Effectiveness of Sertraline Alone and Interpersonal Psychotherapy Alone in Treating Women With Postpartum Depression

Phase 2

Completed

Conditions: Depression, Postpartum

Interventions: Behavioral: Interpersonal psychotherapy (IPT)
Drug: Placebo
Drug: Sertraline
Behavioral: Clinical management
Behavioral: Mothercrafting

Registration Number: NCT00602355

Lead Sponsor: Women and Infants Hospital of Rhode Island

Brief Summary: This study will evaluate the effectiveness of antidepressant medication alone and interpersonal psychotherapy alone in treating women with postpartum depression.

Detailed Description: Postpartum depression (PPD) occurs in approximately 13% of postpartum women. The impact of PPD is significant, including emotional distress for the woman as well as disturbances in infant development. Common signs of depression after childbirth may include anxiety, irritability, low energy, and lack of concern for self or infant. If left untreated, PPD may last for more than 1 year, causing strain on family life and the mother's relationship with her infant. Infants of depressed mothers are also at a higher risk for developmental delays, behavioral problems, and difficulty eating and sleeping. Despite the public health significance of PPD, relatively little research has been done to determine the most effective treatments. Specifically, there is a lack of research concerning the use of antidepressant medication for treating PPD. Interpersonal psychotherapy (IPT), which focuses on interpersonal issues related to depression, has been more thoroughly studied for the treatment for PPD, but it has not been compared to the other treatment. This study will evaluate the effectiveness of antidepressant medication alone and IPT alone in treating women with PPD.

Participation in this double-blind study will last 9 months. Participants will first undergo initial assessments, which include interviews about depressive symptoms, self-report forms about medical history, blood tests, and a pregnancy test. Participants will then be randomly assigned to one of three treatments: sertraline, placebo, or IPT. All three treatments will be administered over 13 weeks. Participants assigned to take sertraline or placebo will attend nine 30-minute sessions over the 13-week treatment period. During these sessions, participants will be administered the study medication and will be assisted with parenting issues and skills by a psychiatrist. Participants receiving IPT will attend weekly 50-minute sessions over the 13-week treatment period. These sessions will focus on improving relationships with others, setting goals, and increasing coping skills. All participants will also complete interviews and questionnaires about their depression once a month. Following the 13 weeks of treatment, participants will undergo follow-up assessments at Months 3 and 6 post-treatment. Follow-up assessments will repeat initial interviews and questionnaires and will include a form about the infant's nature.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 162

Inclusion Criteria

Primary DSM-IV diagnosis of major depressive disorder by clinical interview
Score of greater than 12 on HAM-D
Delivery of an infant within the 12 months prior to study entry
Able to speak and read English sufficiently to complete the study procedures
Willing to use effective birth control methods throughout the study

Exclusion Criteria

Woman whose infant has died prior to study entry
Current or past diagnosis of bipolar disorder, schizophrenia or other psychotic disorder;
Diagnosis of alcohol or drug abuse or dependence (except nicotine) or anorexia in the past year;
Psychotic symptoms;
Acute suicidal or homicidal risks;
Women who have been on an antidepressant for more than 14 days prior to consent, (if less than 14 days and willing to taper off, will be eligible to continue once tapered off);
Women on daily anxiolytic medication (i.e. benzodiazepine, buspirone) or daily psychoactive herbal preparation (St. John's Wort or Fish Oil) (if willing to discontinue these substances may be eligible once they have been tapered off);
Medications taken PRN over the listed dose and frequency (women will still be eligible if they take: Lunesta/Eszopiclone 3 mg or less, up to 3 nights a week, Ambien/Zolpidem 5mg or less, Ambien CR 6.25 mg or less, up to 3 nights a week, Lorazepam or equivalent benzodiazepine dose: 0.5 mg up to 3 nights a week, Sonata/Zaleplon: 5 mg or less, up to 3 nights a week, Rozerem/Ramelteon: 8 mg or less, up to 3 nights a week);
If they take antidepressants PRN for insomnia (eg: Desyrel/Trazodone, Elavil/Amitriptyline, Remeron/Mirtazapine;
Ongoing concurrent psychotherapeutic treatment or psychotherapeutic treatment within the last month;
Psychiatric symptoms requiring specialized psychiatric treatment;
Significant medical disorder that would make sertraline treatment contra-indicated,
Previous trial of IPT therapy with a certified IPT therapist or an adequate trial of sertraline (i.e. at least 8 weeks of at least 100 mg daily of sertraline).

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
1 (Placebo)	Mothercrafting	Participants receiving placebo pill with clinical management plus mothercrafting
1 (Placebo)	Clinical management	Participants receiving placebo pill with clinical management plus mothercrafting
3 (IPT)	Interpersonal psychotherapy (IPT)	Participants receiving interpersonal psychotherapy (IPT) alone
1 (Placebo)	Placebo	Participants receiving placebo pill with clinical management plus mothercrafting
2 (Sertraline)	Mothercrafting	Participants receiving active medication sertraline with clinical management plus mothercrafting
2 (Sertraline)	Clinical management	Participants receiving active medication sertraline with clinical management plus mothercrafting
2 (Sertraline)	Sertraline	Participants receiving active medication sertraline with clinical management plus mothercrafting

Primary Outcome Measures

Name	Time	Method
Hamilton Depression Rating Scale (HAM-D)	Measured at baseline; post-treatment; and Months 3 and 6 of follow-up	Measure total ranges from 0 to 50, with lower scores indicating better outcomes.

Secondary Outcome Measures

Name	Time	Method
Depression Illness Severity Based on Beck Depression Inventory (BDI)	Measured at baseline; post-treatment; and Months 3 and 6 of follow-up	Measure total ranges from 0 to 56, with lower scores indicating better outcomes.
Global Illness Severity Based on Clinical Global Impression (CGI) Scale	Measured at baseline; post-treatment; and Months 3 and 6 of follow-up	Measure total ranges from 1 to 7, with lower scores indicating better outcomes.
Social Functioning Based on Postpartum Adjustment Questionnaire (PPAQ)	Measured at baseline; post-treatment; and Months 3 and 6 of follow-up	Measure total ranges from 1 to 5, with lower scores indicating better outcomes.
Hamilton Anxiety Rating Scale (HARS)	Measured at baseline; post-treatment; and Months 3 and 6 of follow-up	Measure total ranges from 0 to 56, with lower scores indicating better outcomes.