PREVENTION+

BACKGROUND: Perinatal depression can have a deleterious impact on mothers and infants.

PURPOSE: To evaluate psychological therapies for perinatal depression.

DATA SOURCES: 6 databases from January 2000 to March 2025.

STUDY SELECTION: Randomized controlled trials (RCTs) of psychological therapies for people with depression during pregnancy and up to 1 year postpartum.

DATA EXTRACTION: 6 researchers extracted study data and assessed the risk of bias and strength of evidence (SoE).

DATA SYNTHESIS: Forty-four RCTs were included. Cognitive behavioral therapy (CBT; k = 25, n = 2962) was probably more effective than treatment as usual (TAU) in reducing depressive symptoms by an equivalent -1.7 points (95% CI, -2.0 to -1.3 points) on the Edinburgh Postnatal Depression Scale (EPDS; range, 0 to 30 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (relative risk [RR], 1.7 [CI, 1.3 to 2.3]) (low SoE). Behavioral activation (k = 3, n = 508) may be more effective than TAU in reducing depressive symptoms by an equivalent -1.5 EPDS points (CI, -2.6 to -0.5 points) (low SoE). There may be no differences in depressive symptoms between CBT and counseling (k = 3, n = 226; EPDS, -0.5 [CI, -1.5 to 0.5]) or counseling and TAU (k = 3, n = 247; EPDS, -0.8 [CI, -2.6 to 1.0) (low SoE). Interpersonal therapy (IPT; k = 9, n = 1003) was probably more effective than TAU in reducing depressive symptoms by an equivalent -1.7 EPDS points (CI, -2.9 to -0.5 points) (moderate SoE) and may have greater recovery rates from depressive symptoms (RR, 1.2 [CI, 0.97 to 1.5]) (low SoE).

LIMITATIONS: Participants were not blinded to treatment, study variation in country, interventions, populations, or reducing SoE. Differences may not be clinically important.

CONCLUSION: For treatment of perinatal depression, CBT, behavioral activation, and IPT may be effective.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality (AHRQ).

Physician rater

This study has uncertain utility for clinical practice. It shows improvement but at a level that might not be clinically relevant.

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