Utilizing Therapy To Improve Postpartum Depression: A Review Of The Literature
Content Warning: Please be advised that this article mentions birth trauma, gender dysphoria, suicide, and other potentially triggering topics. Read with discretion.
The changes brought on by pregnancy, childbirth, and parenthood can lead to various emotions, such as joy, fear of birth, anxiety, or dejection. Many new parents may experience short-term sadness, crying, anxiety, and irritability. These occurrences often resolve within three to five days of onset. However, if your symptoms remain or are severe, it may be a sign of postpartum depression, a serious mental health condition.
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
This type of depression can occur anytime in the first year or more after giving birth and may cause difficulties in caring for yourself or your baby. While you're at a higher risk if you previously experienced clinical depression, many of those diagnosed with postpartum depression may have no previous history of depression.
Complications during birth, such as stillbirth, premature birth, or general birth trauma, can increase the risk of postpartum depression. Adoptive parents, non-birthing parents, and foster parents may also experience postpartum depression. The condition is not limited to gender, sexuality, or background.
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 often involves a combination of therapy and medication management. However, several barriers can prevent individuals from seeking professional medical advice. Not having health insurance and caring for an infant may cause difficulty for some parents in reaching out for support in person.
Online counseling and interventions can 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. 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.
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.
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?
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
Researchers continue to examine the efficacy of treating postpartum depression using online interventions, and a meta-analysis was performed on seven studies completed between 2008-2018. The analysis revealed a moderate effect size of 0.642, which means that the interventions effectively reduced symptoms of postpartum depression. In six of the seven studies, symptoms decreased significantly for parents receiving the intervention.
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 brought 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.
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.
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.
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 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 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 therapy can be affordable for many people, and clients can choose between video, 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 therapy platform like ReGain.