Prevention of postpartum depression

Findings from existing prevention trials are still too preliminary to provide recommendations firm enough to inform practice. However, several preventive interventions that have shown positive effects warrant further investigation. These include intensive midwife-managed care for women unselected based on risk; prenatal couples classes for women with low self esteem; interpersonal therapy for economically disadvantaged pregnant women; brief in-hospital CBT or mother-to-mother peer support for atrisk postpartum women, and sertraline or high dose estrogen for women with known histories of PPD. It should also be noted that one approach tested, debriefing after childbirth, has raised concerns that it could lead to harmful effects and therefore caution is warranted. Overall, the growing body of research suggests that there is hope of developing interventions to prevent PPD. Future trials must now determine which approaches will be most efficacious, cost-effective, and feasible to disseminate widely. The Sidebar (see page 596) lists a number of recommendations for further study, based on the findings and limitations of existing trials. We are encouraged to see the growth in empirical attention focused on PPD prevention, both internationally and, more recently, in the United States. It should also be noted that two approaches tested, debriefing after childbirth and postpartum administration of synthetic progestogen, have raised concerns regarding possible harmful effects and, therefore, caution is warranted.