Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression: Cochrane systematic review
Assessed as up to date: 2013/03/26
A meta-analysis of 21 studies suggests the mean prevalence rate for depression across the antenatal period is 10.7%, ranging from 7.4% in the first trimester to a high of 12.8% in the second trimester. Due to maternal treatment preferences and potential concerns about fetal and infant health outcomes, diverse non-pharmacological treatment options are needed.Objectives
To assess the effect of interventions other than pharmacological, psychosocial, or psychological interventions compared with usual antepartum care in the treatment of antenatal depression.Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2013), scanned secondary references and contacted experts in the field to identify other published or unpublished trials.Selection criteria
All published and unpublished randomised controlled trials of acceptable quality evaluating non-pharmacological/psychosocial/psychological interventions to treat antenatal depression.Data collection and analysis
Both review authors participated in the evaluation of methodological quality and data extraction. Results are presented using risk ratio (RR) for categorical data and mean difference (MD) for continuous data.Main results
Six trials were included involving 402 women from the United States, Switzerland, and Taiwan. For most comparisons a single trial contributed data and there were few statistically significant differences between control and intervention groups.
In a trial with 38 women maternal massage compared with non-specific acupuncture (control group) did not significantly decrease the number of women with clinical depression or depressive symptomatology immediately post-treatment (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.25 to 2.53; mean difference (MD) -2.30, 95% CI -6.51 to 1.91 respectively). In another trial with 88 women there was no difference in treatment response or depression remission rates in women receiving maternal massage compared with those receiving non-specific acupuncture (RR 1.33, 95% CI 0.82 to 2.18; RR 1.14, 95% CI 0.59 to 2.19 respectively).
In a trial with 35 women acupuncture specifically treating symptoms of depression, compared with non-specific acupuncture, did not significantly decrease the number of women with clinical depression or depressive symptomatology immediately post-treatment (RR 0.47, 95% CI 0.11 to 2.13; MD -3.00, 95% CI -8.10 to 2.10). However, women who received depression-specific acupuncture were more likely to respond to treatment compared with those receiving non-specific acupuncture (RR 1.68, 95% CI 1.06 to 2.66).
In a trial with 149 women, maternal massage by a woman's significant other, compared with standard care, significantly decreased the number of women with depressive symptomatology immediately post-treatment (MD -6.70, 95% CI -9.77 to -3.63).
Further, women receiving bright light therapy had a significantly greater change in their mean depression scores over the five weeks of treatment than those receiving a dim light placebo (one trial, n = 27; MD -4.80, 95% CI -8.39 to -1.21). However, they were not more likely to have a treatment response or experience a higher remission rate (RR 1.79, 95% CI 0.90 to 3.56; RR 1.89, 95% CI 0.81 to 4.42).
Lastly, two trials examined the treatment effect of omega-3 oils. Women receiving omega-3 had a significantly lower mean depression score following eight weeks of treatment than those receiving a placebo (one trial, n = 33; MD -4.70, 95% CI -7.82 to -1.58). Conversely, in a smaller trial (21 women) there was no significant difference in the change in mean depression scores for women receiving omega-3 and those receiving a placebo (MD 0.36, 95% CI -0.17 to 0.89), and women who received omega-3 were no more likely to respond to treatment (RR 2.26, 95% CI 0.78 to 6.49) or have higher remission rates (RR 2.12, 95% CI 0.51 to 8.84). Women in the placebo group were just as likely to report a side effect as those in the omega-3 group (RR 1.12, 95% CI 0.56 to 2.27).Authors' conclusions
The evidence is inconclusive to allow us to make any recommendations for depression-specific acupuncture, maternal massage, bright light therapy, and omega-3 fatty acids for the treatment of antenatal depression. The included trials were too small with non-generalisable samples, to make any recommendations.
Dennis Cindy-Lee, Dowswell Therese
Interventions (other than pharmacological, psychosocial or psychological) for treating antenatal depression
There is not enough evidence available to determine if acupuncture, maternal massage, bright light therapy, or omega-3 fatty acids are effective interventions in treating antenatal depression.
Approximately 12% of women will suffer from depression during their pregnancy. Research suggests that women who experience significant stress, have a history of depression, lack social support, have a history of domestic violence, are not married and living alone, and have an unintended pregnancy or poor relationships may be at a higher risk than other women of developing antenatal depression. Symptoms can include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities that are usually enjoyed, feelings of worthlessness or guilt, poor sleep, a change in appetite, severe fatigue and difficulty concentrating. Unfortunately, depression during pregnancy is related to poor maternal self-care behaviours, which may influence the baby's health; it also places a woman at significant risk of developing postpartum depression. Many women prefer not to take medication during their pregnancy and they are often interested in other complementary forms of treatment. The review found only six randomised controlled trials involving 402 women evaluating depression-specific acupuncture (the insertion of needles into the superficial body tissues for remedial purposes), maternal massage, bright light therapy, and omega-3 fatty acids for the treatment of antenatal depression. The included trials were too small to reach any conclusions; they also used a variety of interventions, outcome measures and comparisons. The trials provided insufficient evidence to determine if these therapies are effective treatments for antenatal depression. Further research is needed.
Implications for practice
The evidence is inconclusive to allow us to make any recommendations for the treatment of antenatal depression. The trials included evaluated various interventions and were too small with non-generalisable samples to make any recommendations.
Implications for research
Antenatal depression is common, and perhaps more prevalent than postpartum depression (Bennett 2004a). Further, research consistently indicates that for many women, antenatal depression continues into the postpartum period leaving the woman and her child at risk for the negative outcomes associated with both antenatal (Bennett 2004b) and postpartum depression (Grace 2003). In the light of potential or perceived concerns associated with the use of anti-depressant medication during pregnancy and the potential lack of resources to access or obtain psychosocial or psychological interventions, other alternative forms of treatment are needed for antenatal depression. There are an increasing number of randomised controlled trials for alternative treatments. The quality of many trials remains an issue, with variability in diagnostic criteria, small sample sizes, limitations of blinding and placebo controls, and few systematic evaluations of side effects. Even for those treatments with reasonable evidence of efficacy, there are variations and lack of standardisation in dosage, potency, and concentration, all of which make it difficult for health professionals and women to be confident they are using the same doses as described in clinical studies. Future research needs to address these issues. There is, on balance, greater evidence and clinical experience with traditional treatments (pharmacotherapy and psychotherapy).Get full text at The Cochrane Library
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