Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineSep 17, 2021

Changes in sleep-wake timing predict lasting treatment results in depression patients who prefer evenings

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Updated Mar 31, 2026

Abstract

Thirty-three participants (36%) experienced a change in eveningness after 5 weeks of chronobiological therapy.

A change in eveningness was associated with a 2-fold increase in the likelihood of remission from depression over a 5-month follow-up.
Participants who maintained a change in eveningness were 3.18 times more likely to achieve remission compared to those who did not.
The study involved 91 adult patients with nonseasonal unipolar depression and evening preference.
Change in eveningness was measured using the Morningness-Eveningness Questionnaire.

Simplified

STUDY OBJECTIVES: Eveningness is associated with worse outcomes in depression. It remained unclear if eveningness could be altered with chronobiological therapy and whether such a change would predict long-term outcomes of depression.

METHODS: Data from a randomized controlled trial of 5-week adjunctive bright light therapy with a gradual advance protocol conducted in 91 adult patients with nonseasonal unipolar depression and eveningness (Morningness-Eveningness Questionnaire, score ≤ 41) was examined. "Change of eveningness" was defined by Morningness-Eveningness Questionnaire score over 41 at posttreatment week 5 and "persistent change of eveningness" was defined as maintenance of Morningness-Eveningness Questionnaire score > 41 throughout the follow-up period from week 5 to posttreatment 5 months.

RESULTS: Thirty-three participants (36%) had change of eveningness at week 5. Generalized estimating equations models showed that a change of eveningness at week 5 predicted a 2-fold increase in remission of depression over the 5-month follow up (odds ratio = 2.61 95% confidence interval 1.20-5.71,= .016). Twenty-five participants (75.7%) had a persistent change and were more likely to achieve a remission of depression over the 5-month follow up (odds ratio = 3.18, 95% confidence interval: 1.35-7.50,= .008). P P

CONCLUSIONS: One-third of the patients with depression changed their evening-preference after 5-week of chronotherapeutic treatment, and such change predicted a higher likelihood of depression remission over 5 months of follow-up.

CLINICAL TRIAL REGISTRATION: Registry: Chinese Clinical Trial Registry; Name: Adjunctive light treatment in major depressive disorder patients with evening chronotype-A randomized controlled trial; URL: https://www.chictr.org.cn/showprojen.aspx?proj=11672; Identifier: ChiCTR-IOR-15006937.

CITATION: Chan JWY, Chan NY, Li SX, et al. Change in circadian preference predicts sustained treatment outcomes in patients with unipolar depression and evening preference.. 2022;18(2):523-531. J Clin Sleep Med

Funding

Competing interests

All authors have seen and approved this manuscript. Work for this study was performed at the Department of Psychiatry, The Chinese University of Hong Kong. This study was funded by the Health and Medical Research Fund, The Food and Health Bureau, The Government of Hong Kong Special Administrative Region (Ref 12131131). This was not an industry-supported study. YKW reported grants from General Research Fund of University Grants Committee, Health and Medical Research Fund, Hong Kong SAR, received personal fees for delivering a lecture from Eisai Co., Ltd and sponsorship from Lundbeck HK Limited. JWYC received personal fees for participating in an expert panel meeting from Eisai Co., Ltd. All other authors report no conflicts of interest.

PubMed

Changes in sleep-wake timing predict lasting treatment results in depression patients who prefer evenings

Abstract

Funding

Competing interests

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Abstract

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