School systems aren’t built for kids who fall asleep and wake up late, the so-called “night owls,” which may help explain why this group of teens is more prone to depression.
Now, researchers at UC San Francisco have found a way to help these kids adjust to their natural sleep-cycle rhythms while still fulfilling their school responsibilities. The findings are a welcome sign for adolescents with depression, who are more likely than most to report staying up late.
While 40% of teens overall report being night owls, in those with depression, 80% report late-night sleep patterns.
The key to success with the current intervention was teaching the night owls to structure their lives so they could sleep as late as possible, while gently training their bodies to fall asleep a little earlier.
“A big finding here is that there is a subgroup of teens for whom treating sleep is particularly important for improving depression symptoms,” said Lauren Asarnow, PhD, an adjunct assistant professor in the Department of Psychiatry and Behavioral Sciences, and a clinical psychologist with UCSF Health who specializes in sleep health. “And the other big finding is that they really need to be able to live a life that is more in line with their sleep-wake biology.
It’s biology, not laziness
The study, published in August in the Journal of Child Psychology and Psychiatry, analyzed data from 42 participants with clinical depression who had been part of a larger study of 176 night-owl adolescents. Twenty-four of these adolescents received the intervention, called the Transdiagnostic Sleep and Circadian Intervention (TransS-C), and 18 received educational sessions on how to lead a healthy lifestyle. All participants kept sleep diaries and wore devices that measured the quality of their sleep. They also received 45-minute therapy sessions each week for eight weeks.
At the beginning of the study, all of the teens scored at least 40 on the Children’s Depression Rating Scale, a level that indicates clinically significant depression. A score of 28 or lower indicates remission. After six months, the intervention group’s average score fell to 21.67, compared to 32.5 for the group that received the healthy lifestyle intervention. These results held for at least 12 months, at which point the intervention scored 24.97, while controls were at 32.75.
Changes in Study Group’s Depression Rating Scale
The graphs below show the average scores on the Children’s Depression Rating Scale for different intervention groups in the study. A score of 40 is indicative of depression, and a score of 28 or lower indicates remission.
A larger study has since been funded by the National Institute of Mental Health, and it will be open for enrollment to 200 teens in the Bay Area this fall.
About 3 million adolescents have at least one major depressive episode in a given year, and about 40% don’t respond to treatment. Teens whose natural tendencies are to fall asleep later and wake up later are at higher risk for recurrent depression, more severe depression, suicidality and poor antidepressant response, research shows.
“There is a saying in our psychology and psychiatry clinics that the best treatment for depression and anxiety is summer break,” Asarnow said. “We need to stop calling these kids ‘lazy.’ A lot of the time it is just their biology. It’s not their fault.”
Read the study
- Journal of Child Psychology and Psychiatry: Report from a randomized control trial: improved alignment between circadian biology and sleep–wake behavior as a mechanism of depression symptom improvement in evening-type adolescents with depressive symptoms
About UCSF Psychiatry and Behavioral Sciences
The UCSF Department of Psychiatry and Behavioral Sciences and the Langley Porter Psychiatric Institute are among the nation's foremost resources in the fields of child, adolescent, adult, and geriatric mental health. Together they constitute one of the largest departments in the UCSF School of Medicine and the UCSF Weill Institute for Neurosciences, with a mission focused on research (basic, translational, clinical), teaching, patient care, and public service.
UCSF Psychiatry and Behavioral Sciences conducts its clinical, educational, and research efforts at a variety of locations in Northern California, including the UCSF Nancy Friend Pritzker Psychiatry Building; UCSF Langley Porter Psychiatric Hospital; UCSF Medical Centers at Parnassus Heights, Mission Bay, and Mount Zion; UCSF Benioff Children’s Hospitals in San Francisco and Oakland; Zuckerberg San Francisco General Hospital and Trauma Center; the San Francisco VA Health Care System; UCSF Fresno; and numerous community-based sites around the San Francisco Bay Area.
About the UCSF Weill Institute for Neurosciences
The UCSF Weill Institute for Neurosciences, established by the extraordinary generosity of Joan and Sanford I. "Sandy" Weill, brings together world-class researchers with top-ranked physicians to solve some of the most complex challenges in the human brain.
The UCSF Weill Institute leverages UCSF’s unrivaled bench-to-bedside excellence in the neurosciences. It unites three UCSF departments—Psychiatry and Behavioral Sciences, Neurology, and Neurological Surgery—that are highly esteemed for both patient care and research, as well as the Neuroscience Graduate Program, a cross-disciplinary alliance of nearly 100 UCSF faculty members from 15 basic-science departments, as well as the UCSF Institute for Neurodegenerative Diseases, a multidisciplinary research center focused on finding effective treatments for Alzheimer’s disease, frontotemporal dementia, Parkinson’s disease, and other neurodegenerative disorders.
The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF’s primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.