Symptom Improvement Seen With Interpersonal Psychotherapy, Sertraline in Postpartum Women

Sertraline combined with clinical management may be effective treatment for postpartum depression, according to results of a placebo-controlled study published in the Journal of Affective Disorders.

Women within their first postpartum year who reported a major depressive episode (n=162) were randomly assigned to 12 weeks of Interpersonal Psychotherapy (IPT; n=53), sertraline-clinical management (CM; n=56), or pill placebo-CM (n=53). Women were recruited from 2 study sites: the Women and Infants Hospital in Rhode Island (n=100) and the University of Iowa (n=62). Depressive symptoms and social functioning were captured at pretreatment and 4, 8, and 12 weeks after treatment assignment. 

Participants assigned to the sertraline-CM or placebo-CM conditions received 9 clinical management sessions during the 12-week trial. CM sessions included inquiry about symptoms, medication compliance, and adverse effects, as well as psychoeducation regarding infant development and childrearing. After the initial 50-minute CM session, sessions were 20 to 30 minutes in length. Sertraline and placebo were dosed flexibly per clinical response and tolerability; the dose titration schedule began at 25 mg and increased to 50 mg at 1 week, then to 100 mg, 150 mg, and a maximum of 200 mg at 3, 7, and 11 weeks, as tolerated. IPT was administered by research therapists in 12 individual 50-minute sessions during the study period.

Women in all treatment groups experienced improvements in depressive symptoms and social adjustment across the 12-week trial. Regarding improvements on the 17-item Hamilton Depression Rating Scale, no significant group-by-time interaction was observed for any treatment mode, although there was a significant main effect of time (P <.0001). However, per the Inventory of Depression and Anxiety Symptoms-General Depression scale, there was a significant group-by-time interaction (P =.030). Specifically, the sertraline-CM group showed more rapid improvement than the IPT group from baseline to 8 weeks (P =.0103) and 12 weeks (P =.0097). Similarly, sertraline-CM also showed quicker improvement from baseline to 12 weeks compared with placebo-CM (P =.0497). A site-by-time interaction was observed, with patients at the Women and Infants Hospital in Rhode Island experiencing more rapid symptom reduction compared with patients at the University of Iowa (P =.046).

Study limitations included high rates of nonengagement with study condition, as well as differential effects of IPT across study sites. Still, as preliminary data, these results suggest that active interventions with or without pharmacological treatment may improve depression symptoms among postpartum women.

Investigators concluded that, “[t]he principal clinical implication of the results of this trial is that there is little to recommend medication or psychotherapy over the other. Women across all three conditions showed significant improvements in the depressive symptoms.”

Reference

O’Hara MW, Pearlstein T, Stuart S, Long JD, Mills JA, Zlotnick C. A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression [published online October 31, 2018]. J Affect Disord. doi: 10.1016/j.jad.2018.10.361