PROTOCOL: Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low and middle‐income countries: A systematic review

Kang, Harmeet Kaur; John, Denny; Bisht, Bandana; Kaur, Manmeet; Alexis, Obrey; Worsley, Aaron James

doi:10.1002/cl2.1074

Cited by 7 publications

(8 citation statements)

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“…The review is based on the protocol published (Kang, 2020 ). Randomized controlled trials (RCTs), feasibility trials, and quasi‐experimental designs were eligible for this study.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low‐ and middle‐income countries: A systematic review

Kang,

Bisht,

Kaur

et al. 2024

Campbell Systematic Reviews

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BackgroundPostpartum depression (PPD) is a condition that can affect any woman regardless of ethnicity, age, party, marital status, income, and type of delivery. This condition is highly prevalent worldwide. PPD, if not treated timely, can affect the maternal‐child bond and can have a detrimental impact on the future cognitive, emotional, and behavioral development of the child. Interpersonal psychotherapy (IPT) has been reported as an effective treatment of PPD in previous studies as this focuses on relationship and social support issues. Previous reviews conducted in developed nations have reported the superior efficacy of IPT in comparison to other treatment options. There is no systematic review conducted in low to middle‐income countries on the efficacy of IPT on PPD. Therefore it was necessary to undertake a systematic review to assess the effectiveness of IPT in reducing the depression among postpartum women in low and middle‐income countries (LMICs).ObjectivesThe main aim of this systematic review was to assess the effectiveness of IPT alone or in conjunction with pharmacological therapy and/or other psychological and psychosocial interventions, in reducing depressive symptoms among women diagnosed with PPD residing in LMICs.Search MethodsThe systematic search encompassed several prominent databases and grey literature. Furthermore, experts specializing in the field of IPT were consulted to identify any relevant studies conducted in LMICs that fulfilled the predetermined eligibility criteria. The most recent search update was performed in July 2022.Selection CriteriaThe PICOS criteria were meticulously defined for this review as described. Participants: Postpartum women diagnosed with PPD in LMICs were included. Intervention: IPT either as a standalone treatment or in conjunction with pharmacological therapy was included. Comparison: any form of psychological therapy or pharmacological therapy, whether administered individually or in combination, was considered for comparison. Study designs: experimental and quasi‐experimental, factorial designs, and quantitative components (experimental, quasi‐experimental, factorial designs) of mixed methods designs were eligible to be included. Studies with single‐group study designs and qualitative studies were excluded from the review.Data Collection and AnalysisTwo reviewers from our team conducted a rigorous screening process to determine the eligibility of articles for inclusion. This involved an initial evaluation of titles and abstracts, followed by a comprehensive assessment of the full text of selected articles. In instances where discrepancies arose between the two reviewers, resolution was achieved through discussion or consultation with a third author to establish a consensus. Following the screening process, two team members independently extracted pertinent information and data from the studies that met the inclusion criteria. The treatment effect of the intervention, in comparison to the control group, was subsequently analyzed utilizing the fixed effects model taking into account the small number of studies.Main ResultsA total of 17,588 studies were identified from various databases, and 6493 duplicate studies were removed. Subsequently, 9380 studies underwent independent title and abstract screening resulting in the exclusion of 9040 studies. 345 full texts were thoroughly assessed leading to the exclusion of 341 studies, finally including 4 studies for review. The four included trials were randomized trials and comprised a total sample size of 188 women diagnosed with PPD residing in LMICs. Among these studies, three compared IPT with usual treatment, while one study compared IPT with antidepressant medications (ADMs). In terms of the providers of IPT, in one study, IPT was administered by nurses, while psychologists delivered IPT in another study. In one study, community health workers were responsible for providing IPT. However, in one study, information regarding the specific providers of IPT was not available or reported. The primary outcome measure reported in all four studies was depression, assessed using the Edinburgh Postnatal Depression Scale (EPDS). The geographical distribution of the studies included; one conducted in Zambia, one in Kenya, one in Pakistan, and one in Iran. Out of the four studies, three were included in the meta‐analysis, as missing data from one study could not be obtained. Based on the overall treatment effect, it was found that depression scores decreased significantly more in the IPT group compared to other interventions (usual treatment or ADMs) (standardized mean difference [SMD] −0.62, 95% confidence interval [CI] (−1.01, −0.23), Z = 3.13 (p = 0.002), χ2 = 49.49; df = 2; p < 0.00001; I2 = 96%; 3 studies, n = 136). Out of the three studies, two studies compared the effectiveness of IPT in reducing depression scores specifically when compared to the usual treatment, and in both studies, depression scores were reduced significantly in the IPT group as compared to the usual treatment group. Only one study directly compared the effectiveness of IPT with ADM, reporting that IPT was more effective than ADM in reducing depression scores among postpartum women. Regarding adverse outcomes, only one study reported suicidal ideation with one participant in the IPT group and two in the ADM group (RR 0.50, 95% CI (0.05, 5.30), p = 0.56, n = 78). The same study reported seven participants in the ADM group had adverse drug reactions as compared to none in the IPT group (RR 15.0, 95% CI (0.89, 254), p = 0.06, n = 78).Authors' ConclusionsOur comprehensive search yielded a limited number of four studies conducted in such settings. Despite the scarcity of available evidence, the findings collectively suggest that IPT is indeed an effective treatment for reducing PPD when compared to usual treatment and pharmacological therapy. However given the low certainty of evidence, there is a need for further research in the form of well‐designed randomized controlled trials with larger sample sizes and a reduced risk of bias. Such studies would greatly contribute to enhancing the strength and reliability of the evidence base regarding the effectiveness of IPT in the context of PPD in LMICs. The knowledge generated from future research endeavors would be highly valuable in guiding the development of more affordable and cost‐effective treatment approaches for PPD in resource‐limited settings.

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“…The review is based on the protocol published (Kang, 2020 ). Randomized controlled trials (RCTs), feasibility trials, and quasi‐experimental designs were eligible for this study.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low‐ and middle‐income countries: A systematic review

Kang,

Bisht,

Kaur

et al. 2024

Campbell Systematic Reviews

Self Cite

View full text Add to dashboard Cite

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“…The standard treatment for postpartum depression typically includes psychotherapy and antidepressants. However, due to potential risks associated with exposing infants to antidepressants, psychotherapy is often the preferred treatment option for new mothers ( 27 ). Interpersonal psychotherapy is particularly relevant for postpartum depression as it focuses on the unique interpersonal challenges faced by women during the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

“…Interpersonal psychotherapy is particularly relevant for postpartum depression as it focuses on the unique interpersonal challenges faced by women during the postpartum period. Interpersonal psychotherapy operates on the understanding that interpersonal issues arising during pregnancy, coupled with hormonal changes, can lead to depressive symptoms ( 27 ). Treatment approaches administered by mental health professionals can positively impact mothers with postpartum depression, leading to improved therapeutic outcomes and psychosocial enhancement.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Zuranolone – synthetic neurosteroid in treatment of mental disorders: narrative review

Marecki,

Kałuska,

Kolanek

et al. 2023

Front. Psychiatry

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With each passing year, the number of people suffering from mental disorders grows at a disturbing speed. Neuroactive steroids are a new promising group of drugs with the potential for use in many diseases like postpartum depression, postnatal psychosis, major depression, insomnia, bipolar disorder, and Parkinson’s tremor, due to their ability to modulate the activity of GABAA receptor. Neurosteroids are progesterone metabolites that are synthesized from cholesterol or steroid hormones in various brain regions. They regulate neuronal development, regeneration, and neurotransmission. They are implicated in mood disorders, anxiety disorders, schizophrenia, PTSD, and impulsive aggression. Neurosteroids have been studied for their potential to prevent or treat neurodegenerative diseases such as Alzheimer’s disease and HIV-associated dementia. They can promote neurogenesis, neuronal survival, myelination, and memory function. They can also affect the growth and sensitivity of hormone-dependent brain tumors such as gliomas. Zuranolone, a newly registered neurosteroid drug has shown huge flexibility in both clinical and ambulatory treatment thanks to its pharmacokinetic traits, especially the possibility for oral administration, unlike its predecessor Brexanolone. Zuranolone is a synthetic positive allosteric modulator of the GABAA receptor that can be taken orally. The review aims to summarize the current knowledge on zuranolone as a novel neurosteroid drug for various mental disorders, especially for postpartum mental disorders for which this drug was meant originally. It covers studies indexed in the PubMed, Scopus, and Web of Science databases published since 2017. Keywords used in the search, as well as inclusion and exclusion criteria, are given in the aims and methodology section. The review explains the evidence for the role of neurosteroids, especially allopregnanolone, in the pathophysiology and treatment of postpartum depression. It discusses the mechanisms of neurosteroid action, the changes in neurosteroid levels during pregnancy and postpartum, and the clinical trials of brexanolone and zuranolone, two synthetic analogs of allopregnanolone, for postpartum depression. It provides an overview of the biosynthesis and metabolism of neurosteroids in the central and peripheral nervous system. Furthermore, it explains the different sources and pathways of neurosteroid production and the factors that influence their synthesis and regulation, such as stress, hormones, drugs, and genetic variations. The review also explores the potential relevance of neurosteroids for other psychiatric disorders, such as major depression, bipolar disorder, post-traumatic stress disorder (PTSD), schizophrenia, and premenstrual dysphoric disorder. Finally, it highlights the associations between neurosteroid levels and symptom severity and the effects of neurosteroid modulation on mood, cognition, and neuroplasticity.

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“…It is reported that 50% of postpartum women experience depressive symptoms known as postpartum blues, with the rate of depressive symptoms continuing to increase to postpartum depression and usually cannot be cured without clinical intervention (1). In addition, postpartum blues is almost 80 percent experienced by mothers who give birth for the first time (2).…”

Section: Introductionmentioning

confidence: 99%

Combination Effectiveness of Listening to Music and Listening Murottal to Reduce Postpartum Depression

Saadah

Sumaningsih

Rahayu

et al. 2022

International Journal of Advanced Health Science and Technology

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It was reported that 50% of Postpartum women experience symptoms of stress/anxiety known as postpartum blues, with the level of depressive symptoms continuing to increase to postpartum depression. This condition cannot be cured without clinical intervention. Music iscreated to influence the psychological condition of humans, as well as to provide a sense of security, comfort and fun. To describe the effect of a combination of natural and murotal music to reduce postpartum depression. The contribution of this study is to explain the effect of the combination of natural and murottal music to reduce postpartum depression. This study used a Quasi-Experiment method through pretest-posttest design with a control group and a treatment group. In this case, the intervention group was given a combination of natural and murottal music therapy, in which each intervention was given for 30 minutes for three consecutive days. The number of samples involved was 60 people who were divided into 2 groups of postpartum mothers. The intervention group consists 30 people, while the control group consists 30 people. Data was collected using the EPDS (Edinburgh Postnatal Depression Scale) questionnaire. Data analysis used independent t-test. Results: There were 9 mothers with mild depression and 21 moderate depressions in the intervention group. On the other hand, there were 17 normal mothers and 13 moderately depressed mother in the post-intervention group with t test value of 27.17 and sig of (p) 0.00 v(value) 0.36. Meanwhile in the control group, there were 1 (one) normal mother, 27 mothers who had mild depression and 2 mothers who had moderate levels. There were 19 mothers with low depression and 11 mothers with moderate depression. The results of the t-test obtained 22.13 with sig(p) 0.01 v(value) 0.001. There was an effect of music therapy on the reduction in the incidence of postpartum depression which was very significant after three days of being given music therapy. There was an increase in the level of depression by two levels higher from pre to post in the control group. Furthermore, the results of the t-test on the postpartum blues pretest and posttest showed that there was a significant difference in the incidence of postpartum blues between the control and intervention groups after the intervention period. There is a difference in the value of t 5.04 sig (p) 0.01, even though the value is smaller than t table (0.05). The difference obtained shows that the control group has a risk of experiencing postpartum blues by 2 (two) times compared to the intervention group. Music therapy was given to all postpartum primiparous mothers immediately after delivery. Health services need to prepare facilities and human resources to provide relaxation therapy, namely music therapy as an alternative therapy.

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PROTOCOL: Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low and middle‐income countries: A systematic review

Cited by 7 publications

References 65 publications

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low‐ and middle‐income countries: A systematic review

Effectiveness of interpersonal psychotherapy in comparison to other psychological and pharmacological interventions for reducing depressive symptoms in women diagnosed with postpartum depression in low‐ and middle‐income countries: A systematic review

Zuranolone – synthetic neurosteroid in treatment of mental disorders: narrative review

Combination Effectiveness of Listening to Music and Listening Murottal to Reduce Postpartum Depression

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