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Letters to the Editor   |    
Antepartum Depression: Treatment With Computer-Assisted Cognitive-Behavioral Therapy
Liisa Hantsoo, Ph.D.; C. Neill epperson, M.D.; Michael E. Thase, M.D.; Deborah r. Kim, M.D.
Am J Psychiatry 2013;170:929-930. doi:10.1176/appi.ajp.2013.13020254
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Dr. Epperson has received research support from Novartis and Shire, and Dr. Epperson or a family member owns stock in Abbott Laboratories, AbbVie, Johnson & Johnson, Merck, and Pfizer. Dr. Thase has received consulting fees from Alkermes, Allergan, AstraZeneca, Bristol-Myers Squibb, Dey, Eli Lilly, Forest Laboratories (PGx), Janssen Pharmaceutica, Lundbeck, Merck, Neuronetics, Novartis, Otsuka, Pfizer, Pharmaneuroboost, Roche, Shire US, Takeda, and Transcept; honoraria for educational talks from AstraZeneca, Dey, Lundbeck, and Pfizer; and research funding from the Agency for Healthcare Research and Quality, AstraZeneca, Eli Lilly, Forest Laboratories, NIMH, Otsuka, Pfizer, PharmaNeuroboost, and Roche. Dr. Kim has received research support from Neuronetics. Dr. Hantsoo reports no financial relationships with commercial interests.

From the Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia.

Copyright © 2013 by the American Psychiatric Association

Accepted May , 2013.

To the Editor: Depression affects 7%−12% of pregnant women (1), and left untreated, it is associated with adverse outcomes including preterm birth and lower birth weight (2). Many pregnant women do not pursue treatment because of practical barriers (e.g., lack of time or child care) or fear of adversely affecting fetal health with antidepressant use (3). Computer-assisted cognitive-behavioral therapy (CBT), with demonstrated efficacy in nonpregnant depressed samples (4), uses a web-based multimedia program integrated with abbreviated CBT to reduce the scheduling burden on the patient and to circumvent the risks of antidepressant use. We report here on a patient with a major depressive episode during pregnancy who underwent computer-assisted CBT.

“Ms. B,” a 29-year-old woman, gravida 1, para 0, with two previous depressive episodes, presented at 18 weeks gestation with depressive symptoms including low mood, anhedonia, hypersomnia, low energy, and guilt. A diagnosis of recurrent major depressive disorder was confirmed using the Structured Clinical Interview for DSM-IV. Ms. B had discontinued sertraline (100 mg) 8 months earlier for pregnancy planning. Computer-assisted CBT comprised eight therapy sessions over 6 weeks with a clinical psychologist (3.75 hours of direct contact), with between-session web-based modules (“Good Days Ahead”; Empower Interactive, San Francisco) (5). Therapy sessions included collaborative agenda setting, reviewing skill implementation, and previewing web-based content. Web-based modules included video vignettes, psychoeducational content, and exercises (e.g., automatic thought records). Ms. B had good adherence and experienced remission. She exhibited a 94% reduction in her Hamilton Depression Rating Scale scores from the pretreatment assessment (score, 17) to the posttreatment assessment (score, 1). Her Beck Depression Inventory scores (pretreatment score, 26; posttreatment score, 2) and Edinburgh Postnatal Depression Scale scores (pretreatment score, 17; posttreatment score, 5) also decreased markedly. Her Global Assessment of Functioning score improved from 55 to 90. Subjective report indicated that Ms. B found computer-assisted CBT acceptable, and she expressed satisfaction in avoiding antidepressant use during pregnancy.

Computer-assisted CBT represents a short-term accessible treatment for antepartum depression. Adapting technologies to patient populations facing practical barriers is critical to improving mental health care accessibility. Few randomized controlled trials have assessed CBT for antepartum depression (6), and none have assessed computer-assisted CBT in this population. This case report suggests the need for larger-scale research on the effectiveness of computer-assisted CBT for antepartum depression.

Bennett  HA;  Einarson  A;  Taddio  A;  Koren  G;  Einarson  TR:  Prevalence of depression during pregnancy: systematic review.  Obstet Gynecol 2004; 103:698–709
[CrossRef] | [PubMed]
 
Grote  NK;  Bridge  JA;  Gavin  AR;  Melville  JL;  Iyengar  S;  Katon  WJ:  A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.  Arch Gen Psychiatry 2010; 67:1012–1024
[CrossRef] | [PubMed]
 
Petersen  I;  Gilbert  RE;  Evans  SJ;  Man  SL;  Nazareth  I:  Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from the Health Improvement Network.  J Clin Psychiatry 2011; 72:979–985
[CrossRef] | [PubMed]
 
Wright  JH;  Wright  AS;  Albano  AM;  Basco  MR;  Goldsmith  LJ;  Raffield  T;  Otto  MW:  Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time.  Am J Psychiatry 2005; 162:1158–1164
[CrossRef] | [PubMed]
 
Wright  JH;  Wright  AS;  Beck  AT: Good Days Ahead: The Multimedia Program for Cognitive Therapy.  Louisville,  Mindstreet, 2004
 
Sockol  LE;  Epperson  CN;  Barber  JP:  A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 2011; 31:839–849
 
References Container
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References

Bennett  HA;  Einarson  A;  Taddio  A;  Koren  G;  Einarson  TR:  Prevalence of depression during pregnancy: systematic review.  Obstet Gynecol 2004; 103:698–709
[CrossRef] | [PubMed]
 
Grote  NK;  Bridge  JA;  Gavin  AR;  Melville  JL;  Iyengar  S;  Katon  WJ:  A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction.  Arch Gen Psychiatry 2010; 67:1012–1024
[CrossRef] | [PubMed]
 
Petersen  I;  Gilbert  RE;  Evans  SJ;  Man  SL;  Nazareth  I:  Pregnancy as a major determinant for discontinuation of antidepressants: an analysis of data from the Health Improvement Network.  J Clin Psychiatry 2011; 72:979–985
[CrossRef] | [PubMed]
 
Wright  JH;  Wright  AS;  Albano  AM;  Basco  MR;  Goldsmith  LJ;  Raffield  T;  Otto  MW:  Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time.  Am J Psychiatry 2005; 162:1158–1164
[CrossRef] | [PubMed]
 
Wright  JH;  Wright  AS;  Beck  AT: Good Days Ahead: The Multimedia Program for Cognitive Therapy.  Louisville,  Mindstreet, 2004
 
Sockol  LE;  Epperson  CN;  Barber  JP:  A meta-analysis of treatments for perinatal depression. Clin Psychol Rev 2011; 31:839–849
 
References Container
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