Effectiveness of Group Interpersonal Psychotherapy in Treating Women With Prenatal Depression

The pregnancy and postpartum periods are times of remarkable emotional and physical change
for a woman, making pregnant women more vulnerable to mood swings and depressive symptoms.
It is estimated that approximately 10% to 15% of pregnant women experience depression, which
can cause severe psychological distress for the woman as well as disturbances in infant
development. Infants of depressed mothers are at a higher risk for developmental delays,
behavioral problems, and difficulty eating and sleeping. Moreover, new data indicate that
prenatal depression also may adversely affect brain development of the child even before
birth. Despite the high prevalence rates of prenatal depression and its negative
consequences, few studies have tested the effectiveness of interpersonal psychotherapy
(IPT), a treatment for depression that focuses on interpersonal issues and relationships,
during pregnancy. The administration of group prenatal IPT for depression may be effective
in enhancing women's prenatal and postpartum moods and improving fetal and newborn
functioning. This study will compare the effectiveness of group IPT with that of treatment
as usual (TAU) for preventing postpartum depression in pregnant women with depression and
for improving healthy outcomes in their babies. The study will also compare the fetal and
newborn development of babies of healthy mothers with that of babies of depressed mothers.

This study will involve both healthy participants and participants with depression. All
participants will start with an initial assessment visit between the 22nd and 23rd weeks of
pregnancy. For participants who have shown signs of depression based on an initial phone
interview, the initial visit will last about 2 hours and will include questions about
medical and psychiatric history, depressive symptoms, and lifestyle habits and an
examination of uterine blood flow using a Doppler ultrasound machine. Participants who do
not show signs of depression will not undergo these assessments on the initial visit.

Participants found to be depressed on the first visit will then be assigned randomly to
receive group IPT or TAU. Participants assigned to group IPT will attend 12 weekly
psychiatrist-led sessions that will focus on overcoming relationship problems associated
with depression. The first two and last sessions will be alone with the psychiatrist and the
remaining sessions will be with a group of five to eight other pregnant women. Participants
assigned to TAU will be referred to outpatient treatment, which may include cognitive
behavioral psychotherapy, insight-oriented psychotherapy, and/or antidepressant medication.
TAU participants receiving psychotherapy will attend 12 weekly treatment sessions comparable
to the IPT group sessions; treatment for TAU participants receiving antidepressant
medication may last longer than 12 weeks. During the treatment period, all participants will
fill out weekly forms about their moods and will have monthly interviews with a
psychiatrist. Upon completion of treatment, participants will have a 30-minute final
evaluation meeting.

All participants, including healthy participants, will be asked to attend two sessions
focused on their babies' development, one occurring between the 36th and 38th weeks of
pregnancy and one shortly after giving birth. During the first developmental session,
participants will complete a questionnaire about mood; undergo heart rate, breathing, and
blood pressure monitoring; undergo an ultrasound; and perform a word matching task. The
second developmental session will occur between 20 and 30 hours after birth of the baby and
will include a newborn testing session that will consist of physiological and
neurobehavioral assessments. Healthy participants' study participation will be over upon
completion of the second developmental session. Depressed participants will be contacted by
phone once every 2 weeks for 6 months after giving birth.

Inclusion Criteria:

- Score of at least 10 on the Edinburgh Postnatal Depression Scale (EPDS)

Exclusion Criteria:

- Multi-fetal pregnancy

- Taking medications that affect the cardiovascular system (e.g., doxazosin)

- History of suicide attempt or current suicidal ideation

- Psychotic features

- Life-time history of bipolar disorder

- Current eating disorder

- Currently diagnosed with any of the following: obsessive compulsive disorder, major
depression with melancholic features, severe major depression, panic disorder,
organic brain syndrome, mental retardation, antisocial personality disorder,
borderline personality disorder, or presence of three or more schizotypal features

- Smokes cigarettes

- Substance dependence or abuse

- Complicated pregnancy or delivery

- Premature delivery

- Neonate medical/developmental problems

- Taking a psychotropic medication at the time of the initial phone contact with study
investigators