Effectiveness of Sertraline Alone and Interpersonal Psychotherapy Alone in Treating Women With Postpartum Depression

Postpartum depression (PPD) occurs in approximately 13% of postpartum women. The impact of
PPD is significant, including emotional distress for the woman as well as disturbances in
infant development. Common signs of depression after childbirth may include anxiety,
irritability, low energy, and lack of concern for self or infant. If left untreated, PPD may
last for more than 1 year, causing strain on family life and the mother's relationship with
her infant. Infants of depressed mothers are also at a higher risk for developmental delays,
behavioral problems, and difficulty eating and sleeping. Despite the public health
significance of PPD, relatively little research has been done to determine the most
effective treatments. Specifically, there is a lack of research concerning the use of
antidepressant medication for treating PPD. Interpersonal psychotherapy (IPT), which focuses
on interpersonal issues related to depression, has been more thoroughly studied for the
treatment for PPD, but it has not been compared to the other treatment. This study will
evaluate the effectiveness of antidepressant medication alone and IPT alone in treating
women with PPD.

Participation in this double-blind study will last 9 months. Participants will first undergo
initial assessments, which include interviews about depressive symptoms, self-report forms
about medical history, blood tests, and a pregnancy test. Participants will then be randomly
assigned to one of three treatments: sertraline, placebo, or IPT. All three treatments will
be administered over 13 weeks. Participants assigned to take sertraline or placebo will
attend nine 30-minute sessions over the 13-week treatment period. During these sessions,
participants will be administered the study medication and will be assisted with parenting
issues and skills by a psychiatrist. Participants receiving IPT will attend weekly 50-minute
sessions over the 13-week treatment period. These sessions will focus on improving
relationships with others, setting goals, and increasing coping skills. All participants
will also complete interviews and questionnaires about their depression once a month.
Following the 13 weeks of treatment, participants will undergo follow-up assessments at
Months 3 and 6 post-treatment. Follow-up assessments will repeat initial interviews and
questionnaires and will include a form about the infant's nature.

Inclusion Criteria:

- Primary DSM-IV diagnosis of major depressive disorder by clinical interview

- Score of greater than 12 on HAM-D

- Delivery of an infant within the 12 months prior to study entry

- Able to speak and read English sufficiently to complete the study procedures

- Willing to use effective birth control methods throughout the study

Exclusion Criteria:

- Woman whose infant has died prior to study entry

- Current or past diagnosis of bipolar disorder, schizophrenia or other psychotic
disorder;

- Diagnosis of alcohol or drug abuse or dependence (except nicotine) or anorexia in the
past year;

- Psychotic symptoms;

- Acute suicidal or homicidal risks;

- Women who have been on an antidepressant for more than 14 days prior to consent, (if
less than 14 days and willing to taper off, will be eligible to continue once tapered
off);

- Women on daily anxiolytic medication (i.e. benzodiazepine, buspirone) or daily
psychoactive herbal preparation (St. John's Wort or Fish Oil) (if willing to
discontinue these substances may be eligible once they have been tapered off);

- Medications taken PRN over the listed dose and frequency (women will still be
eligible if they take: Lunesta/Eszopiclone 3 mg or less, up to 3 nights a week,
Ambien/Zolpidem 5mg or less, Ambien CR 6.25 mg or less, up to 3 nights a week,
Lorazepam or equivalent benzodiazepine dose: 0.5 mg up to 3 nights a week,
Sonata/Zaleplon: 5 mg or less, up to 3 nights a week, Rozerem/Ramelteon: 8 mg or
less, up to 3 nights a week);

- If they take antidepressants PRN for insomnia (eg: Desyrel/Trazodone,
Elavil/Amitriptyline, Remeron/Mirtazapine;

- Ongoing concurrent psychotherapeutic treatment or psychotherapeutic treatment within
the last month;

- Psychiatric symptoms requiring specialized psychiatric treatment;

- Significant medical disorder that would make sertraline treatment contra-indicated,

- Previous trial of IPT therapy with a certified IPT therapist or an adequate trial of
sertraline (i.e. at least 8 weeks of at least 100 mg daily of sertraline).