Interpersonal Psychotherapy (IPT) is a time-limited psychotherapy which is based on the theory that deficiencies or disruptions in interpersonal relationships play an important role in the emergence and persistence of depression. The primary goals of IPT are to reduce symptom severity, improve interpersonal functioning, increase social support and decrease social isolation. IPT has been demonstrated to be effective for the treatment of depression in a variety of clinical settings.
Michael o’Hara and Scott Stuart were the first to demonstrate the effectiveness of this psychotherapy for the treatment of postpartum depression. Since that time, several studies have explored the use of IPT for the treatment of depression during pregnancy (or antenatal depression). In 2013, Spinelli and colleagues reported on a 12-week, bilingual, randomized clinical treatment trial which compared interpersonal psychotherapy for antenatal depression (IPT-P) with a parenting education program (PEP) in pregnant women who met DSM-IV criteria for major depressive disorder.
They observed that interpersonal psychotherapy was beneficial for the treatment of antenatal depression; however, the parenting education program control intervention proved to be equally beneficial. Because depression severity has been shown to influence treatment response in antidepressant treatment trials, Spinelli and colleagues decided to reanalyze the data from this trial, this time limiting analyses to women with moderately severe depressive symptoms.
For this reanalysis, 75 of the 110 study participants who met DSM-IV criteria for major depressive disorder and scored ? 16 on the 17-item Hamilton Depression Rating Scale (HDRS-17) were classified as moderately depressed. At 8 weeks, the IPT-P group had significantly lower HDRS-17 and EPDS depression ratings than the PEP group (respectively, P = .008 and P = .046). Depressive symptoms remained low but lost significance versus those for the PEP group by week 12 due to attrition and smaller sample size.
The findings of this reanalysis demonstrate that among women with moderate severity of depression, IPT-P is markedly more effective than an educational program. This finding is perhaps not that surprising; however, it does highlight the importance of appropriately assessing the treatment needs of pregnant and postpartum women with depression. While certain approaches — such as increasing levels of support or educational programs — may be effective for women with milder symptoms of depression, women with more severe depression will most likely need different types of treatment.
As we move forward with universal depression screening in pregnant and postpartum women, we are definitely more treatment referrals for perinatal mood and anxiety disorders. But this and other studies, as well as our clinical experience, underscore the fact that perinatal depression is heterogeneous. All women who are identified as being “depressed” (because they have an EPDS score above a certain cut-off) are not alike. We must make sure that after screening, we must determine which interventions and treatments are most appropriate, and we must help women to access appropriate resources and treaters who are familiar with treating women during pregnancy and the postpartum period.
Ruta Nonacs, MD PhD
Spinelli MG, Endicott J, Goetz RR, Segre LS.
J Clin Psychiatry. 2016; 77(4):535-40.
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