Antepartumpostpartum depression

Pregnancy and the postpartum period are times of heightened depressive risk for patients who may wish to avoid pharmacotherapy. Spinelli at Columbia University is using IPT to treat women with antepartum depression. Pregnancy is deemed a role transition that involves the depressed pregnant woman's self-evaluation as a parent, physiological changes of pregnancy, and altered relationships with the spouse or significant other and with other children. "Complicated pregnancy" has been added as a fifth potential interpersonal problem area. Session timing and duration are adjusted for bed rest, delivery, obstetrical complications, and child care, and postpartum mothers may bring children to sessions. As with depressed HIV-positive patients, therapists use telephone sessions and hospital visits as necessary (Spinelli, 1997). A controlled clinical trial is comparing 16 weeks of acute IPT and 6-month follow-up sessions to a didactic parent education group in depressed pregnant women.

O'Hara et al. (2000) compared 12 weeks of IPT to a waiting list for 120 women with postpartum depression. The investigators assessed both the mothers' symptom states and their interactions with their infants (Stuart & O'Hara, 1995). In the IPT group, 38% met HDRS and 44% met BDI remission criteria, whereas comparable responses on each measure in the waiting-list control group were 14%. Sixty percent of IPT patients and 16%

of controls reported more than a 50% BDI improvement. Postpartum women receiving IPT also improved significantly on social-adjustment measures relative to the control group.

Klier et al. (2001) adapted IPT to a 9-week, 90-minute group format and treated 17 women with postpartum depression. Scores on the 21-item Ham-D fell from 19.7 to 8.0, suggesting efficacy. In a still more intriguing study, Zlotnick et al. (2001) treated 37 women at risk for postpartum depression with either four 60-minute sessions of an IPT-based group approach or usual treatment. This preventive application resembles a group form of interpersonal counseling (Klermanetal., 1987), a simplified version of IPT. Six of 18 women in the control condition, but none of 17 in the interpersonal group, developed depression at

3 months postpartum.

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