Mothers with postnatal depression should have access to psychological therapies as an alternative to antidepressants, when treated in primary care.
That is the recommendation from researchers at Brighton and Sussex Medical School (BSMS) who reviewed 10 clinical trials, involving 1,324 depressed new mothers, and found that counselling and cognitive behavioral therapy (CBT) are effective alternatives to antidepressant medication.
Led by Dr Elizabeth Ford, (pictured) Research Fellow in Primary Care Epidemiology at BSMS, they found that offering patients psychological therapy in primary care resulted in reduced depressive symptoms and a higher level of remission immediately after the treatment.
Dr Ford said: “Approximately 13 per cent of mothers experience postnatal depression during the first year after delivery, with 90 per cent of cases being managed in primary care.
“Antidepressant medication is commonly used as a first-line treatment by GPs for postnatal depression due to long waits on the NHS to access psychotherapy. However, the potential side-effects of antidepressants, and possible risks to the baby when breastfeeding, cause concern for mothers and doctors. It is really important that GPs have good evidence for other treatment options to recommend to their patients, and that the people who commission NHS services have evidence so that effective treatments can be made available. We carried out this meta-analysis to bring together all the available evidence on this topic.”
The analysis focused on psychotherapy provided in community settings, whether by trained nurses, health visitors or psychotherapists based in general practice clinics.
Other benefits of the therapies included improvements in anxiety and stress, marital relationships, adjustment to parenthood and perceived social support.
While no particular type of therapy emerged as being the most effective, interpersonal therapy and cognitive behavioral therapy showed promising results.
The findings suggests that when commissioning local services for perinatal mental health, commissioners should provide easily accessible talking therapies in community settings, so that new mothers with depression can have quick access to these important treatments.
The findings are published in ‘Effectiveness of Psychological Interventions for Postnatal Depression in Primary Care: A Meta-Analysis’ published in Annals of Family Medicine. The authors are Dr Elizabeth Ford, Sian Stephens, Dr Priya Paudyal and Prof Helen Smith, from BSMS.