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Treatment Options

Services for Mothers

Focus on symptom reduction and enhancement of general functioning.

Primary Services

Counseling

First-line treatment for mild to moderate PPD (PPD),1-4 effective approaches include Interpersonal Therapy5-11 and Cognitive Behavior Therapy.8-15 Women with severe PPD may also benefit from pharmacological treatment.1-4

  • Pharmacological Treatment

First-line treatment for severe PPD,16-18 effective antidepressant medications include Sertraline,5,11,19-21 Paroxetine,11,21-23 and Nortriptyline.11,19 Although few adverse effects reported in infants exposed to antidepressant medication through breast milk, the long-term effects of infant exposure on neurocognitive development are unknown. Women with PPD may benefit from assistance with Treatment Decision Making during this time.

Complimentary Services

  • Peer Support

Entails provision of reassurance and emotional support, validation of feelings, and informational assistance.24 Encompasses a diverse array of services, from in-person peer support groups to telephone-based peer support,8 with emerging evidence for effectiveness.8,9,24,25

  • Services that Address Poor Sleep Quality

May involve a range of interventions, from education about sleep hygiene practices to pharmacological treatment.26 Rehabilitation counselors can provide mothers with information about sleep hygiene practices and help mothers develop a plan to decrease infant-related sleep interruptions by enhancing support in nighttime infant-care26 Sleep hygiene practices include practices such as only using the bed for sleeping, getting out of bed and engaging in a non-stimulating activity after 20 minutes of trying to sleep, avoiding stimulating substances or activities within four hours of desired bedtime, and establishing a night-time routine. 27

  • Supported Employment

Evidence-based practice that entails assisting individuals in every stage of employment.28 Employment is an important component of risk and recovery in PPD.29-31 One study found that at six months postpartum, employed mothers were less likely to have depressive symptoms than unemployed mothers29 Two other studies found that returning to work after childbirth was an important factor in recovery for consumers with PPD.30,31 Because supported employment enhances employment outcomes—and employment itself promotes recovery32—this practice may facilitate recovery for women with severe PPD33

Services for Parenting and the Mother-Infant Relationship

Focus on enhancing parenting skills and developing healthy mother-child relationships. Important component of treatment,34, 35 as treatment of PPD symptoms does not significantly improve the mother-child relationship.36

  • Parent Education

Provides parents with knowledge and techniques for meeting the physical and emotional needs of their infants.37 One review found improvements in mothers’ psychosocial health, with mothers in the parent training group showing a reduction in depression and anxiety compared to the control group.38 Another review found that children from birth to age three showed significant improvement in behavioral and emotional adjustment after their parents’ completion of parenting programs.39 Includes parent education workshops37 and manualized parent education programs such as The Incredible Years program.40  

  • Home Visiting

Nurses, Social Workers, or trained volunteers provide in-home parenting support and training.41 More effective when delivered by nurses, rather than by paraprofessionals.42,43

  • Includes the Nurse-Family Partnership (NFP)
    • Nurses provide home visiting services for low-income, first-time mothers that begin in pregnancy and continue until the child is two years old.44 Offer parent education and skills training, counseling and parenting support, and referrals to other services (e.g. job training, healthcare, childcare, etc.).44 Longitudinal, randomized controlled trials found nurse visited mothers and children had more responsive interactions,42 and that children showed superior language and cognitive development,42, 43, 45 had higher academic achievement,45-47 had fewer behavior problems and less aggression,45 and were less likely to have internalizing disorders47 than controls.
    • Also includes the Parents as Teachers (PAT) program
      • §    Home visiting program that provides parent education, coaching, and support based on the Born to Learn curriculum.48, 49 Also provides developmental screenings and community resource referral.48, 49Several studies have found beneficial effects for enrolled families in the areas of parenting practices,49, 50 and school achievement and readiness.4

 

  • Mother-Infant Therapies

Dyadic therapies that involve both the mother and the infant, focusing on altering negative maternal representations and/or behaviors to improve mother-infant interactions.51 For example, Toddler Parent Psychotherapy (or Child Parent Psychotherapy) is a mother-infant therapy that focuses on altering negative maternal representations of one’s child, of oneself as a mother, and of one’s relationship with her child.52 Several approaches have been found to improve both mother-infant interactions and infant attachment security, including:

  • Toddler Parent Psychotherapy52, 53, 54
  • Psychodynamic Psychotherapy (PPT)55, 56
  • Watch, Wait and Wonder (WWW)57, 58

Other approaches—such as Parent Child Interaction Therapy59, 60 and Infant Massage61-64—were found to improve mother-infant interactions by enhancing maternal responsiveness. Interaction Coaching was also found to enhance maternal responsiveness.11, 65

Services for infants

Focus on remediating developmental delays, preventing impaired development, and optimizing developmental outcomes

Early Head Start

Provide center-based daycare services and case management to low-income families with children under 3 years of age.66-68 Some programs also offer home visiting and parenting education.66-68 A randomized controlled trial found that 3 year old children in the program had greater sustained attention, less aggressive behavior, and better language and cognitive development than control children.67