Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: A systematic review. (December 2018)

• Record Type: Journal Article
• Authors: Nillni, Yael I.; Mehralizade, Aydan; Mayer, Laura; Milanovic, Snezana
• Is Part Of: Clinical psychology review. Volume 66(2018)
• Page Start: 136
• Page End: 148
• Publication Date: 2018-12
• Subjects: Anxiety -- Depression -- Posttraumatic stress disorder -- Treatment -- Pregnancy -- Postpartum; Clinical psychology -- Periodicals; Psychology, Pathological -- Periodicals; Psychotherapy -- Periodicals; Psychology, Clinical -- Periodicals; Electronic journals; 616.89
• DOI: 10.1016/j.cpr.2018.06.004
• Languages: English
• ISSNs: 0272-7358

Abstract

Abstract: Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression ( n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies ( n = 5), collaborative care models ( n = 2), complementary and alternative medicine approaches ( n = 18), light therapy ( n = 3), brain stimulation ( n = 2), and psychopharmacological interventions ( n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed. Highlights: Perinatal psychiatric disorders are associated with adverse outcomes. 78 studies for depression, anxiety, and trauma-related disorders are reviewed. There is strong support for the use of CBT and IPT for perinatal depression. Treatment studies for perinatal anxiety and trauma-related disorders are limited. Psychopharmacological effectiveness trials are limited despite their increased use.