Meta-analysis suggests that slightly more than one in ten women with postpartum depression may get relief of symptoms with non-medication therapies

Slightly more than one in ten women with postpartum depression may get some relief of symptoms with non-medication therapies such as counseling and peer support groups, according to a meta-analysis in Issue 4 (2007) of the Cochrane Database of Systematic Reviews.

Although an estimated 13 percent of new mothers who experience postpartum depression, could achieve some relief of symptoms with counseling and peer support, at least one expert cautioned against ruling out drug therapy altogether because studies did not track long-term outcomes.

Not only are affected mothers at a higher risk of developing future episodes of depression, but the condition can negatively affect interactions between babies and mothers. Children of depressed mothers are at greater risk of language deficits, social difficulties and attention problems.

Although the condition can be treated with antidepressant medications, “research suggests that 50 percent of mothers will not take a pharmacological treatment for postpartum depression,” often due to concerns about medication side effects or passing the medicine to infants in breast milk, said Cindy-Lee Dennis, PhD, the review’s lead author.

“We need an alternative to pharmacological interventions,” said Dennis, a perinatal researcher and associate professor at the University of Toronto, Ontario. Her review evaluated nine randomized controlled trials conducted in the United States, the United Kingdom, Canada and Australia.

The review included 956 women in 9 trials with symptoms of postpartum depression and found that, compared with usual postpartum care, mothers who received any type of psychosocial or psychological intervention had a 30-percent lower risk of still having depressive symptoms at the final study assessment, which occurred within the first year postpartum.

“Women prefer to talk to someone to help them work through their depression … Mother-to-mother or peer support is extremely important in the postpartum period. It provides realistic social norms of what it is like to be a mother,” Dennis said.

Previous studies have shown that there is a clear connection between postpartum depression and a lack of social support, but despite this relationship, few well-designed studies have evaluated the effect of support groups and counseling in alleviating new moms’ depressive symptoms, according to Dennis.

Health care professionals facilitated all of the social and psychological interventions in this review, which were face-to-face except for one that involved telephone-based peer support.

Both social interventions (such as counseling and peer support) and psychological interventions (such as cognitive behavioral therapy) appeared to be similarly effective in reducing symptoms, based on results from the two trials that compared them.

“The review is helpful in some ways, but really points out the deficiency in research in this area in general,” said Jennifer Payne, MD, co-director of the Women’s Mood Disorders Center at Johns Hopkins School of Medicine.

Although the review results suggest that new moms with depression benefit from social and psychological interventions, the review authors said that the included trials could not offer data on whether these interventions reduced depression symptoms long-term.

“When you have someone with a first onset of depression and it’s mild to moderate, those are usually the patients that I think about offering psychological intervention, but anytime someone is mildly to moderately depressed, you have to think about medication, usually in conjunction with a psychological intervention,” Payne said.


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