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About our University
of Pittsburgh research group
Antepartum depression case descriptions
Beyond the expected physical discomforts of pregnancy (sleep problems, frequent urination, appetite changes, burden of new weight, and so on) pregnant mothers may face emotional changes that seriously affect their mood, energy, work and social life, and motivation. In other words, serious depression can be associated with pregnancy. Technically, it is called "antepartum depression," and it affects as many as 10% of pregnant mothers.
Medication treatment of antepartum depression depends on a risk/benefit analysis. The decision must weigh the severity of the depression and consider how drugs might affect the fetus. An alternative non-drug treatment strategy, bright light therapy, is also undergoing clinical trials at three university clinical centers (Columbia, Pittsburgh, Yale). Initial results have been very promising and show positive effects of light therapy (see case study link in the menu to the left). The results are in final review for publication in a major medical journal.
(Because this is still an exploratory treatment approach, light therapy is not yet widely offered for antepartum depression in clinical practice. The new ultraviolet-free units we are testing are not available anywhere!)
Who is eligible for participation?
Participants include pregnant women from age 18 through 40 who are currently experiencing depression, whether it began before or after the onset of pregnancy. Throughout the study they will maintain coverage by their own obstetrician, who will verify normal medical status. Women will not be invited into the study if they have a current medical illness (including eye diseases) or if they are using psychiatric medication, including antidepressants. Participants also must be able to regularly go to sleep no later than 1 a.m. and sleep no later than 10 a.m.
All use of alcohol or recreational drugs is prohibited.
How is treatment administered?
Participants will be loaned a portable, lightweight light box for use at a tabletop at home. They will be randomly assigned to one of two dose levels of light under study, both within a comfortable room light range and one expected to be more effective than the other. (Specific information about the dose level is withheld from participants and clinical staff until the trial is completed, in order to enable careful dose comparisons). Participants reserve 60 minutes each morning (specific times individually assigned based on wake-up time) when they sit at the light box and engage in any quiet activity with eyes open, such as reading, writing, listening to music and having breakfast. To make time for treatment, participants may be asked to wake up slightly earlier than has been normal for them. Treatment continues daily for five weeks, during which progress is monitored by log sheets, telephone contact with staff, and periodic clinic visits. Although the trial seeks to demonstrate alleviation of depressive symptoms, supervisory staff may recommend use of the alternate light dose or an entirely different treatment at any point in the trial if the depression worsens significantly.
After the five-week trial participants will have the opportunity to continue with treatment if it has been successful, or try an alternate treatment regimen if it appears that a different light configuration would be beneficial. The staff will also offer guidance toward treatment following birth of the baby, if that is indicated.
Light therapy and melatonin production
A promising avenue of investigation is the relation between the antidepressant response to light therapy and changes in the body's production of the hormone melatonin, which can be measured in saliva. Participants in this study will collect small samples of saliva at home On two evenings, before and after treatment with light. Absorbent swabs placed in the mouth are deposited into capped plastic tubes and refrigerated for return to the clinic.
Potential risks of this treatment approach
There is a strong incentive to explore new non-drug treatments for depression in pregnancy, given that standard antidepressant medications may directly affect the fetus, and indeed there is no established or proven medication treatment for such depression. The potential risks of light therapy, as administered in this study, are very low. If patients receive too much light, they can become irritable or show disturbed sleep, but these side effects are readily controlled by adjusting the light dose (for example, by reducing the daily exposure duration). In a very few cases -- which thus far include no pregnant patients -- too much light has induced an overactive state, which also can be controlled by dose adjustment. Such a side effect profile compares very favorably with that for standard antidepressants, and the rapid reversibility through light dose adjustments distinctly minimizes risk. More information about the nature of the research and the risks and benefits of the treatment offered with be provided during the informed consent process.
