Usefulness
of light therapy in antepartum depression
In
patients suffering from certain subtypes of
major depressive disorder successful treatment
may include both light therapy and drug therapy.
Although depression during pregnancy is quite
common antidepressant use is controversial, and
alternative treatment options in pregnant women
are rare. The risks of depression during
pregnancy are not negligible and often lead to
postpartum depression which can compromise the
child's neurodevelopment and enhances the risk
for early-onset psychiatric disorders.
An attractive alternative is the light therapy
which is a potentially non-toxic antidepressant.
Recently an open-label study has shown that
morning light therapy has an antidepressant
effect during pregnancy. A double-blind
placebo-controlled pilot study has now been
carried out to further investigate this
potential therapy.
Ten pregnant women with major depressive
disorder, diagnosed according to DSM-IV
criteria, were randomly assigned to five weeks
of treatment with either a 7000 lux (active) or
500 lux (placebo) light box. After this period,
the subjects could continue their therapy for a
five-week extension phase. Clinical status was
monitored using the Structured Interview Guide
for the Hamilton Depression Scale-Seasonal
Affective Disorder Version. Salivary melatonin
levels were measured for indexing circadian
rhythm.
During the randomized controlled trial, a
non-significant tendency in favor of active
treatment was observed. In the ten-week trial,
treatment with active light was significantly
effective (p = 0.001) with an effect size (0.43)
similar to that of antidepressant drug trials.
An association between successful therapy with
bright light and phase advances of the melatonin
rhythm was found.
These findings support the results of the
previous open study, however a larger clinical
trial is needed to fully appreciate the
therapeutic potential and safety of the bright
light therapy for antepartum depression.
Epperson
CN, Terman M, Terman JS, Hanusa BH, Oren DA,
Peindl KS, Wisner KL. Randomized clinical trial
of bright light therapy for antepartum
depression: preliminary findings. J Clin
Psychiatry 65: 421-425, 2004.