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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