A meta-analysis of treatments for perinatal depression

Department of Psychology, University of Pennsylvania, United States.
Clinical psychology review (Impact Factor: 7.18). 07/2011; 31(5):839-49. DOI: 10.1016/j.cpr.2011.03.009
Source: PubMed


This meta-analysis assessed efficacy of pharmacologic and psychological interventions for treatment of perinatal depression. A systematic review identified 27 studies, including open trials (n=9), quasi-randomized trials (n=2), and randomized controlled trials (n=16) assessing change from pretreatment to posttreatment or comparing these interventions to a control group. Uncontrolled and controlled effect sizes were assessed in separate meta-analyses. There was significant improvement in depressive symptoms from pretreatment to posttreatment, with an uncontrolled overall effect size (Hedges' g) of 1.61 after removal of outliers and correction for publication bias. Symptom levels at posttreatment were below cutoff levels indicative of clinically significant symptoms. At posttreatment, intervention groups demonstrated significantly greater reductions in depressive symptoms compared to control groups, with an overall controlled effect size (Hedges' g) of 0.65 after removal of outliers. Individual psychotherapy was superior to group psychotherapy with regard to changes in symptoms from pretreatment to posttreatment. Interventions including an interpersonal therapy component were found to have greater effect sizes, compared to control conditions, than interventions including a cognitive-behavioral component. Implications of the findings for clinical practice and future research are discussed.

21 Reads
  • Source
    • "Wisner et al., 2009) might improve maternal disorders and offspring outcomes, but during pregnancy and lactation potential risks and benefits have to be evaluated (Arch et al., 2012; Bonari et al., 2004; Wisner et al., 2009). Psychotherapies involving the family and interventions designed to improve mother-infantinteraction are promising strategies that need further research attention (Sockol et al., 2011; Stein et al., 2014). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Peripartum anxiety and depressive disorders are associated with adverse consequences for mother and child. Thus, it is important to examine risk factors, correlates and course patterns of anxiety and depressive disorders during pregnancy and after delivery. In the prospective-longitudinal Maternal Anxiety in Relation to Infant Development (MARI) Study, n=306 expectant mothers were recruited from gynaecological outpatient settings in Germany and completed up to seven waves of assessment from early pregnancy until 16 months postpartum. Anxiety and depressive disorders and potential risk factors/correlates were assessed with the Composite International Diagnostic Interview for Women (CIDI-V), medical records and additional questionnaires. Although peripartum anxiety and depressive disorders appeared to be persistent in some women, others reported major changes with heterogeneous courses and shifts between diagnoses and contents. There was a considerable amount of incident disorders. Strongest predictors for peripartum anxiety and depressive disorders were anxiety and depressive disorders prior to pregnancy, but psychosocial (e.g. maternal education), individual (e.g. low self-esteem), and interpersonal (e.g. partnership satisfaction, social support) factors were also related. Knowing the aims of the study, some participants may have been more encouraged to report particular symptoms, but if so, this points to the importance of a comprehensive assessment in perinatal care. Peripartum time is a sensitive period for a considerable incidence or persistence/recurrence of anxiety and depressive disorders albeit the course may be rather heterogeneous. Interventional studies are needed to examine whether an alteration of associated factors could help to prevent peripartum anxiety and depressive disorders. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 01/2015; 175C:385-395. DOI:10.1016/j.jad.2015.01.012 · 3.38 Impact Factor
  • Source
    • "Although CBT is an established treatment for mild-to-moderate nonpuerperal major depression, far less is known about its effectiveness for treating antenatal depression. The same meta-analysis of 27 heterogeneous studies reviewed earlier found CBT to be beneficial for perinatal depression, albeit with small-to-medium effects.54 In a randomized trial, CBT adapted for perinatal depression in outpatients was associated with greater improvement in depressive symptoms than standard care over 16 weeks of follow-up.56 "
    [Show abstract] [Hide abstract]
    ABSTRACT: In pregnant women with major depression, the overarching goal of treatment is to achieve or maintain maternal euthymia, thus limiting both maternal and fetal exposure to the harmful effects of untreated or incompletely treated depression. However, the absence of uniformly effective therapies with guaranteed obstetric and fetal safety makes the treatment of major depression during pregnancy among the most formidable of clinical challenges. Clinicians and patients are still faced with conflicting data and expert opinion regarding the reproductive safety of antidepressants in pregnancy, as well as large gaps in our understanding of the effectiveness of most antidepressants and nonpharmacological alternatives for treating antenatal depression. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated maternal depression during pregnancy, the effectiveness of interventions for maternal depression during pregnancy, and potential obstetric, fetal, and neonatal risks associated with antenatal antidepressant use.
    Drug, Healthcare and Patient Safety 09/2014; 6:109-29. DOI:10.2147/DHPS.S43308
  • Source
    • "Several metaanalyses exist to date and suggest that psychological interventions are efficacious in reducing depressive symptoms (Cuijpers et al., 2008; Dennis and Hodnett, 2007; Lumley et al., 2004; Sockol et al., 2011) at rates similar to those of antidepressant medications (De Crescenzo et al., 2013; Sockol et al., 2011). No conclusive data exist to suggest the superiority of one psychotherapy modality to another in the treatment of PPD (Fitelson et al., 2010), although there is some evidence that IPT, which directly addresses interpersonal problems (e.g., role transitions, relational conflicts), may be more efficacious than CBT, which targets maladaptive depressogenic cognitions (Bledsoe and Grote, 2006; Sockol et al., 2011). However, as with pharmacotherapy, a mere decrease in depressive symptoms is often not enough to enhance maternal functions (Forman et al., 2007; Murray et al., 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The role of oxytocin in the treatment of postpartum depression has been a topic of growing interest. This subject carries important implications, given that postpartum depression can have detrimental effects on both the mother and her infant, with lifelong consequences for infant socioemotional and cognitive development. In recent years, oxytocin has received attention for its potential role in many neuropsychiatric conditions beyond its well-described functions in childbirth and lactation. In the present review, we present available data on the clinical characteristics and neuroendocrine foundations of postpartum depression. We outline current treatment modalities and their limitations, and proceed to evaluate the potential role of oxytocin in the treatment of postpartum depression. The aim of the present review is twofold: a) to bring together evidence from animal and human research concerning the role of oxytocin in postpartum depression, and b) to highlight areas that deserve further research in order to bring a fuller understanding of oxytocin's therapeutic potential.
    Brain research 11/2013; 1580. DOI:10.1016/j.brainres.2013.11.009 · 2.84 Impact Factor
Show more