapy for half an hour every morning for 4 weeks at home. At several time points, namely before the start of light therapy, during light therapy, after completion of 4 weeks of light therapy and after 4 weeks follow-up, several psychometrical, psychophysiological and glucometabolic measures will be performed.DiscussionIf light therapy effectively improves mood and insulin sensitivity in type 2 diabetes patients with a major depressive episode, light therapy may be a valuable patient friendly addition to the currently available treatment strategies. Additionally, if our data support the role of restoration of circadian rhythmicity, such an observation may guide further development of chronobiological treatment strategies in this patient population.Trial registrationThe Netherlands Trial Register (NTR) NTR4942. Registered 13 January 2015.
Highlights
Major depression and type 2 diabetes often co-occur
If our data support the role of restoration of circadian rhythmicity, such an observation may guide further development of chronobiological treatment strategies in this patient population
To the best of our knowledge, we are the first to investigate the effects of light therapy on depressive symptoms and insulin sensitivity in type 2 diabetes (T2D) patients with a major depressive episode
Summary
Major depression and type 2 diabetes often co-occur. Novel treatment strategies for depression in type 2 diabetes patients are warranted, as depression in type 2 diabetes patients is associated with poor prognosis and treatment results. Light therapy has been shown to be an effective antidepressant that ‘resets’ the biological clock. We here describe the protocol of a study that evaluates the hypothesis that light therapy improves mood as well as insulin sensitivity in patients with a major depressive episode and type 2 diabetes. Meta-analytic evidence has shown that antidepressant treatments, both psychological and pharmacological, are only moderately effective in the reduction of depressive symptoms in T2D patients [19, 20]. Glycaemic improvements from anti-depressant therapies have been very modest [20] and some antidepressant drugs have even shown negative metabolic effects, such as weight gain [21] and glucose dysregulation [22]. There clearly is a need for more efficacious treatment strategies of major depression in T2D patients, which improve both psychiatric symptoms and glycaemic control [23]
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