Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: a systematic review
Open accessAbstract
Women with psychiatric disorders during pregnancy and the postpartum period (i.e., perinatal period) are at increased risk for adverse maternal and child outcomes. Effective treatment of psychiatric disorders during the perinatal period is imperative. This review summarizes the outcomes of 78 studies focused on the treatment of depression, anxiety, and trauma-related disorders during the perinatal period. The majority of studies focused on perinatal depression (n = 73). Of the five studies focused on anxiety or trauma-related disorders, only one was a randomized controlled trial (RCT). The most studied treatment was cognitive behavioral therapy (CBT; n = 22), followed by interpersonal psychotherapy (IPT; n = 13). Other interventions reviewed include other talk therapies (n = 5), collaborative care models (n = 2), complementary and alternative medicine approaches (n = 18), light therapy (n = 3), brain stimulation (n = 2), and psychopharmacological interventions (n = 13). Eleven studies focused specifically on treatment for low-income and/or minority women. Both CBT and IPT demonstrated a significant benefit over control conditions. However, findings were mixed when these interventions were examined in low-income and/or minority samples. There is some support for complementary and alternative medicine approaches (e.g., exercise). Although scarce, SSRIs demonstrated good efficacy when compared to a placebo. However, SSRIs did not outperform another active treatment condition (e.g., CBT). There is a tremendous need for more studies focused on treatment of perinatal anxiety and trauma-related disorders, as well as psychopharmacological effectiveness studies. Limitations and future directions of perinatal treatment research, particularly among low-income and/or minority populations, are discussed.
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Screening and treatment for PTSD during pregnancy is largely unavailable in usual care, and there is a lack of PTSD treatment in the perinatal period.
“Despite the strong association between PTSD and adverse perinatal outcomes, screening and treatment during pregnancy is largely unavailable in usual care, and there is a lack of PTSD treatment in the perinatal period [8].”
From Written exposure therapy for treatment of perinatal PTSD among women with comorbid PTSD and SUD: A pilot study examining feasibility, acceptability, and preliminary effectiveness (2023) · cites this paper as [8]
The Results (‘Available treatments’; page unavailable) found only two studies of perinatal PTSD treatment, supporting a shortage of treatment research. The Discussion (‘Gaps in the literature and future directions’; page unavailable) describes barriers to psychiatric treatment generally, but the paper does not establish that PTSD screening and treatment during pregnancy are largely unavailable in usual care, or that PTSD treatment itself is absent throughout the perinatal period. (LLM, conf=0.86)
Experimental — accuracy not yet measuredCognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are the gold standard treatments for PMADs.
“Currently, Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) are the gold standard treatments for PMADs [11]”
From Acceptance-based process variables on postpartum well-being and distress: The mediating role of psychological flexibility (2024) · cites this paper as [11]
The Conclusions (page unavailable) say CBT and IPT are the most studied treatments for perinatal depression and both have a strong evidence base. They also say there is almost no knowledge of effective treatments for perinatal anxiety and trauma-related disorders, so the review does not support calling both therapies gold-standard treatments for PMADs as a whole. (LLM, conf=0.91)
Experimental — accuracy not yet measuredExisting reviews highlight the effectiveness of a number of interventions for peripartum depression, including medication, health promotion interventions and psychological interventions.
“Existing reviews highlight the effectiveness of a number of interventions for PPD including medication (eg, antidepressant medication), health promotion interventions (eg, educational home visits) and psychological interventions (eg, cognitive–behavioural therapy (CBT) and interpersonal therapy.16–27”
From Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol (2019) · cites this paper as [23]
The Discussion’s psychopharmacological summary reports benefit from antidepressants in two placebo-controlled trials, and the Conclusions identify CBT and IPT as having a strong evidence base for perinatal depression. The Results report benefit from group psychoeducation, but do not establish the effectiveness of educational home visits; they report that supportive home visits did not outperform usual care. The review also cautions that evidence for medication effectiveness remains sparse. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPrevious qualitative studies have highlighted practice barriers (transportation difficulties, attending appointments around feeding and sleep schedules, childcare needs) and psychological barriers (stigma, sleep deprivation, fear of having child removed) to psychological interventions during the peripartum period.
“Previous qualitative studies have highlighted both practice (eg, transportations difficulties, attending appointments around feeding and sleep schedules, childcare needs) and psychological (stigma, sleep deprivation, fear of having child removed) barriers.23 45”
From Effectiveness and acceptability of cognitive-behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol (2019) · cites this paper as [23]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredSeveral reviews have found cognitive-behavioural therapy to be an effective psychological intervention for peripartum depression.
“several reviews have found CBT to be an effective psychological intervention for PPD.23 25 26 30”
There is strong evidence that perinatal mental health conditions can be prevented and effectively treated through psychotherapy and/or pharmacotherapy.
“Importantly, there is strong evidence that PMH conditions can be prevented52-54 and effectively treated through psychotherapy54-57 and/or pharmacotherapy.58,59”
From The transition to parenthood in obstetrics: enhancing prenatal care for 2-generation impact (2022) · cites this paper as [57]
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A Blended Cognitive–Behavioral Intervention for the Treatment of Postpartum Depression: A Case Study
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From Interactive Regulation in Infancy to Relationship-Focused Interventions
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Adverse psychosocial factors in pregnancy and preterm delivery
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Treatment for perinatal depression: movement towards scalability
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The Use of Cannabis and Its Effects on Postpartum Depression
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Research Progress in the Treatment of Postpartum Depression
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Perinatal Care for Individuals With a History of Sexual Trauma
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Striking the Balance: Bipolar Disorder in the Perinatal Period
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- Authors
- Nillni, Y. I., Mehralizade, A., Mayer, L., & Milanovic, S.
- Affiliations
- Boston University (US)
- Boston Medical Center (US)
- Corresponding author
- Nillni, Yael I.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 66
- Pages
- 136-148
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC6637409
- OpenAlex
- W2807198361
- Cited by
- 207
- References
- 154
- Citations by year
- 2026: 19 · 2025: 33 · 2024: 33 · 2023: 29 · 2022: 33 · 2021: 28 · 2020: 22 · 2019: 6 · 2018: 3
- FWCI
- 2.68
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NICHD (1K23HD087428-01A1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- perinatal depression, perinatal anxiety, trauma-related disorders, perinatal period, cognitive behavioral therapy, interpersonal psychotherapy, collaborative care, complementary and alternative medicine, phototherapy, brain stimulation, selective serotonin reuptake inhibitors, psychopharmacological treatment, treatment outcomes
- MeSH terms
- Trauma and Stressor Related Disorders, Complementary Therapies, Anxiety Disorders, Depressive Disorder, Female, Humans, Pregnancy, Pregnancy Complications, Psychotherapy
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