Perinatal Depression: An Evidence-Based Review of Integrative Treatment
Special Reports, DepressionPerinatal depression is a significant problem with long-term negative consequences for women, their children, and society. Although most of the registry data for modern antidepressants are reassuring, there are still a great many unknowns regarding their use in pregnancy and lactation. In addition, many patients experience disappointing results from current standard treatments (both psychopharmacology and psychotherapy).
In the face of the current uncertainty about long-term safety, as well as frequently limited effectiveness, many women choose to avoid standard treatment, and instead prefer integrative treatments that incorporate complementary and alternative therapies. This article reviews the evidence base for these treatments (Table).
Depression is generally less common in active women, but these results are variable, and treatment data have been limited and inconclusive. Exercise has been shown to be comparable to both psychotherapeutic and pharmacologic treatments for depression. Even vigorous exercise is generally considered safe during pregnancy, with certain caveats such as avoidance of scuba diving and sports with a high risk of abdominal trauma, as well as taking into account any medical or obstetrical complications and the woman’s general level of fitness. Although there are insufficient data for conclusions on prevention, significant improvements in antenatal depression have been seen with exercise. Most of these studies used a yoga-based exercise program, which is reviewed in detail below. For now, standard exercise recommendations in pregnancy are prudent and may assist in alleviating depressive symptoms.
Pregnancy massage is an inexpensive, well-accepted treatment that can be delivered in the home after initial training. Partner-provided massage for depressed pregnant women improves depression, relationship measures, and neonatal outcomes, and results in fewer prenatal complications. Mothers who used baby massage had less postpartum depression and better parenting outcomes. Massage, either given or received, appears to be a low-risk and potentially beneficial addition to treatment for perinatal depression. Combining group interpersonal psychotherapy with massage can be helpful for both depression and anxiety. Interpersonal psychotherapy was also helpful, albeit to a lesser degree.