© COPYRIGHT 2004 PHYSICIANS POSTGRADUATE PRESS, I NC. © COPYRIGHT 2004 PHYSICIANS POSTGRADUATE PRESS, I NC. Epperson et al. 422 J Clin Psychiatry 65:3, March 2004 hirteen percent of pregnant women meet criteria for major depressive disorder during pregnancy, 1 Randomized Clinical Trial of Bright Light Therapy for Antepartum Depression: Preliminary Findings C. Neill Epperson, M.D.; Michael Terman, Ph.D.; Jiuan Su Terman, Ph.D.; Barbara H. Hanusa, Ph.D.; Dan A. Oren, M.D.; Kathleen S. Peindl, Ph.D.; and Katherine L. Wisner, M.D. Background: Bright light therapy was shown to be a promising treatment for depression during pregnancy in a recent open-label study. In an extension of this work, we report findings from a double-blind placebo-controlled pilot study. Method: Ten pregnant women with DSM-IV major depressive disorder were randomly as- signed from April 2000 to January 2002 to a 5-week clinical trial with either a 7000 lux (active) or 500 lux (placebo) light box. At the end of the randomized controlled trial, subjects had the option of continuing in a 5-week exten- sion phase. The Structured Interview Guide for the Hamilton Depression Scale-Seasonal Affective Disorder Version was administered to assess changes in clinical status. Salivary melatonin was used to index circadian rhythm phase for comparison with antidepressant results. Results: Although there was a small mean group advantage of active treatment throughout the randomized controlled trial, it was not statisti- cally significant. However, in the longer 10-week trial, the presence of active versus placebo light produced a clear treatment effect (p = .001) with an effect size (0.43) similar to that seen in anti- depressant drug trials. Successful treatment with bright light was associated with phase advances of the melatonin rhythm. Conclusion: 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. (J Clin Psychiatry 2004;65:421–425) T although treatment options for the pregnant patient are limited by concern for fetal well-being. 2,3 Untreated ma- ternal psychiatric illness can compromise fetal health. Depression may be a risk factor for preeclampsia, 4 and co- occurring maternal anxiety is associated with premature birth, lower birth weights, 5 and childhood behavioral dis- turbances. 6 Antepartum depression is the strongest predic- tor of postpartum depression, which further compromises the child’s neurodevelopment and increases the risk for early-onset depression and substance abuse. 7 Although most antidepressants do not cause major birth defects, they may adversely affect neonatal adaptation, growth, and long-term neurodevelopment. 8,9 Given data that indicate that bright light therapy is ef- fective in the treatment of nonseasonal depression 10–12 and the need to find safe somatic therapies for depressed preg- nant women, we recently conducted an open-label trial of light therapy for women with major depressive disorder during pregnancy. 13 We found that morning bright light for 60 minutes daily reduced depression scale scores by 49% in 16 women after 3 weeks and by 59% in 7 women who extended their treatment to 5 weeks. We now report our findings from a pilot placebo-controlled trial. In addi- tion, we addressed the hypothesis that the effectiveness of Received May 16, 2003; accepted July 30, 2003. From the Departments of Psychiatry (Drs. Epperson and Oren) and Ob/Gyn (Dr. Epperson), Yale University School of Medicine, New Haven, Conn.; New York State Psychiatric Institute and Department of Psychiatry, Columbia University, New York, N.Y. (Drs. Terman and Terman); Departments of Medicine (Dr. Hanusa) and Psychiatry (Dr. Wisner), University of Pittsburgh School of Medicine, Pittsburgh, Pa.; and Department of Psychiatry, Thomas Jefferson University, Philadelphia, Pa. (Dr. Peindl). This study was funded by the National Institute of Mental Health, Bethesda, Md., grants MH01830 (Dr. Epperson), MH42931 (Drs. Terman and Terman), and MH606335 and MH53735 (Dr. Wisner); the Ethel F. Donaghue Women’s Health Investigator Program at Yale University, New Haven, Conn. (Drs. Oren and Epperson); and the U.S. Department of Veterans Affairs Career Award (Dr. Oren). The authors thank Thomas B. Cooper, M.A., for the design and execution of the melatonin assays and Deborah A. Deliyannides, M.D., M. Mila Macchi, Ph.D., Kathryn Czarkowski, M.A., Catherine Piontek, M.D., and Belinda Hartley, M.D., for clinical evaluation of subjects. Corresponding author and reprints: C. Neill Epperson, M.D., Assistant Professor of Psychiatry and Ob/Gyn, Yale University School of Medicine, University Towers, Suite 2H, 100 York Street, New Haven, CT 06511 (e-mail: neill.epperson@yale.edu). 421