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IPT for Perinatal Depression

Rationale and Empirical Evidence for IPT and Brief IPT for Perinatal Depression

Because depression during pregnancy appears to be strongly related to lack of perceived support from significant others, particularly the spouse or partner (O’Hara & Swain, 1996), an interpersonal approach to treatment and prevention of antenatal depression, therefore, may be not only judicious, but also critical.  IPT has demonstrated efficacy in many domains, including the acute treatment of postpartum depression.  O’Hara, Stuart, Gorman, & Wenzel (2000) conducted a randomized trial of 120 mostly White, well-educated, married or cohabitating women who experienced an onset of major depression postpartum and who were successfully treated with 12 sessions of IPT.

IPT also has a role in preventing postpartum depression by reducing antenatal depression because it targets the specific symptoms and interpersonal problem areas (especially role transitions and interpersonal conflicts) experienced by depressed women not only during the postpartum period Steuart & O’Hara, 1995) but also during the pregnancy. A number of studies have evaluated the effects of IPT intervention for high-risk women with antenatal major depression. Spinelli (1997) added to IPT the special role transition of “complicated pregnancy,” which encompasses current medical problems during pregnancy and a history of perinatal loss, medical problems, and sexual trauma. Results from a pilot study (Spinelli, 1997) showed that 16 weekly session of IPT significantly decreased depressive symptoms in 9 pregnant women (mostly Hispanic and White) with major depression. Subsequently, Spinelli and Endicott (2003) conducted a randomized, controlled 16-week trial of IPT for 50 pregnant women with major depression and found that women in the IPT group, compared to those in a parent education group, reported a greater decrease in depressive symptoms.  Recently, Spinelli et al. (2016) found that among women with moderate levels of depression during pregnancy, IPT was more effective in reducing depression than the parent education condition.

Given that the dropout rate is so high in low-income, minority individuals in need of treatment for depression (J. Miranda & Dwyer, 1993), a brief, effective treatment for depression may increase treatment engagement by alleviating the burden of attending numerous sessions (Swartz et al., 2008).  Brief IPT (8 sessions) seems particularly applicable for treating depression in pregnant, low-income, racially and ethnically diverse women. Along with alleviating the burden of numerous treatment sessions, the time pressure afforded by Brief IPT fits with pregnant women’s motivations to feel better as quickly as possible before their baby is born, and it appears to be an effective alternative to pharmacological treatment. Moreover, the idea that depression takes place in an interpersonal context (Klerman et al., 1984) seems to be culturally consonant with the collectivist worldviews of diverse racial/ethnic minority groups (Hall, 2001).

Brief IPT has received empirical support in a number of studies of socio-economically disadvantaged, racially and ethnically diverse pregnant women with depression (Grote et al; 2004; 2009; 2016; Lenze et al., under review). Brief IPT consists of 8 individual sessions provided over 8 or more weeks. It retains the core features of standard IPT, such as strengthening social supports, building on patient strengths and coping strategies, and resolving interpersonal problems. At the same time, brief IPT offers several advantages over standard IPT. First, it reduces the treatment burden for overwhelmed, pregnant or parenting women with multiple acute and chronic stressors. Second, to promote a quicker treatment response, brief IPT techniques have been expanded to include behavioral activation strategies that can be shared with family members/friends and assigned as weekly homework with an interpersonal focus.

Brief IPT can be supplemented with IPT Maintenance to prevent postpartum depressive relapse or recurrence.