Evidence-Based Treatments and Pathways to Care

Psychological interventions such as interpersonal psychotherapy, cognitive behavioral therapy, and nondirective counseling are effective interventions for postnatal depression. Less work has addressed perinatal anxiety and antenatal depression. Preventive interventions, delivered during pregnancy or soon after delivery, also have been found to be effective for high-risk women. Pharmacologic treatments are widely used during both pregnancy and the postpartum period. Few randomized trials have evaluated antidepressant medication, but their wide use in practice and observational studies suggest that they are as effective. Complementary and alternative medicine (CAM) interventions are increasingly preferred by perinatal women, and early research suggests that many of them will prove to be efficacious. Pathways to care are diverse around the world. Collaborative care entails the coordination of primary care (general practice, obstetrics) and mental health care to ensure that perinatal women receive needed mental health care. The maternal-child health-care system is another venue for the delivery of mental health care through the direct delivery of brief counseling to depressed perinatal women in both high-income and low- and middle-income countries. Although much progress has been made in delivering mental health care to perinatal women, access to this care remains a challenge around the world.