Antepartum Postpartum Depression

Pregnancy and the postpartum period are times of heightened depressive risk for patients who may wish to avoid pharmacotherapy. Spinelli & Endicott (2003) compared 16 weeks of IPT to a weekly parenting education control programme in a group of 38 antepartum women with major 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). The IPT group showed significantly greater improvement of depression than the parent education control programme. O'Hara et al. (2000) compared 12 weeks of IPT to a waiting list for 120 women with postpartum depression. The IPT group showed greater improvement than the waiting-list control group on measures of depression and social adjustment.

Klier etal. (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 counselling (Klerman et al., 1987), a simplified version of IPT. Six of 18 women in the control condition, but none of 17 in the interpersonal group, developed depression after three months postpartum.

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