Study: Postpartum Depression Alleviated With Prenatal Anti-Anxiety Therapy

A preventative approach to common mental health issues using cognitive behavioral therapy benefits mothers and babies. 

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Societal expectations that the postpartum period is filled with joy can make episodes of depression feel exponentially more isolating when as many as one in five mothers experience it.

The effects of postpartum depression can be felt by women and their children—sometimes for many years. However, new research shows how specially designed therapy and exercises that target anxiety in pregnant mothers can significantly reduce incidents of postpartum depression.

A clinical trial divided 755 women into either a prenatal intervention group or a routine care group to compare episodes of anxiety and depression in the first six weeks after delivery. Those in the intervention group received six sessions—and homework—based on cognitive behavioral therapy.

“Actually the results were so strong. It really worked for those women we recruited into the study, who had at least mild anxiety symptoms that could range to more severe,” lead researcher Pam Surkan told The Epoch Times. Ms. Surkan is a professor at Johns Hopkins Bloomberg School of Public Health in Baltimore. “We saw an 81 percent reduction in the likelihood of getting postpartum depression.”

The results were published in February in Nature Medicine. Among the women in the intervention group, 12 percent reported a major depressive episode, compared to 41 percent in the control group.

“The take-home message would be that you can prevent postpartum depression if you can reduce symptoms of anxiety in pregnancy,” Ms. Surkan said, adding that the women noted the benefits of learned breathing and relaxation exercises. “A lot of these programs are out there, but nobody knows if they work or not.”

Accessible Care

The researchers spent a year developing the program—called Happy Mother-Healthy Baby—with input from psychology experts, mothers, and health care providers.

Cognitive behavioral therapy, the gold standard for treating anxiety, teaches how to recognize and replace intrusive, fear-based thoughts and behaviors—such as fear of miscarriage—with more constructive ones.

Non-specialists were trained to deliver therapy to women in Pakistan who were at least 22 weeks pregnant. The idea was to see if a cost-effective option could be used to reach as many women as possible. The researchers chose Pakistan because a population they had access to already had both lower income and higher levels of anxiety.

Ms. Surkan is seeking grant funding to test the program in the Baltimore area. Since the results were published, health care systems have reached out about adopting the program. She said researchers intend to make it broadly available once it is developed for the United States.

Catherine Schmidt, a licensed clinical psychologist specializing in women’s anxiety (who was not part of the study), told The Epoch Times in an email that the finding is especially encouraging for women and health care facilities with limited resources.

“One of the most promising aspects of this study is that the interventions were not done by trained professionals but rather non-specialists,” she said, adding that it illustrates how beneficial it can be to espouse broad access to effective tools.

Healthier Babies

“Investing in maternal mental health truly is an investment in our children and communities,” Ms. Schmidt added. “Healthy and mentally sound mothers are able to attune to their children’s needs more effectively, which fosters a sense of safety and connection in their child during those critical first few months postpartum.”

Both prenatal anxiety and postpartum depression can be debilitating for the women and also their children, Ms. Surkan explained. Previous research has noted the connection between the two and the extended harm to babies.

For instance, women suffering from maternal depression are more likely to have preterm birth and spontaneous abortion, as well as have babies with low birth weight who suffer from passivity, withdrawal, dysregulated attention and arousal, and lower cognition. All are difficulties that can persist throughout life, according to a 2004 article in Paediatrics and Child Health.

A big reason for this, Ms. Surkan said, is because it’s harder for women experiencing postpartum depression to be motivated to take the best care of their children.

Mother’s symptoms—such as intrusive thoughts, hopelessness, rumination, irritability, or mood swings—may go unnoticed or ignored simply because they are already very overwhelmed and focused on surviving, Ms. Schmidt said.

The dramatic changes of giving birth and bringing a new baby home make it harder to identify problems, according to Postpartum Support International, an organization that offers education and connects families to support resources.

Help in Prenatal Period Is Vital

Early intervention is best, including simple preventative strategies. However, postpartum depression can be accompanied by feelings of shame or embarrassment, which further complicates care.

“Transitioning to motherhood can feel very isolating and confusing, and women are highly susceptible to mental illness during this critical time,” Ms. Schmidt said. “A large amount of stigma remains when it comes to women’s mental health during postpartum, and we still have a lot of progress to make.”

Not only are anti-anxiety programs like Happy Mother-Healthy Baby helpful, but so is access to specialists like lactation consultants, therapists, doulas, nutritionists, and infant sleep specialists.

Lack of support can leave a new mother feeling disappointed. And then there are additional stressors, Ms. Schmidt explained, such as cultural pressures to breastfeed and feeling like a failure when formula is needed, or dealing with changes in job security or finances.

“When it comes to women’s mental health, preventative measures and providing support before things escalate is most effective,” she said. “Catching symptoms early can make all the difference. That’s one of the strengths of this study: they provided tools ahead of time.”

Finding Support

The U.S. Department of Human and Health Services Office on Women’s Health offers these additional postpartum tips:

• Call 1-833-TLC-MAMA (1-833-852-6262) anytime for free, confidential support. If you are in crisis, you can also call or text the Suicide and Crisis Lifeline at 988.
• Ask for help—be honest and specific about your needs. You may even want to create a support plan before delivery.
• Find a support group—hospitals, churches, and community organizations often offer specific postnatal community groups.
• Talk to a health care professional—ask about resources and other support.
• Take care of yourself—rest, eat well, take breaks, and talk to the people in your life about your emotions and struggles.
• Avoid making any major life changes during this time.