Summary
Objective: The lack of systematic efficacy research makes the selection of optimal treatment for postpartum depression (PPD) difficult. Moreover, the treatment decisions for women with PPD who are breastfeeding are heavily influenced by their concerns about infant exposure to antidepressant medication. The objective of this pilot trial was to examine the clinical characteristics of women with PPD associated with treatment selection.
Method: This open pilot trial offered 23 women with PPD one of 3 treatment options: sertraline, interpersonal psychotherapy (IPT), or their combination administered in an outpatient mental health setting over 12 weeks. Baseline and treatment outcome measures included the Hamilton Rating Scale for Depression (HRSD), the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS).
Results: Completers across all 3 treatment groups (n = 18) experienced significant clinical improvement with each of the 3 treatment modalities on the HRSD (p < 0.001), BDI (p < 0.001) and EPDS (p < 0.001). There were trends for women with a prior depression to more frequently choose sertraline as a treatment (alone or with IPT, p = 0.07), and for women who were breastfeeding to choose sertraline (alone or with IPT, p = 0.10) less frequently.
Conclusion: In this small sample of women with PPD, most women chose IPT with or without sertraline. A larger randomized study could further confirm the suggested predictors of treatment selection identified in this study: previous depression and breastfeeding status.
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References
AC Abreu S Stuart (2005) ArticleTitlePharmacologic and hormonal treatments for postpartum depression Psychiatr Ann 35 568–576
L Appleby R Warner A Whitton B Faragher (1997) ArticleTitleA controlled study of fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression BMJ 314 932–936 Occurrence Handle9099116 Occurrence Handle1:CAS:528:DyaK2sXis1Gqs7o%3D
CL Battle C Zlotnick IW Miller T Pearlstein M Howard (2006) ArticleTitleClinical characteristics of perinatal psychiatric patients: a chart review study J Nerv Ment Dis 194 369–377 Occurrence Handle16699387 Occurrence Handle10.1097/01.nmd.0000217833.49686.c0
AT Beck A Beamesderfer (1974) ArticleTitleAssessment of depression: the depression inventory Mod Probl Pharmacopsychiatry 7 151–169 Occurrence Handle4412100 Occurrence Handle1:STN:280:DyaE2M%2Fgslamtg%3D%3D
E Boath E Bradley C Henshaw (2004) ArticleTitleWomen’s views of antidepressants in the treatment of postnatal depression J Psychosom Obstet Gynaecol 25 221–233 Occurrence Handle15715021 Occurrence Handle1:STN:280:DC%2BD2M%2FosFGjug%3D%3D Occurrence Handle10.1080/01674820400017889
VK Burt R Suri L Altshuler Z Stowe VC Hendrick E Muntean (2001) ArticleTitleThe use of psychotropic medications during breast-feeding Am J Psychiatry 158 1000–1009 Occurrence Handle10.1176/appi.ajp.158.7.1001
H Chabrol F Teissedre J Armitage M Danel V Walburg (2004) ArticleTitleAcceptability of psychotherapy and antidepressants for postnatal depression among newly delivered mothers J Reprod Infant Psychol 22 5–12 Occurrence Handle10.1080/02646830310001643094
JL Cox JM Holden R Sagovsky (1987) ArticleTitleDetection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale Br J Psychiatry 150 782–786 Occurrence Handle3651732 Occurrence Handle1:STN:280:DyaL1c%2FgtFahtw%3D%3D Occurrence Handle10.1192/bjp.150.6.782
CL Dennis (2004) ArticleTitleTreatment of postpartum depression, part 2: a critical review of nonbiological interventions J Clin Psychiatry 65 1252–1265 Occurrence Handle15367054
CL Dennis DE Stewart (2004) ArticleTitleTreatment of postpartum depression, part 1: a critical review of biological interventions J Clin Psychiatry 65 1242–1251 Occurrence Handle15367053 Occurrence Handle1:CAS:528:DC%2BD2cXptVegsLg%3D
J Fawcett P Epstein SJ Fiester I Elkin JH Autry (1987) ArticleTitleClinical management – imipramine/placebo administration manual. NIMH Treatment of Depression Collaborative Research Program Psychopharmacol Bull 23 309–324 Occurrence Handle3303100 Occurrence Handle1:STN:280:DyaL2s3ptVequg%3D%3D
SL Grace A Evindar DE Stewart (2003) ArticleTitleThe effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature Arch Womens Mens Health 6 263–274 Occurrence Handle1:STN:280:DC%2BD3srkvVCmsw%3D%3D Occurrence Handle10.1007/s00737-003-0024-6
M Hamilton (1960) ArticleTitleA rating scale for depression J Neurol Neurosurg Psychiatry 23 56–62 Occurrence Handle14399272 Occurrence Handle1:STN:280:DyaF3c7ltFyksw%3D%3D Occurrence Handle10.1136/jnnp.23.1.56
S Misri X Kostaras (2002) ArticleTitleBenefits and risks to mother and infant of drug treatment of postnatal depression Drug Saf 25 903–911 Occurrence Handle12381212 Occurrence Handle1:CAS:528:DC%2BD38XovVejuro%3D Occurrence Handle10.2165/00002018-200225130-00002
S Misri P Reebye M Corral L Milis (2004) ArticleTitleThe use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial J Clin Psychiatry 65 1236–1241 Occurrence Handle15367052 Occurrence Handle1:CAS:528:DC%2BD2cXptVegsLs%3D Occurrence Handle10.4088/JCP.v65n0913
DJ Newport MM Wilcox ZN Stowe (2001) ArticleTitleAntidepressants during pregnancy and lactation: defining exposure and treatment issues Semin Perinatol 25 177–190 Occurrence Handle11453615 Occurrence Handle1:STN:280:DC%2BD38%2FitFyhsg%3D%3D Occurrence Handle10.1053/sper.2001.24901
MW O’Hara S Stuart LL Gorman A Wenzel (2000) ArticleTitleEfficacy of interpersonal psychotherapy for postpartum depression Arch Gen Psychiatry 57 1039–1045 Occurrence Handle11074869 Occurrence Handle1:STN:280:DC%2BD3M3osVehsg%3D%3D Occurrence Handle10.1001/archpsyc.57.11.1039
Segre LS, Stuart S, O’Hara MW (2004) Interpersonal psychotherapy for antenatal and postpartum depression. Primary Psychiatry 11: 52–56, 66.
DK Sit KL Wisner (2005) ArticleTitleDecision making for postpartum depression treatment Psychiatr Ann 35 577–585
ZN Stowe J Casarella J Landry CB Nemeroff (1995) ArticleTitleSertraline in the treatment of women with postpartum major depression Depression 3 49–55
S Stuart MW O’Hara LL Gorman (2003) ArticleTitleThe prevention and psychotherapeutic treatment of postpartum depression Arch Womens Ment Health 6 S57–S69 Occurrence Handle14615924 Occurrence Handle10.1007/s00737-003-0003-y
DJ van Schaik AF Klijn HP van Hout HW van Marwijk AT Beekman M de Haan R van Dyck (2004) ArticleTitlePatients’ preferences in the treatment of depressive disorder in primary care Gen Hosp Psychiatry 26 184–189 Occurrence Handle15121346 Occurrence Handle10.1016/j.genhosppsych.2003.12.001
AM Weissman BT Levy AJ Hartz S Bentler M Donohue VL Ellingrod KL Wisner (2004) ArticleTitlePooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants Am J Psychiatry 161 1066–1078 Occurrence Handle15169695 Occurrence Handle10.1176/appi.ajp.161.6.1066
A Whitton R Warner L Appleby (1996) ArticleTitleThe pathway to care in post-natal depression: women’s attitudes to post-natal depression and its treatment Br J Gen Pract 46 427–428 Occurrence Handle8776916 Occurrence Handle1:STN:280:DyaK28zntlaitw%3D%3D
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Pearlstein, T., Zlotnick, C., Battle, C. et al. Patient choice of treatment for postpartum depression: a pilot study. Arch Womens Ment Health 9, 303–308 (2006). https://doi.org/10.1007/s00737-006-0145-9
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DOI: https://doi.org/10.1007/s00737-006-0145-9