1085 EARLY VS. LATE WAKE THERAPY IMPROVES MOOD IN ANTEPARTUM VS. POSTPARTUM DEPRESSION BY DIFFERENTIALLY ALTERING MELATONIN AND SLEEP TIMING.

Abstract

Introduction: Critically-timed wake therapy improves mood in one day in most depressed patients (DP). We tested the hypothesis that early- night wake therapy (EWT: sleep 3:00 - 7:00 am) vs. late-night wake therapy (LWT: sleep 9:00 pm - 01:00 am) improves mood more in antepartum vs. postpartum depression by differentially altering melatonin and sleep timing relationships. Method(s): In 50 women: 26 antepartum (17 healthy comparison (HC) subjects, 9 DP, by DSM-IV criteria) and 24 postpartum (8 HC, 16 DP) initially randomized to a cross-over trial of one night of either EWT or LWT, we measured, pre- and post-treatment, interview-based mood assessments; plasma melatonin (sampled at 30-min intervals from 6:00 pm - 11:00 am); polysomnography (PSG); and melatonin-sleep phase-angle differences (PADs) in relation to ambient day length. Result(s): After EWT, mood improved significantly more in antepartum vs. postpartum DP; after LWT, mood improved more in postpartum than in antepartum DP. In antepartum DP after EWT, mood improvement correlated with a normalized later melatonin onset time, an earlier sleep onset and a reduced PAD between melatonin and sleep onset time. In contrast, in postpartum DP after LWT, mood improvement correlated with normalization and increase in total sleep time. Longer day length was associated with later melatonin onset time and enhanced mood improvement in antepartum DP after EWT. Conclusion(s): In peripartum depression, one night of non-pharmacological behavioral sleep/wake intervention, targeted to specific underlying circadian rhythm abnormalities, improves mood, offering a treatment strategy to women with a potentially severe illness, consistent with the aims of "precision medicine.".