Light Therapy Helpful for Antepartum Depression

Laurie Barclay, MD

March 31, 2004 — Light therapy is helpful for antepartum depression, according to the results of a randomized pilot study published in the March issue of the Journal of Clinical Psychiatry.

"Bright light therapy was shown to be a promising treatment for depression during pregnancy in a recent open-label study," write C. Neill Epperson, MD, from Yale University in New Haven, Connecticut, and colleagues. "Antepartum depression is the strongest predictor of postpartum depression, which further compromises the child''s neurodevelopment and increases the risk for early-onset depression and substance abuse."

From April 2000 to January 2002, ten pregnant women with major depressive disorder, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria, received five weeks of treatment with either a 7,000 lux (active) or 500 lux (placebo) light box, and they could then continue treatment in a five-week extension phase. The structured Interview Guide for the Hamilton Depression Scale–Seasonal Affective Disorder Version was used to monitor clinical status.

During the randomized controlled trial, there was a nonsignificant trend favoring active treatment. In the 10-week trial, however, active light produced a clear treatment effect (P = .001) similar to the effect size seen in antidepressant drug trials (0.43).

Successful treatment with bright light was associated with phase advances of the melatonin rhythm, as reflected in salivary melatonin measurements. One woman had transient hypomania, but there were no other adverse effects.

Study limitations include small sample size and possible clinical benefit associated with the 500 lux light.

"These findings provide additional evidence for an active effect of bright light therapy for antepartum depression and underscore the need for an expanded randomized clinical trial," the authors write. "Dosing of light is flexible and can be changed daily if untoward effects such as hypomania occur, which enhances the clinical safety of this intervention."

The National Institutes of Mental Health, Yale University, and the U.S. Department of Veterans Affairs Career Award helped fund this study.

J Clin Psychiatry. 2004;65:421-425

Reviewed by Gary D. Vogin, MD