Bright light therapy in pregnant women with major depressive disorder: study protocol for a randomized, double-blind, controlled clinical trial

Abstract

Background: Depression during pregnancy is a common and high impact disease. Generally, 5-10 % of pregnant women suffer from depression. Children who have been exposed to maternal depression during pregnancy have a higher risk of adverse birth outcomes and more often show cognitive, emotional and behavioural problems. Therefore, early detection and treatment of antepartum depression is necessary. Both psychotherapy and antidepressant medication, first choice treatments in a non-pregnant population, have limitations in treating depression during pregnancy. Therefore, it is urgent and relevant to investigate alternative treatments for antepartum depression. Bright light therapy (BLT) is a promising treatment for pregnant women with depressive disorder, for it combines direct availability, sufficient efficacy, low costs and high safety, taking the safety for the unborn child into account as well.

Methods: In this study, 150 pregnant women (12-18 weeks pregnant) with a DSM-V diagnosis of depressive disorder will be randomly allocated in a 1:1 ratio to one of the two treatment arms: treatment with BLT (9.000 lux) or treatment with dim red light therapy (100 lux). Both groups will be treated for 6 weeks at home on a daily basis for 30 min, within 30 min of habitual wake-up time. Follow-up will take place after 6 weeks of therapy, 3 and 10 weeks after end of therapy, at birth and 2, 6 and 18 months postpartum. Primary outcome will be the average change in depressive symptoms between the two groups, as measured by the Structured Interview Guide for the Hamilton Depression Scale - Seasonal Affective Disorder version and the Edinburg Postnatal Depression Scale. Changes in rating scale scores of these questionnaires over time will be analysed using generalized linear mixed models. Secondary outcomes will be the changes in maternal cortisol and melatonin levels, in maternal sleep quality and gestational age, birth weight, infant behaviour, infant cortisol exposure and infant cortisol stress response.

Discussion: If BLT reduces depressive symptoms in pregnant women, it will provide a safe, cheap, non-pharmacological and efficacious alternative treatment for psychotherapy and antidepressant medication in treating antepartum depression, without any expected adverse reactions for the unborn child.

Trial registration: Netherlands Trial Register NTR5476 . Registered 5 November 2015.

Keywords: Circadian rhythm; Clinical trial; Depression; Depressive disorder; Light therapy; Phototherapy; Pregnancy; Therapeutics.

Fig. 1

Schematic diagram of the hypothalamus-pituitary-adrenal gland (HPA) axis. Shown are the different structures and hormones involved in the HPA-axis. CRF, produced and released by the hypothalamus, stimulates the anterior pituitary to produce and release ACTH, which in turn stimulates the production and release of cortisol by the adrenal cortex. Cortisol inhibits both the hypothalamus and pituitary through the GR. PVN = paraventricular nucleus; GR = glucocorticoid receptor; CRF = adrenocorticotrophic hormone releasing factor; ACTH = adrenocorticotrophic hormone; + = stimulating; − = inhibiting

Fig. 2

Sagittal view of the brain. This figure shows a sagittal view of the suprachiasmatic nucleus, the optic chiasm, the optic nerve, the hypothalamus, the pituitary and the pineal gland

Fig. 3

Flowchart of overview study. DSM = Diagnostic and Statistical Manual of Mental Disorders; BLT = bright light therapy; DRLT = dim red light therapy