Six RCTs were included in the review (n=1,151): five assessed interventions for treatment (n=420) and one an intervention for prevention (n=731) of postpartum depression. Four trials used an intention-to-treat analysis.
Non-directive counselling (two RCTs): One trial found a statistically significant reduction in the proportion of women with depression and significant improvements on the EPDS and a structure interview immediately following the intervention compared with the control group. A second RCT used counselling as a preventative measure and found no differences between the intervention and control groups.
CBT (three RCTs): One RCT found that six sessions of CBT and fluoxetine were both effective in lowering rates of depression and reducing depressive scores; combined CBT plus fluoxetine did not provide additional benefit. A second RCT found significant benefits in both rates and symptoms of depression. The third trial found no statistically significant differences between CBT and weekly clinic visits.
Comparison of multiple interventions (one RCT): Women randomised to either CBT, psychodynamic therapy or non-directive counselling all had lower rates of depressive disorder and lower EPDS scores than women in a control group; these post-intervention differences were not maintained at follow-up.