As a field we have focused primarily on the detection of perinatal mood and anxiety disorders; however, one should be aware of the growing body of literature that suggests that certain interventions may actually decrease a woman’s vulnerability to postpartum depression.
In a group of women with histories of postpartum depression, Wisner and colleagues described a beneficial effect of prophylactic treatment with a selective serotonin reuptake inhibitor (SSRI) antidepressant . In this double blind, placebo-controlled study, 22 women with histories of postpartum depression were randomized to receive treatment with either sertraline (Zoloft) or placebo. Of the 14 women who received Zoloft, only one woman had recurrence of depression. In contrast, four (50%) of the eight women in the placebo group developed PPD.
Other studies have assessed the efficacy of nonpharmacologic interventions. These studies were primarily carried out in populations who did not have an elevated risk for PPD (as compared to the women included in the Wisner study above who had histories of PPD).
A recent Cochrane review of 28 preventative interventions for PPD (Dennis and Doswell, 2013) indicated that women who received a psychosocial or psychological intervention were significantly less likely to experience PPD or depressive symptoms compared to women who received standard care. The most promising interventions in the prevention of PPD were professionally-based home visits, peer-based telephone support, and interpersonal psychotherapy-based interventions. What is notable in this review is that while some of these interventions consist of psychotherapeutic techniques delivered by highly trained specialists, many of the most successful interventions are relatively simple and could be more easily implemented at sites with limited resources.
Caron Zlotnick and colleagues at Brown University have explored the use of interventions in women who typically have limited access to mental health services. In a recent study, these researchers examined the efficacy of an intervention based on the principles of interpersonal therapy (IPT) in reducing the risk of PPD in a group of pregnant women on public assistance.
In this randomized controlled trial, 205 pregnant women who were 18 years old or older, on public assistance, and at risk for PPD were randomized to receive either the IPT group intervention (n=104) or the treatment as usual (TAU, n=101). The Cooper Survey Questionnaire (CSQ), a 17-item validated predictive index for PPD was used to identify women at increased risk for PPD. (This survey assesses for previously identified risk factors for PPD such as previous mood disorder, lack of social support, and relationship discord.)
The IPT–based intervention, ROSE (Reach Out, Stand strong, Essentials for new mothers) Program, was designed to be administered to pregnant women in small groups (2–5 women) and consists of psychoeducational components and IPT-based skills for improving relationships and building social supports. Participants attended four, 90-minute group sessions over a 4-week period and a 50-minute individual booster session within 2 weeks after delivery. Sessions were led by a health educator (a registered nurse) and two individuals with bachelor’s degrees.
At 6 months, the overall depression rate in the intervention group (16%) was lower than the control group (31%) and the effect of the intervention was statistically significant. While we do not know if this intervention will have similar efficacy in a more heterogeneous sample of women, these findings are exciting. The authors pointed out that this ROSE program was designed to be delivered by trained paraprofessionals and thus could help to increase access to care and could easily be implemented in obstetrical practices as a component of prenatal care.
Ruta Nonacs, MD PhD
Dennis CL, Dowswell T. Psychosocial and psychological interventions for preventingpostpartum depression. Cochrane Database Syst Rev. 2013 Feb 28.
Zlotnick C, Tzilos G, Miller I, Seifer R, Stout R. Randomized controlled trial to prevent postpartum depression in mothers on public assistance. J Affect Disord. 2015 Sep 30;189:263-268. [Epub ahead of print]