In Psychology301, we were taught about many various topics, including social psychology,biopsychology and how the brain works, and psychological disorders andtreatment. Many of these areas were very interesting to me, but I decided thatthis research paper will be on treatment for women with postpartum depression(PPD). The firstjournal article I read was titled “Patient choice of treatment for postpartumdepression: a pilot study”, had eight different contributors.
In theintroduction, what PPD is and its general consequences were discussed. “Postpartumdepression (PPD) is increasingly recognized as causing substantial morbidityand functional impairment in the mother and long-term negative consequences forinfant and child development” (Pearlstein, 2006). Women and their families havedifficulty in deciding what treatment to undergo, whether it be verbal therapyor biomedical therapy.
The main reason it is so hard to decide is that therehasn’t been much research done comparing these two to help sway them one way oranother. According to the authors, only one such study exists that examines theeffectiveness of medication of women with PPD with the use of a placebo. Inthis study 87 women were split into four groups, using a placebo and a drugcalled fluoxetine, and one or six verbal therapy sessions. The results showedthat the drug provided better results, no matter how many therapy sessions weretaken. It’s also difficult to decide which type of treatment would work thebest because there also isn’t much research done about the effects ofmedication to infants who are breastfed by their mothers. Studies that arecoming to light show that there shouldn’t be an effect, but people are stillreluctant.
The introduction section then continues to discuss that patientsdiagnosed with some sort of disorder related to depression would like to chooseverbal therapy over medication. The point of this research paper is thendiscussed, where the authors say that this study was done to look at whatfactors play a role in treatment choice for a larger group of selectedindividuals. A type of verbal therapy, called interpersonal psychotherapy (IPT),was used, along with a drug called sertraline, and then a combination of theboth. This study also looked at the differences between the levels of severityin depression before and after treatment was given. The paper then moves on tothe methods section, where the readers are told how the experiment was done. Womendiagnosed with PPD were all chosen from the same psychiatric hospital and wereallowed to choose from the three different treatment options (mentioned above)that were administered over a period of twelve weeks. There were many factorsused to determine whether each woman was eligible for the research study ornot.
Some inclusion factors were an age between eighteen and fifty, and had tohave a score within a certain range for various tests. Some of the exclusionfactors were a history of a psychotic or substance disorder. All of theparticipants were then educated on the bad effects of PPD and the possibleadvantages from receiving treatment. The participants were also educated on theother forms of treatment, like medication.
After this, all of the women chosethe option they preferred the most. The medication, sertraline, was initiallyprescribed at 25 mg daily, but gradually increased to 150 mg daily over theperiod of twelve weeks. The verbal therapy, IPT, was conducted in twelvesessions lasting fifty minutes each. The results were observed with theHamilton Rating Scale for Depression (HRSD), the Edinburgh Postnatal DepressionScale (EPDS), and a Beck Depression Inventory (BDI) which were all taken at thebeginning and then at the intervals of four, eight, and twelve weeks. To fullyunderstand the data and its results, statistical tests were used. The paperthen goes on to the results section. Twenty-three women participated in thisresearch study, and eleven of them selected IPT, two of them chose sertraline,and ten of them chose the combination option.
Looking at just the data takenfrom the beginning of the study, there wasn’t a significant difference in anyof the scores between all twenty-three women. The authors stated here thattwelve of the twenty-three women were breastfeeding when the study started. Theresearchers noticed a trend that the breastfeeding women were more likely tochoose the treatment option that didn’t have medication. There was also anothertrend where women who had a history of depression ended up choosing thetreatment plan that involved medication. Out of the twenty-three women whostarted the research study, only eighteen of them were able to fully go throughit. Out the eighteen women, nine of them chose just IPT, two of them chose justsertraline, and the other seven chose the combination treatment. Thestatistical tests used were paired t-testsand analyses of covariance. The paired t-testsshowed that the three groups improved in their state.
For the analyses ofcovariance, the sertraline group wasn’t incorporated because there were onlytwo people; again, there wasn’t a big difference between the other two groups.”Thus… there was no evidence for differential efficacy of treatments in termsof depression symptom reduction” (Pearlstein, 2006). Women who werebreastfeeding and chose any option involving sertraline didn’t report anynegative effects. Lastly, the discussion section was introduced. In this section,parts of the paper were summarized, such as informing the women of benefits andrisks, and trends that were seen. The authors state that even though all threetreatment options were shown to help the women’s condition, the number of womeninvolved in the study was too small to be able to see if and which option wasbetter than the other ones.
The paper concludes with what future studies shouldset out to accomplish. The nextresearch paper I read was called “Interpersonal Psychotherapy Adapted for theGroup Setting in the Treatment of Postpartum Depression”, which was written byfour authors. In the introduction, general information about PPD was discussedand how IPT was chosen for this research study because it narrows its focus oncertain issues related to areas involving PPD. It is then stated that thisresearch article is going to be about a study done using IPT for the treatmentof PPD in a group setting. The paper then moves on to the methods section. Thissection discusses that this study was done in Vienna, Austria, and there wereseventeen women who ended up being selected for the study. A majority of theseventeen individuals were diagnosed with major depression.
Two groups of tenand seven were made of the seventeen, and at the end, eleven women remained whocompleted the entire study. Before any part of the research started, the womenwere all told how IPT works in a group setting in two individual sessions. Thenthere were nine group sessions, and the study ended with another individualsession. For this study, each of the participants were given each other’s phonenumbers, and this was done to increase socialization and decrease solitude.
Thepaper states that, “A group approach provides an opportunity for members towork on interpersonal issues they experience in the outside world” (Klier,2001). During treatment, Baseline Axis I diagnoses were performed, and multipletests were given to assess the symptoms of depression and interpersonalfunctions. The Hamilton Rating Scale for Depression-German version (Ham-D-21)and the Edinburg Postnatal Depression Scale (EPDS) were used for depressivesymptoms. The Inventory of Interpersonal Problems (IIP) was used forinterpersonal functioning. The Dyadic Adjustment Scale (DAS) was used formarital relationship changes. Data was collected for the four tests threetimes: at the beginning of treatment, at the end of treatment, and six monthsafter the treatment. Next talked about is the results section.
Looking at themean scores for EPDS and Ham-D-21 at pre-treatment and post-treatment, there isnotable difference. There was no difference between the women who completed thestudy and those who dropped out. Ten out of the seventeen women showed fullrecovery when looking at the Ham-D-21 scores; two showed no recovery and fiveshowed partial recovery. Two multivariable analyses of variance test were doneto see whether the effects of the treatments lasted or not. EPDS and Ham-D-21were used for this. The results showed that the depression scores were much lowerat six months post-treatment compared to the before treatment started. Theauthors then included a case example to help readers understand the study, andthen they moved on to the discussion.
They claim that, “…the results of thisopen pilot treatment trial suggest that a group IPT approach may be efficaciousfor the treatment of postpartum depression” (Klier, 2001). The group approachof IPT lets the women know that other women are experiencing the same symptoms,which helps decrease the feelings of loneliness. Most of the women who finishedthe study showed a decrease in their symptoms of depression. The authors thenwent on to state the limitations, some of which were a small number of women,no control group, and too short of a time frame for the follow up. They thenwent on to discuss future goals for their team of researchers. Most of the women who finished the studyshowed a decrease in their symptoms of depression. The authors then went on tostate the limitations, some of which were a small number of women, no controlgroup, and too short of a time frame for the follow up.
They then went on todiscuss future goals for their team of researchers. The thirdresearch article I read was called the “Controlled trial of the short- andlong-term effect of psychological treatment of post-partum depression”, which waswritten by four individuals. The introduction talked about what PPD is and thenegative consequences of it, and then it was stated that this study was acontrolled study where three different types of psychological treatment wereused to see whether or not they improved the conditions of women with PPD. Nextcame the methods section.
Women from the records of Addenbrooke’s Hospital inCambridge who seemed to show signs of PPD were offered to be a part of theresearch study. A number of factors were used to include and exclude women. Thewomen who ended up being selected, two hundred and six, were randomly splitinto four groups: routine primary care, cognitive behavioral therapy,psychodynamic therapy, and non-directive counseling. The women in the routineprimary care group were the control.
The women received their treatment everyweek in their own homes. Edinburg Postnatal Depression Scale (EPDS) andStructured Clinical Interview for DSM-III-R (SCID) were used to provide data onthe mood of the mothers. Pairwise comparisons, linear and logistic models, andthe SAS program were all used to interpret the data. Out of the two hundred andsix women selected, one hundred and seventy-one of them completed the study,which was defined as completing at least four sessions of therapy. Datacollected at 4.5 months showed that the women in the three experimental groupshad lower EPDS scores compared to the control group.
The EPDS scores also werelower for all four groups after the sessions had ended. However, after 4.5months, all four groups showed relatively the same EPDS scores. Looking at thedata taken five years after treatment, many of the women had another pregnancy,and twenty-seven of them had symptoms of PPD.
This data showed that the therapythat was given to the women after their first pregnancy did not help themduring their subsequent ones. In the discussion section, the authors talk abouthow women are reluctant to participate in studies that involve medication andthat studies that involve verbal therapy are more liked by women and areeffective. They also assert that, “it seems likely that for the majority ofprimiparous women with post-partum depression initial support needs to beoffered on a one-to-one basis” (Cooper, 2003). The data of the study shows thatat 4.5 months postpartum, the treatments all showed signs of helping the women,but at 9 months and 5 years postpartum, these benefits were not thatsignificant anymore.