Depression after childbirth: Can psychosocial and psychological treatment approaches help?

Antidepressants are an important treatment for some women. But women with postnatal depression tend to prefer treatments without medication. Talking to a supportive, non-judgmental person often really helps mothers who are depressed. Psychotherapists can offer this kind of help.

There are many different psychological treatments for people who have depression. Not all of them have been formally assessed in studies, though. Researchers from the Cochrane Collaboration looked for studies on psychosocial support and psychological treatments, to see if any of these approaches have been proven to help with postnatal depression.

The Cochrane researchers found ten studies involving almost 1,000 women who had postnatal depression. Various kinds of psychological treatment were used in these studies. The studies showed that psychological treatment is more effective at making postnatal depression go away than the usual postnatal care women receive after giving birth:

• 57 out of 100 women who received the usual postnatal care were still depressed one year after the studies began.
• 40 out of 100 women who had psychological treatment were still depressed after one year.

In other words, psychological treatment helped the depression go away in an extra 17 out of 100 women.

Most of the studies included in the Cochrane researchers' analysis looked at non-directive counseling, cognitive behavioral therapy or interpersonal psychotherapy. These treatments were given by trained psychologists and counselors.

Non-directive counseling involves talking, with the aim of being emotionally supportive while not giving any advice. There is not necessarily a fixed number of sessions.

Cognitive behavioral therapy (CBT) involves a series of sessions – usually about ten, although this can vary. The aim of CBT is to identify thought patterns and behaviors that might be making life unnecessarily difficult, and then change them. In postnatal depression, this involves things like finding out what is making it hard for the mother to cope with her emotions and the changes brought on by motherhood. For example, if she often has thoughts like, “I’m a bad mother and I will always be a bad mother,” the CBT therapist will help her work on changing that belief.

Interpersonal psychotherapy involves weekly sessions with a psychotherapist for a limited period of time. This treatment focuses on the woman’s symptoms as well as certain issues that become more important as her role in life (being a mother) and relationships with her partner and other people close to her change. That's why it is called “interpersonal psychotherapy.” The goal is to develop individual strategies to address the identified problems.

The Cochrane researchers didn't include studies on group therapy or self-help groups. There's also not much good-quality research on other types of psychological treatment, such as psychotherapy that focuses on early childhood experiences.