Postpartum depression (PPD) is relatively common, occurring in about 10 to 15% of women after delivery. Non-pharmacologic interventions, including interpersonal psychotherapy, have been shown to be effective for the treatment of PPD. In addition, several reports have documented the efficacy of selective serotonin reuptake inhibitors (SSRIs) and the serotonin norepinephrine reuptake inhibitor venlafaxine (Effexor). In a recent report, Misri and colleagues have evaluated whether the addition of Cognitive-Behavioral Therapy (CBT) to standard antidepressant treatment improves outcomes in women with postpartum depression and co-morbid anxiety.
In this study, 35 women with postpartum depression with co-morbid anxiety were randomly assigned to a group receiving either paroxetine (Paxil) alone (n =16) or paroxetine plus 12 sessions of CBT (n =19) for a period of 12 weeks. Paroxetine was initiated at 10 mg and increased according to an individually tailored, flexible dosing scheme up to a maximum of 50 mg/day. Clinical improvement was assessed by a blinded rater using the following instruments: Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety, Yale-Brown Obsessive Compulsive Scale, Clinical Global Impressions Scale, Edinburgh Postnatal Depression Scale.
Both treatment groups showed a highly significant reduction (p <0.01) in mood and anxiety symptoms. Response rates, defined as a 50% reduction in HAM-D scores, were high in both groups: 87.5% for the paroxetine group and 78.9% for the combination group. Groups did not differ significantly with regard to dose of paroxetine at remission or measures of depression, anxiety, and obsessive-compulsive symptoms at endpoint. The mean dose needed to achieve remission was 36.25 mg in the paroxetine monotherapy group and 32.50 mg in the combination group. Although the group treated with paroxetine and CBT appeared to recover more quickly than the paroxetine monotherapy group, this finding was not statistically significant. This study indicates that treatment with paroxetine monotherapy and combination therapy using paroxetine plus CBT are both efficacious in reducing depression and anxiety symptoms. In this sample, there appeared to be no additional benefits from combining the two treatment modalities.
Ruta Nonacs, MD PhD
Misri S, Reebye P, Corral M, Milis L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004 Sep;65(9):1236-41.