Daniel Carlat, MDDr. Carlat has disclosed that he has no significant relationships with or financial interests in any commercial companies pertaining to this educational activity.
It’s not all about meds. This is especially true in treating postpartum depression, because so many women are understandably reluctant to expose their breast-feeding infants to antidepressants. This article reviews interpersonal therapy (IPT) as an effective modality for post-partum depression.
Recall that according to DSM-4, post-partum depression has an onset up to 4 weeks after childbirth, but many authorities use 3 months as a more realistic time frame. It may be triggered by precipitous declines in estrogen and other hormones after delivery, but there’s clearly more to it than that, since a past history of depression powerfully predicts a future postpartum depression. It is common, afflicting about 13% of all women who deliver (1). It should not be confused with “baby blues,” however, which strikes most women soon after delivery, peaks around day 4, and disappears by day 10. Standard antidepressants are effective, though there have been few controlled trials.
The big news in post-partum treatment is that IPT is rising to the top of the heap of non-drug treatments. The most impressive study to demonstrate its effectiveness was published in 2000 in the Archives of General Psychiatry (2). A total of 120 women with postpartum depression were randomly assigned to one of two groups: A waiting list condition (WLC), and interpersonal therapy (IPT) consisting of 12 weekly sessions conducted by private practice doctoral-level therapists who had received special IPT training for the study. The results? Patients receiving IPT showed a 43.8% remission rate vs. a 13.7% remission rate in the WLC group.
So what is IPT? This tiny article can’t do more than introduce some of its basic concepts, of course; excellent training courses and books are available (3). But the IPT approach is so intuitively appealing that you will probably want to use some of these techniques immediately.
Patients with post-partum depression showed an impressive 43.8% remission rate with Interpersonal Therapy (IPT).
IPT begins with the assumption that the disorder being treated--in this case, post-partum depression--is either triggered or worsened by problems in important relationships. Consequently, it is crucial early in therapy to obtain a “relationship inventory”--a listing of relationships and a description of their strengths and weaknesses.
Then, the IPT therapist and the patient work together to agree on a therapeutic focus. According to a companion article by the authors of the Archives study already mentioned (4), most women with post-partum depression are confronted with problems in role transitions, and this will often be the focus of therapy.
The transition from pregnancy to motherhood is a time of both joy and anxiety, but for many women the anxiety becomes paramount. She may constantly second-guess her ability to successfully adopt the new role of being a mom. She may view herself as a failure, and become guilty that she is not enjoying motherhood as she is “supposed” to.
Aside from eliciting and clarifying such feelings, the therapist explores how the patient’s relationships are helping or hindering her coping abilities. Her husband may be too overwhelmed by his own role transition to be supportive. Her extended family may be critical of her for not enjoying motherhood. If she is back at work, her employer and co-workers may be completely unsympathetic to her plight.
In addition to the basic supportive role that any good therapist provides, the IPT therapist will suggest specific ways of improving relationships, such as encouraging the patient to be honest with others about her feelings, to be more assertive about asking for support, and to actively build a new support system.
Medications may still be necessary, but often, IPT techniques will ease your patient’s pain enough to get her over the post-partum “hump” and back on her way to coping with the normal, everyday catastrophes of motherhood.
TCR VERDICT: IPT: It’s time to learn it and use it
1.Wisner KL, Parry BL, and Piontek CM. Postpartum depression. N Engl J Med 2002; 347(3):194-199. 2. O’Hara MW, Stuart S, Gorman LL, et al. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry 2000; 57:1039-1045. 3. Klerman GL, Weissman MM, Rounsaville BJ, et. al. Interpersonal Psychotherapy of Depression. 1984: Basic Books. 4. Stuart S and O’Hara MW. IPT for perinatal depression. International Society for Interpersonal Psychotherapy, internet publication at www.interpersonalpsychotherapy.org/perinatal_depression.htm