Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review

Abstract

Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.

Effectiveness and acceptability of cognitive–behavioural therapy based interventions for maternal peripartum depression: a systematic review, meta-analysis and thematic synthesis protocol

“…No limits will be placed on the severity of depression at baseline. Exclusion criteria are: (1) intervention for mood disorders other than depression (eg, bipolar affective disorder) and (2) intervention explicitly targeting the prevention of symptoms of depression in at-risk mothers in the perinatal period 23. For example, a study with the aim to treat current depression during the antepartum period, with an aim to prevent depression during the postpartum period would be eligible for inclusion.…”

“…Existing reviews highlight the effectiveness of a number of interventions for PPD including medication (eg, antidepressant medication), health promotion interventions (eg, educational home visits) and psychological interventions (eg, cognitive–behavioural therapy (CBT) and interpersonal therapy 16–27. However, the cost:benefit ratio for medication shifts for PPD given unclear evidence concerning safety during the pregnancy,28 and mothers’ concerns regarding medication use while breast feeding 29.…”

“…Further, women experiencing PPD indicate a preference for psychological interventions over medication 29. Although there are mixed findings regarding the superiority of one type of psychological intervention over another,17 25 27 several reviews have found CBT to be an effective psychological intervention for PPD 23 25 26 30. As such CBT-based interventions are recommended as a first-line intervention in clinical guidelines for a number of common mental health difficulties 31.…”

“…A recent study found low rates of intervention engagement in PPD populations in clinical settings, with up to 86% of those suitable for psychological interventions failing to receive any support 44. Previous qualitative studies have highlighted both practice (eg, transportations difficulties, attending appointments around feeding and sleep schedules, childcare needs) and psychological (stigma, sleep deprivation, fear of having child removed) barriers 23 45. Although there is some evidence suggesting interventions adapted to address these barriers, can improve intervention engagement19 there is a lack of systematic research investigating how such barriers are addressed by interventions and how uniquely tailoring interventions to the peripartum period may increase engagement and acceptability.…”

Therapy of peripartum mental disorders

“…Cognitive-behavioral psychotherapy (CBT) and interpersonal psychotherapy (IPT) are shown to be the most efficient in the treatment of peripartum depression (9,10). CBT focuses on adopting an adaptive way of thinking, behavior patterns or both, and results in positive changes in the emotional state.…”