Utilizing Therapy To Improve Postpartum Depression: A Review Of The Literature

Pregnancy, childbirth, and parenthood can bring about an array of emotions such as joy, fear, anxiety, or dejection. Although, new parents may also experience short-term mood disorder like sadness, crying, irritability, and anxiety. Such symptoms often resolve within five days; however, if they persist or worsen, it may be an indication of postpartum depression, a critical mental health condition that requires attention from health care professionals. 

What is postpartum depression? 

Postpartum depression is a form of depression outlined in the DSM-5. It is a severe mental health condition that can feel devastating for those impacted and is more than "baby blues." Common symptoms of postpartum depression can include: 

• Difficulty bonding with your newborn
• Intense irritability and anger
• Feeling restless or moody
• Low motivation or energy
• Thoughts of hurting the baby or yourself
• Feelings of hopelessness, shame, or guilt

Postpartum depression is a type of mood disorder that can affect mothers during the first year after giving birth. It can make it difficult to care for yourself and your baby. Although those with a history of clinical depression may be at higher risk, postpartum depression can also occur in women without any previous history of depression. Individual therapy sessions can provide effective treatment options.

Complications during birth, like stillbirth, premature birth, or birth trauma, may increase the risk of postpartum depression. However, postpartum depression isn't limited to birthing parents or any particular gender, sexuality, or background. Adoptive parents, non-birthing parents, and foster parents may also experience postpartum depression. It is essential to seek help from healthcare professionals and licensed therapists who offer family therapy for effective treatment options.

If you are experiencing thoughts or urges of suicide, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. 

Internet‐based interventions for postpartum depression

Treatment for postpartum depression typically involves a combination of talk therapy, medication management, and support from family and friends. The best online therapy options provide messaging and live therapy sessions with your own therapist, making it easier to get treatment, even for those without an insurance provider. Online postpartum therapy is a convenient solution for new parents who may find it challenging to seek support in person while caring for an infant. In some cases, online therapists can even prescribe medication* to help manage symptoms. 

The best online counseling options can typically bypass hurdles such as scheduling conflicts, distance, and a lack of transportation. Online therapy can also be more cost-effective than traditional therapy, as traditional therapy often costs around $100-$200 per session (even with health insurance). In the long run, neglecting to seek treatment for postpartum depression may cost more than a therapist. Reaching out for support can be brave. 

Researchers in China sought to analyze the effectiveness of online counseling and interventions in decreasing postpartum depression by examining information from previously published studies. The following summary details their methods and results from the meta-analysis of seven studies on internet-based counseling for postpartum depression.

*It is important to note that BetterHelp's therapists cannot prescribe medication as they are not medical doctors. For assistance with medication management, it’s recommended that you speak with a health care provider.

Included studies

Researchers retrieved 34 full-text articles to assess whether they met inclusion criteria, which were as follows:

• Included adult pregnant parents over 18 
• Used an intervention provided by email, phone, Skype, or a website
• Used a waitlist or traditional in-person treatment for the control group
• Measured outcomes focused on postpartum depression
• Were a randomized control trial

Ultimately, seven studies published between 2008-2018 were examined in the meta-analysis, including information about 2,277 parents organized from research in Australia, Sweden, the US, Canada, and the UK.

Although the inclusion criteria narrowed the studies' parameters, they still had varied characteristics. Six studies followed up with participants 10 to 17 weeks after the intervention, but one followed up six months postpartum. The studies used a total of five different assessments to measure postpartum depression.

Method

The outcome of all seven studies was described in one of two ways in the meta-analysis. After completing the intervention, the researchers noted whether the participants still fit the diagnostic criteria for postpartum depression. They used statistical analysis software to dive deeper into the studies, looking at the following aspects:

• Was cognitive behavioral therapy or behavioral action utilized?  
• Did they offer less than eight sessions or eight or more?
• Did participants have therapist support or not?

Results

The online interventions produced a moderate effect in eliminating postpartum depression. In almost every study included in the analysis, participants in the intervention group showed improvement compared to those in the control group. In six of the studies, postpartum depression symptoms decreased significantly. The remaining study, which used mood management internet intervention, demonstrated that the intervention significantly lowered the risk of postpartum for parents with the most severe symptoms.

The most influential studies had the following characteristics:

• Followed up for over 12 weeks after the intervention
• Utilized cognitive-behavioral therapy interventions
• Included eight or more sessions
• Offered exclusive therapist support

The research in summary

Future research

While online counseling offers several benefits, it may be easier for participants to stop attending sessions without a degree of accountability. In the seven meta-analysis studies, the percentage of participants who didn't follow through from beginning to end ranged from 0% to 87.1%. Future research can examine strategies to encourage follow-throughs, such as phone calls and website contact systems.

The bulk of research regarding postpartum depression focuses on mothers. However, approximately one in ten fathers experience depression before and after pregnancy. Providing the appropriate support for new fathers, non-binary parents, transgender parents, adoptive parents, and foster parents may be a priority of future research. 

Transgender men may also give birth and experience postpartum depression. In one study on transgender men and pregnancy, postpartum depression was often connected with gender dysphoria related to chest feeding and the cessation of hormone therapy. This study may indicate a requirement for further studies on the impact of postpartum depression on transgender and gender-diverse parents. 

How to reduce symptoms of postpartum depression

Various personal and environmental factors may play into postpartum depression. Below are a few ways to cope with postpartum depression symptoms. 

Limit visitors at first 

Save your mental and physical energy for family and friends who will refresh you. If certain individuals in your life make you feel disrespected, stressed, or tired, don't invite them to visit your baby at first. Spend time with your immediate family and care for yourself and your child. 

Ask for support 

On the other hand, if you want to isolate or withdraw from those you love, it may be beneficial to ask for support. Consider that asking for support may show those in your life that you appreciate their guidance and care, and needing help may not be selfish. You can also consider finding support through a postpartum therapist or psychiatrist. 

Rest as much as possible 

Sleeping with a newborn baby can be challenging. Studies show that a lack of sleep can cause health concerns, so you may want to find creative solutions to sleep. Consider asking your partner or family to help you with your baby when you feel sleep-deprived. Ensure you're not caring for your child alone. Community resources may be available to you if you're a single parent. Try to limit stressful activities and take naps if needed throughout the day. 

Engage in healthy habits 

Participate in activities that bring you joy before having your child, such as listening to your favorite music or enjoying movie nights with your partner. Modify activities as needed. For example, if you used to take your dog on a weekend hike at the local nature preserve, schedule a shorter walk around your neighborhood instead.

Connect with other parents

There can be many parenting groups online that are dedicated to various niches. You might also find postpartum depression support groups online. Whether you want support from parents with the same age children or parents who have similar hobbies, you may find it through the Internet. You can also visit local playgroups and library classes to meet local parents. Building a relationship with others in a similar situation may assist you in relieving feelings of isolation and loneliness.

Join a support group 

Support groups, like those offered at Postpartum Support International, can be a beneficial resource, and they often help parents discuss mental health challenges, including depressive symptoms. 

Healthcare providers might recommend that support groups be used in conjunction with traditional therapy, like family counseling. You might also find support groups or group therapy led by a licensed counselor or specialist in postpartum depression or parenting. 

How can loved ones offer support?

If you're concerned that someone you know may be experiencing postpartum depression, encourage them to speak to a healthcare provider. In addition, you can provide support through the following methods. 

Emotional support 

Listen to concerns and complaints to hear them, not solve them. Offer encouragement and the opportunity for an overwhelmed parent to unplug if they can. You might consider taking a crying baby for a walk so the infant can be soothed and the parent can rest. You might also consider inviting them to social activities or including the whole family in events. 

Mental support 

The mental load of caring for a newborn can be immense and might feel overwhelming at times. Be intentional about noticing tasks you can take care of so the new parent may not have to concern themselves with it. For example, you could take the trash to the curb for pickup, help an older child pick an outfit for school, or bring meals during the week. 

Physical support 

Volunteer for tasks that might relieve the new parent of any physical burden, such as exercising the dog or doing a load of laundry.

Seeking professional support 

A 2021 clinical trial compared the effect of adding a one-day online cognitive behavioral therapy-based workshop to the usual care offered to parents experiencing postpartum depression. The results revealed that those who completed the additional workshop experienced statistically significant improvements in postpartum depression, anxiety, social support, and the mother-infant relationship. Online therapy services can benefit many parents experiencing this condition. 

If leaving the house with an infant in tow feels like a challenge, consider scheduling a check-in with an online mental health provider. The sign-up process to schedule online therapy sessions can be straightforward, and you may receive a therapist match within 24 to 48  hours. A therapist through a platform like BetterHelp can help you work through any distressing emotions related to parenthood, postpartum depression, or other concerns. 

Online postpartum depression therapy can be affordable for many people, and clients can choose between video chat, phone, and live chat sessions with their therapist match. If you and your partner are struggling with postpartum depression or experiencing relationship concerns due to a new child, you can also consider reaching out for support through a couples online therapy platform like Regain.