Depression during pregnancy (antenatal depression) is relatively common, affecting about 10% of women. While there is a growing body of literature supporting the reproductive safety of certain antidepressants, our understanding of how these psychotropic medications affect the developing fetus remains incomplete. In this setting, women typically choose to avoid antidepressant therapy. For this reason, there is a clear need for effective non-pharmacologic treatments for women at high risk for antenatal depression.
Interpersonal therapy (IPT) is a time-limited, problem-oriented form of individual psychotherapy that has been demonstrated to be effective in many different populations, including women with postpartum depression. Spinelli and colleagues have recently published two reports supporting its efficacy in women with depression during pregnancy. In a preliminary open trial, it was demonstrated that a 16-week course of IPT resulted in the remission of depressive symptoms in all 13 women with antenatal depression who participated in this study (Spinelli 1997). Of the ten women available for postpartum follow-up, none experienced postpartum depression.
In a subsequent controlled clinical trial, 50 pregnant women with DSM-IV major depression were randomized to receive either 16 weeks of interpersonal therapy or a parenting education program (Spinelli and Endicott, 2003). 38 women completed the study. Based on ratings of mood using the Beck Depression Inventory and the Hamilton Depression Rating Scale, about half of the women receiving interpersonal therapy showed improvement (> 50% reduction in scores). Remission, defined as a Clinical Global Impression (CGI) score of < or = 2, was observed in 60.0% of the interpersonal psychotherapy group and in only 15.4% of the parenting education control group.
These two studies demonstrate that interpersonal therapy may be an effective non-pharmacologic option for women with antenatal depression. Although remission rates appear to be relatively low, these rates are comparable to those observed in other outpatient treatment studies of major depression. In the second controlled study, IPT was compared to another intervention, a parenting education program. Both interventions involved weekly contact with a mental health professional, yet there was a clear difference in the efficacy of the two, suggesting a unique treatment effect of IPT. Not only does IPT appear to treat the acute symptoms of depression, the first study suggests that IPT may help to prevent postpartum depression in this population at high risk for affective illness after delivery. Given the efficacy of this non-pharmacologic treatment in this setting, the next step is to determine if this intervention may be useful in preventing recurrence of depression in women at high risk for depressive illness during pregnancy.
Ruta Nonacs, M.D., Ph.D.
Spinelli MG. Interpersonal psychotherapy for depressed antepartum women: a pilot study. Am J Psychiatry. 1997 Jul;154(7):1028-30.
