In also isn’t much research done about

In Psychology
301, we were taught about many various topics, including social psychology,
biopsychology and how the brain works, and psychological disorders and
treatment. Many of these areas were very interesting to me, but I decided that
this research paper will be on treatment for women with postpartum depression
(PPD). 

The first
journal article I read was titled “Patient choice of treatment for postpartum
depression: a pilot study”, had eight different contributors. In the
introduction, what PPD is and its general consequences were discussed. “Postpartum
depression (PPD) is increasingly recognized as causing substantial morbidity
and functional impairment in the mother and long-term negative consequences for
infant and child development” (Pearlstein, 2006). Women and their families have
difficulty in deciding what treatment to undergo, whether it be verbal therapy
or biomedical therapy. The main reason it is so hard to decide is that there
hasn’t been much research done comparing these two to help sway them one way or
another. According to the authors, only one such study exists that examines the
effectiveness of medication of women with PPD with the use of a placebo. In
this study 87 women were split into four groups, using a placebo and a drug
called fluoxetine, and one or six verbal therapy sessions. The results showed
that the drug provided better results, no matter how many therapy sessions were
taken. It’s also difficult to decide which type of treatment would work the
best because there also isn’t much research done about the effects of
medication to infants who are breastfed by their mothers. Studies that are
coming to light show that there shouldn’t be an effect, but people are still
reluctant. The introduction section then continues to discuss that patients
diagnosed with some sort of disorder related to depression would like to choose
verbal therapy over medication. The point of this research paper is then
discussed, where the authors say that this study was done to look at what
factors play a role in treatment choice for a larger group of selected
individuals. A type of verbal therapy, called interpersonal psychotherapy (IPT),
was used, along with a drug called sertraline, and then a combination of the
both. This study also looked at the differences between the levels of severity
in depression before and after treatment was given. The paper then moves on to
the methods section, where the readers are told how the experiment was done. Women
diagnosed with PPD were all chosen from the same psychiatric hospital and were
allowed to choose from the three different treatment options (mentioned above)
that were administered over a period of twelve weeks. There were many factors
used to determine whether each woman was eligible for the research study or
not. Some inclusion factors were an age between eighteen and fifty, and had to
have a score within a certain range for various tests. Some of the exclusion
factors were a history of a psychotic or substance disorder. All of the
participants were then educated on the bad effects of PPD and the possible
advantages from receiving treatment. The participants were also educated on the
other forms of treatment, like medication. After this, all of the women chose
the option they preferred the most. The medication, sertraline, was initially
prescribed at 25 mg daily, but gradually increased to 150 mg daily over the
period of twelve weeks. The verbal therapy, IPT, was conducted in twelve
sessions lasting fifty minutes each. The results were observed with the
Hamilton Rating Scale for Depression (HRSD), the Edinburgh Postnatal Depression
Scale (EPDS), and a Beck Depression Inventory (BDI) which were all taken at the
beginning and then at the intervals of four, eight, and twelve weeks. To fully
understand the data and its results, statistical tests were used. The paper
then goes on to the results section. Twenty-three women participated in this
research study, and eleven of them selected IPT, two of them chose sertraline,
and ten of them chose the combination option. Looking at just the data taken
from the beginning of the study, there wasn’t a significant difference in any
of the scores between all twenty-three women. The authors stated here that
twelve of the twenty-three women were breastfeeding when the study started. The
researchers noticed a trend that the breastfeeding women were more likely to
choose the treatment option that didn’t have medication. There was also another
trend where women who had a history of depression ended up choosing the
treatment plan that involved medication. Out of the twenty-three women who
started the research study, only eighteen of them were able to fully go through
it. Out the eighteen women, nine of them chose just IPT, two of them chose just
sertraline, and the other seven chose the combination treatment. The
statistical tests used were paired t-tests
and analyses of covariance. The paired t-tests
showed that the three groups improved in their state. For the analyses of
covariance, the sertraline group wasn’t incorporated because there were only
two people; again, there wasn’t a big difference between the other two groups.
“Thus… there was no evidence for differential efficacy of treatments in terms
of depression symptom reduction” (Pearlstein, 2006). Women who were
breastfeeding and chose any option involving sertraline didn’t report any
negative effects. Lastly, the discussion section was introduced. In this section,
parts of the paper were summarized, such as informing the women of benefits and
risks, and trends that were seen. The authors state that even though all three
treatment options were shown to help the women’s condition, the number of women
involved in the study was too small to be able to see if and which option was
better than the other ones. The paper concludes with what future studies should
set out to accomplish.

The next
research paper I read was called “Interpersonal Psychotherapy Adapted for the
Group Setting in the Treatment of Postpartum Depression”, which was written by
four authors. In the introduction, general information about PPD was discussed
and how IPT was chosen for this research study because it narrows its focus on
certain issues related to areas involving PPD. It is then stated that this
research article is going to be about a study done using IPT for the treatment
of PPD in a group setting. The paper then moves on to the methods section. This
section discusses that this study was done in Vienna, Austria, and there were
seventeen women who ended up being selected for the study. A majority of the
seventeen individuals were diagnosed with major depression. Two groups of ten
and seven were made of the seventeen, and at the end, eleven women remained who
completed the entire study. Before any part of the research started, the women
were all told how IPT works in a group setting in two individual sessions. Then
there were nine group sessions, and the study ended with another individual
session. For this study, each of the participants were given each other’s phone
numbers, and this was done to increase socialization and decrease solitude. The
paper states that, “A group approach provides an opportunity for members to
work on interpersonal issues they experience in the outside world” (Klier,
2001). During treatment, Baseline Axis I diagnoses were performed, and multiple
tests were given to assess the symptoms of depression and interpersonal
functions. The Hamilton Rating Scale for Depression-German version (Ham-D-21)
and the Edinburg Postnatal Depression Scale (EPDS) were used for depressive
symptoms. The Inventory of Interpersonal Problems (IIP) was used for
interpersonal functioning. The Dyadic Adjustment Scale (DAS) was used for
marital relationship changes. Data was collected for the four tests three
times: at the beginning of treatment, at the end of treatment, and six months
after the treatment. Next talked about is the results section. Looking at the
mean scores for EPDS and Ham-D-21 at pre-treatment and post-treatment, there is
notable difference. There was no difference between the women who completed the
study and those who dropped out. Ten out of the seventeen women showed full
recovery when looking at the Ham-D-21 scores; two showed no recovery and five
showed partial recovery. Two multivariable analyses of variance test were done
to see whether the effects of the treatments lasted or not. EPDS and Ham-D-21
were used for this. The results showed that the depression scores were much lower
at six months post-treatment compared to the before treatment started. The
authors then included a case example to help readers understand the study, and
then they moved on to the discussion. They claim that, “…the results of this
open pilot treatment trial suggest that a group IPT approach may be efficacious
for the treatment of postpartum depression” (Klier, 2001). The group approach
of IPT lets the women know that other women are experiencing the same symptoms,
which helps decrease the feelings of loneliness. Most of the women who finished
the study showed a decrease in their symptoms of depression. The authors then
went on to state the limitations, some of which were a small number of women,
no control group, and too short of a time frame for the follow up. They then
went on to discuss future goals for their team of researchers.  Most of the women who finished the study
showed a decrease in their symptoms of depression. The authors then went on to
state the limitations, some of which were a small number of women, no control
group, and too short of a time frame for the follow up. They then went on to
discuss future goals for their team of researchers. 

The third
research article I read was called the “Controlled trial of the short- and
long-term effect of psychological treatment of post-partum depression”, which was
written by four individuals. The introduction talked about what PPD is and the
negative consequences of it, and then it was stated that this study was a
controlled study where three different types of psychological treatment were
used to see whether or not they improved the conditions of women with PPD. Next
came the methods section. Women from the records of Addenbrooke’s Hospital in
Cambridge who seemed to show signs of PPD were offered to be a part of the
research study. A number of factors were used to include and exclude women. The
women who ended up being selected, two hundred and six, were randomly split
into four groups: routine primary care, cognitive behavioral therapy,
psychodynamic therapy, and non-directive counseling. The women in the routine
primary care group were the control. The women received their treatment every
week in their own homes. Edinburg Postnatal Depression Scale (EPDS) and
Structured Clinical Interview for DSM-III-R (SCID) were used to provide data on
the mood of the mothers. Pairwise comparisons, linear and logistic models, and
the SAS program were all used to interpret the data. Out of the two hundred and
six women selected, one hundred and seventy-one of them completed the study,
which was defined as completing at least four sessions of therapy. Data
collected at 4.5 months showed that the women in the three experimental groups
had lower EPDS scores compared to the control group. The EPDS scores also were
lower for all four groups after the sessions had ended. However, after 4.5
months, all four groups showed relatively the same EPDS scores. Looking at the
data taken five years after treatment, many of the women had another pregnancy,
and twenty-seven of them had symptoms of PPD. This data showed that the therapy
that was given to the women after their first pregnancy did not help them
during their subsequent ones. In the discussion section, the authors talk about
how women are reluctant to participate in studies that involve medication and
that studies that involve verbal therapy are more liked by women and are
effective. They also assert that, “it seems likely that for the majority of
primiparous women with post-partum depression initial support needs to be
offered on a one-to-one basis” (Cooper, 2003). The data of the study shows that
at 4.5 months postpartum, the treatments all showed signs of helping the women,
but at 9 months and 5 years postpartum, these benefits were not that
significant anymore.