partner-assisted interpersonal psychotherapy or antidepressant medication for antenatal depression

Conditions: Partner Assisted Interpersonal Psychotherapy; Treatment as Usual

Summary: purpose: to compare a novel psychotherapy, partner-assisted interpersonal psychotherapy (pa-ipt), with treatment as usual (tau) in a sample of pregnant women seeking treatment for major depressive disorder (mdd) at the university of north carolina at chapel hill (unc-ch) perinatal psychiatry program. participants: 52 women, ages 18-45, who are 16-29 weeks pregnant and experiencing a depressive episode, and their partners. methods: women and their identified partners will complete a diagnostic interview, complete measures of depressive symptom severity at baseline, and be randomized to treatment with pa-ipt or tau. women randomized to tau will be treated by unc physicians according to the unc-ch perinatal psychiatry program's algorithm for treatment of prenatal mdd (usually one of a number of antidepressant medications, tailored to the individual, although some women may opt against medication altogether and still be eligible to enroll). women randomized to pa-ipt will participate in 8 therapy sessions with their identified partner over a 12-week period, along with one refresher session at or around 6 weeks postpartum. women and partners will be assessed for change in depressive symptoms and relationship satisfaction during pregnancy at visits 4 and 8, and postpartum at 6-week and 6-month visits. hypothesis: the investigators anticipate notable improvement in both groups similar in magnitude, however it is hypothesized that couples participating in pa-ipt will have higher relationship satisfaction post-treatment (controlling for baseline satisfaction) than those receiving tau.


Eligibility criteria:
inclusion criteria: * females aged 18-45 years * 16-29 weeks estimated gestational age * able to provide informed consent * english or spanish language literacy * in a committed relationship cohabiting for at least 6 months with a dyadic adjustment scale rating \< 90 or with an identified family member or friend residing in the same home * meet criteria for diagnostic and statistical manual of mental disorders-fourth edition text revision (dsm-iv) diagnosis of major depressive disorder (mdd) * hrsd-17 score is equal or greater than 16 at diagnostic evaluation and randomization * medically healthy and without fetal anomaly according to history exclusion criteria: * no identified primary care, nurse midwife, or obstetrical physician to monitor pregnancy; participant or physician refuses to sign release of information * by patient report, history of partner verbal, emotional, or physical abuse * partner unable or unwilling to participate * dsm-iv diagnoses of bipolar 1 or 2 or any psychotic episode * substance abuse within the last 6 months * eating disorder * current use of other therapies for depression including individual psychotherapy, herbal remedies or other complementary/alternative therapies, antidepressant medication outside the study protocol * active suicidal ideation * identified partner has dsm-iv diagnoses of bipolar 1 or 2 or any psychotic episode * interpersonal violence or abuse

Keywords: pregnancy antenatal major depressive disorder psychotherapy antidepressant medication partners spouses interpersonal psychotherapy