Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine https://doi.org/10.7326/ANNALS-24-03520 Dr. Elyse Couch et al.
Points
- Forty-four randomized controlled trials were included to evaluate psychological therapies for perinatal depression.
- Cognitive behavioral therapy probably reduced depressive symptoms by negative one point seven EPDS points compared to treatment as usual.
- Behavioral activation may also reduce depressive symptoms by negative one point five EPDS points compared to treatment as usual.
- Interpersonal therapy probably reduced depressive symptoms by negative one point seven EPDS points, showing moderate evidence.
- No significant differences were found between CBT, counseling, or counseling and treatment as usual for depressive symptoms.
Summary
This systematic review and meta-analysis evaluated the effectiveness of psychological therapies for depression during the perinatal period, encompassing pregnancy up to one year postpartum. A comprehensive search across six databases from January 2000 to March 2025 identified 44 randomized controlled trials (RCTs) meeting the inclusion criteria. Six researchers independently extracted data, assessed the risk of bias, and determined the strength of evidence (SoE) for each included study.
Cognitive behavioral therapy (CBT; 25 studies, n = 2962) was found to be probably more effective than treatment as usual (TAU), reducing depressive symptoms by an equivalent of -1.7 points (95% CI, -2.0 to -1.3 points) on the Edinburgh Postnatal Depression Scale (EPDS; range, 0 to 30 points), with moderate SoE. Furthermore, CBT may lead to greater recovery rates from depressive symptoms (relative risk [RR], 1.7; 95% CI, 1.3 to 2.3) with low SoE. Behavioral activation (3 studies, n = 508) may also be more effective than TAU, reducing depressive symptoms by an equivalent of -1.5 EPDS points (95% CI, -2.6 to -0.5 points), with low SoE.
Interpersonal therapy (IPT; 9 studies, n = 1003) was probably more effective than TAU in reducing depressive symptoms by an equivalent of -1.7 EPDS points (95% CI, -2.9 to -0.5 points), with moderate SoE. It may also have greater recovery rates from depressive symptoms (RR, 1.2; 95% CI, 0.97 to 1.5) with low SoE. No significant differences in depressive symptoms were observed between CBT and counseling (3 studies, n = 226; EPDS, -0.5; 95% CI, -1.5 to 0.5) or between counseling and TAU (3 studies, n = 247; EPDS, -0.8; 95% CI, -2.6 to 1.0), both with low SoE.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03520
References
Couch, E., Mai, H. J., Kanaan, G., Caputo, E. L., Lewis, O., Zahradnik, M. L., Howard, M., Bohlen, L. C., Konnyu, K., & Balk, E. M. (2025). Effectiveness of psychological therapies for depression during the perinatal period: A systematic review and meta-analysis. Annals of Internal Medicine, ANNALS-24-03520. https://doi.org/10.7326/ANNALS-24-03520
