A Randomized, Double-Blind, Placebo-Controlled Study of Light Therapy for Antepartum Depression

Objective: Affective disorder during pregnancy is a common condition requiring careful judgment to treat the depression while minimizing risk to the fetus. Following up on promising pilot trials, we studied the efficacy of light therapy.

Method: Twenty-seven pregnant women with nonseasonal major depressive disorder according to DSM-IV (outpatients, university polyclinic) were randomly assigned to 7,000 lux fluorescent bright white or 70 lux dim red (placebo) light administered at home in the morning upon awakening for 1 h/d in a 5-week double-blind trial carried out between October 2004 and October 2008. Clinical state was monitored weekly with the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale (HDRS) with Atypical Depression Supplement (SIGH-ADS). Changes of rating scale scores over time were analyzed with the general linear model. Differences from baseline of SIGH-ADS and 17-item HDRS scores at every time point were the dependent variables, time was the within-subjects factor, and treatment was the between-subjects factor. The model also included baseline score of depression and gestational age at intervention start.

Results: The superiority of bright light over dim light placebo was shown for both SIGH-ADS (R2 = 0.251; F3,23 = 3.91; P < .05) and HDRS (R2 = 0.338; F3,23 = 5.42; P < .01) when analyzing the week-by-week change from baseline, and HDRS scores showed a significant interaction of treatment with time (F4,92 = 2.91; P < .05). Categorical analysis revealed that the response rate (HDRS ≥ 50% improvement) at week 5 was significantly greater for bright light (81.3%, n = 16) than for placebo light (45.5%, n = 11) (P < .05). Remission (final score ≤ 8) was attained by 68.6% versus 36.4%, respectively (P < .05). Expectation ratings did not differ significantly between groups.

Conclusions: Bright white light treatment for 5 weeks improved depression during pregnancy significantly more than placebo dim red light. The study provides evidence that light therapy, a simple, cost-effective antidepressant modality with minimal side effects for the mother and no known risk for the unborn child, may be a useful nonpharmacologic approach in this difficult situation.

Trial Registration: clinicaltrials.gov Identifier: NCT01043289

J Clin Psychiatry 2011;72(7):986-993

Submitted: April 21, 2010; accepted August 20, 2010.

Online ahead of print: April 5, 2011 (doi:10.4088/JCP.10m06188blu).

Corresponding author: Anna Wirz-Justice, PhD, Centre for Chronobiology, Psychiatric Hospitals of the University of Basel, Wilhelm Klein Strasse 27, CH-4012 Basel, Switzerland (anna.wirz-justice@unibas.ch).