Nov. 14, 2000 -- Talk therapy can help bad cases of the "new-baby blues." The finding, published in the November issue of the Archives of General Psychiatry, suggests that breastfeeding mothers with clinical depression may not have to risk the possible side effects of antidepressant drugs on their infants.
"Psychiatrists often are going to want to use medications, but we do have a psychotherapy that works," study author Michael W. O'Hara, PhD, tells WebMD. "If women don't want to take medication, this would be an alternative for them."
Postpartum depression affects 8% to 12% of new mothers. Although often dismissed as the baby blues, this major depression can have long-lasting effects -- not only for women but also for their children, who virtually lose their mothers to depression during a crucial period of development. While antidepressant drugs can help, evidence suggests that these drugs take longer to work in women with postpartum depression.
O'Hara and colleagues at the University of Iowa in Iowa City evaluated the effect of psychotherapy in treating postpartum depression. They chose a type of therapy called interpersonal psychotherapy, which already has been shown effective in the treatment of major depression.
"The therapy places depression in an interpersonal context," O'Hara says. "Basically, the therapy frames depression as a medical disorder that causes both biological and interpersonal problems, and certainly has interpersonal consequences. It [suggests] that one's interpersonal relationships are quite important to how one adjusts and to the vulnerability one has to depression."
Treatment proceeds first by working with the patient to establish that depression is indeed the problem. Then the therapist helps the patient identify specific problems -- which in postpartum depression usually revolve around role transitions and conflict in important relationships.
"You help the patient identify one or two problems to be worked on, explore the basic dimensions of the problem, brainstorm a bit about how the patient might address these problems, and then have the patient come back, report on how it went, and work on it a bit more," O'Hara says. "It is very much a problem-focused psychotherapy where the patient takes a major role in working. The therapist helps the patient stay on track and focus on problem solving."
O'Hara's team enrolled 120 women with severe postpartum depression. Half received 12 weeks of interpersonal psychotherapy and the other half were put on a 12-week waiting list to receive the treatment. This served as the comparison group. The women who underwent psychotherapy had significantly greater improvements than the untreated group on all study measures. On average, their depression got much better -- and about 40% of the women completely recovered.
"In the treated group, a goodly proportion simply recovered, and a lot got better but didn't have a complete recovery," O'Hara says. "Our aim in this study was really to establish interpersonal psychotherapy as a treatment for postpartum depression. It does indicate that other psychotherapies will have the same effect. ... When women contacted me from out of state during study enrollment, I would say to them, 'Find a competent mental health professional and you will get pretty good care even if they don't do interpersonal psychotherapy.'"
Postpartum depression expert Marie J. Hayes, PhD, says that modern society fails to support women in the year following the birth of a child. The University of Maine psychologist, who was not involved in the O'Hara study, says the study findings support her theory that lack of social support is the reason why more women than ever before are developing postpartum depression.
"There has been an erosion of support to the point that women are actually alienated just after giving birth," Hayes tells WebMD. "So women are left with the same level of responsibility as [before giving birth], but with additional needs for physical and psychological recovery as well as the need to establish the entire nutritional support for the infant. ... What's going on is that [doing the right things as a mother] is something the brain is predisposed to do ... but this can be derailed in an environment that is not presenting the proper cues of social and physical support."
Interpersonal psychotherapy, Hayes says, addresses part of this problem by helping women get some of the social support they need after the birth of a child. However, she says that it takes care of only one part of the problem.
"It doesn't necessarily say to the woman that the responsibility for her roles should be on break," Hayes suggests. "There should be a significant, programmed break in her postpartum responsibilities -- and some help with the baby. I think [interpersonal psychotherapy] is certainly barking up the right tree in terms of addressing the woman's social support. But it still is putting the onus on the woman -- it says to her, 'You are not adjusting, lets see why.' I am saying it is the culture's responsibility to wake up to the fact that mothers' needs are being systematically denied."
O'Hara is following the women who participated in the study -- and their children -- to see whether psychotherapy has long-term benefits.