ABSTRACT
BACKGROUND: Studies on specific psychotherapy for depressed mothers of small children are rare. The aim of the present study was to investigate the effectiveness of a newly developed cognitive-behavioral group intervention for depressed mothers compared to standard individual therapy. SAMPLING AND METHODS: In a naturalistic design, 31 mothers suffering from depressive disorders with children aged ≤4 years who had consecutively been admitted to our specialized clinic for mentally ill mothers were assigned to the group treatment, and the following 21 were admitted to the control group receiving standard individual therapy. The group treatment consisted of 12 group sessions and 1 couple session and was administered to five consecutive groups. Participants completed interviews and questionnaires - the Beck Depression Inventory and the Symptom Checklist- 90-R - before and 3 months after therapy. RESULTS: The treatment group and the control group showed a significant improvement in their depression, with no significant differences between the two treatment strategies. The women in group therapy, however, required fewer antidepressants, and group treatment was observed to be more effective in reducing anger and hostility. CONCLUSION: This form of group treatment for depressed women in early motherhood may have some important advantages over individual therapy; effects were small, however, and should be replicated in a further study.
Subject(s)
Depression, Postpartum/therapy , Depressive Disorder/therapy , Mothers/psychology , Psychotherapy, Group/methods , Adult , Depression, Postpartum/psychology , Depressive Disorder/psychology , Female , Humans , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVE: Affective disorder during pregnancy is a common condition requiring careful judgment to treat the depression while minimizing risk to the fetus. Following up on promising pilot trials, we studied the efficacy of light therapy. METHOD: Twenty-seven pregnant women with nonseasonal major depressive disorder according to DSM-IV (outpatients, university polyclinic) were randomly assigned to 7,000 lux fluorescent bright white or 70 lux dim red (placebo) light administered at home in the morning upon awakening for 1 h/d in a 5-week double-blind trial carried out between October 2004 and October 2008. Clinical state was monitored weekly with the 29-item Structured Interview Guide for the Hamilton Depression Rating Scale (HDRS) with Atypical Depression Supplement (SIGH-ADS). Changes of rating scale scores over time were analyzed with the general linear model. Differences from baseline of SIGH-ADS and 17-item HDRS scores at every time point were the dependent variables, time was the within-subjects factor, and treatment was the between-subjects factor. The model also included baseline score of depression and gestational age at intervention start. RESULTS: The superiority of bright light over dim light placebo was shown for both SIGH-ADS (R² = 0.251; F(3,23) = 3.91; P < .05) and HDRS (R² = 0.338; F(3,23) = 5.42; P < .01) when analyzing the week-by-week change from baseline, and HDRS scores showed a significant interaction of treatment with time (F(4,92) = 2.91; P < .05). Categorical analysis revealed that the response rate (HDRS ≥ 50% improvement) at week 5 was significantly greater for bright light (81.3%, n = 16) than for placebo light (45.5%, n = 11) (P < .05). Remission (final score ≤ 8) was attained by 68.6% versus 36.4%, respectively (P < .05). Expectation ratings did not differ significantly between groups. CONCLUSIONS: Bright white light treatment for 5 weeks improved depression during pregnancy significantly more than placebo dim red light. The study provides evidence that light therapy, a simple, cost-effective antidepressant modality with minimal side effects for the mother and no known risk for the unborn child, may be a useful nonpharmacologic approach in this difficult situation. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01043289.
Subject(s)
Depressive Disorder, Major/therapy , Phototherapy , Pregnancy Complications/therapy , Adolescent , Adult , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/psychology , Double-Blind Method , Female , Humans , Personality Inventory/statistics & numerical data , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/psychology , Psychometrics , Switzerland , Young AdultABSTRACT
About 11% of pregnant women suffer from a major depression requiring treatment. If left untreated, there are specific risks such as preterm delivery or low birth weight. The initial difficulty lies in diagnosing the depression itself, since many depressive symptoms are falsely ascribed to the pregnancy. A further challenge is choosing the appropriate therapy. Treatment options are psychotherapy, antidepressants, electroconvulsive therapy (ECT), or the new option of light therapy. The choice of the most suitable treatment needs to be done together with the pregnant woman after careful clarification of the potential risks of each treatment option.
