CBT, Behavioral Activation, and IPT Reduce Perinatal Depressive Symptoms

1. In this systematic review and meta-analysis, cognitive behavioral therapy (CBT), behavioral activation, and interpersonal therapy (IPT) were more effective than treatment as usual (TAU) in reducing depressive symptoms in individuals with perinatal depression. 

2. The interventions showed variable effects on anxiety, recovery rates, and parent-infant bonding, with insufficient evidence often limiting definitive conclusions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Perinatal depression, the most common maternal mental health disorder, affects 19% of pregnant individuals and 7-13% postpartum, contributing to adverse outcomes for both mother and infant. Non-pharmacologic treatments, including cognitive behavioral therapy (CBT), interpersonal therapy (IPT), behavioral activation, and nondirective counseling, are often preferred by patients. This systematic review evaluated the efficacy of these interventions to inform clinical practice guidelines. CBT demonstrated a moderate effect in reducing depressive and anxiety symptoms and yielded higher recovery rates compared with treatment as usual (TAU). While CBT did not significantly improve parent-infant bonding or quality of life, it was associated with reduced infant-focused anxiety. Behavioral activation also moderately reduced depressive symptoms, though evidence was insufficient regarding recovery or anxiety outcomes. Comparisons between CBT and nondirective counseling revealed no clear differences in depressive symptom reduction, and data were limited for other outcomes. Nondirective counseling alone showed no clear benefit over TAU, with limited evidence on recovery or anxiety. IPT moderately improved depressive symptoms and recovery rates compared with TAU, but had no advantage for anxiety. Study generalizability is constrained by the lack of treatment blinding, heterogeneity in populations and interventions, poorly defined TAU, and variable outcome measures. Overall, CBT, behavioral activation, and IPT appear more effective than TAU in reducing depressive symptoms, though improvements may be modest and clinically limited.

Click to read this study in AIM

Relevant Reading: Psychological treatment of perinatal depression: a meta-analysis

In-Depth [systematic review and meta-analysis]: This systematic review and meta-analysis evaluated the effectiveness of non-pharmacologic interventions for perinatal mental health outcomes. Studies were identified in MEDLINE, PsycInfo, Embase, CINAHL, and the Cochrane databases from January 2000 to March 2025. Included were randomized controlled trials (RCTs) involving pregnant individuals or those up to 12 months postpartum with new or pre-existing depression, assessing psychological interventions. Excluded were poorly defined interventions, unsupervised peer-to-peer or social media approaches, ingestible treatments, or process-of-care interventions. Primary outcomes were depressive symptoms and recovery, defined as no longer meeting diagnostic criteria or exceeding cutoffs on screening tools. The review included 44 RCTs, with a median participant age of 30.9 years. Among 25 studies reporting race and ethnicity, most predominantly included White participants; six enrolled ≥60% Black participants, and three exclusively recruited Asian or South Asian participants. Risk of bias was high in six studies, moderate in 29, low in two, and unclear in seven, mainly due to inadequate blinding and allocation concealment. CBT was evaluated in 30 RCTs versus treatment as usual (TAU). Meta-analysis showed CBT moderately reduced depressive symptoms (standardized mean difference [SMD], -0.5; 95% CI, -0.7 to -0.4), corresponding to a 1.7-point reduction on the Edinburgh Postnatal Depression Scale (EPDS), and increased recovery rates (relative risk [RR], 1.7; 95% CI, 1.3 to 2.3). CBT also reduced anxiety symptoms (SMD, -0.5; 95% CI, -0.7 to -0.4) and infant-focused anxiety, though it did not significantly affect parent-infant bonding or quality of life. Behavioral activation, assessed in three RCTs, similarly reduced depressive symptoms (SMD, -0.5; 95% CI, -0.8 to -0.2), but evidence for recovery or anxiety outcomes was insufficient. Comparisons between CBT and nondirective counseling found no difference in depressive symptom reduction, and data were insufficient for other outcomes. Nondirective counseling versus TAU also showed no significant benefit. IPT, evaluated in nine RCTs, moderately improved depressive symptoms (SMD, -0.6; 95% CI, -1.0 to -0.2) and recovery rates (RR, 1.2; 95% CI, 0.97 to 1.5) but did not significantly reduce anxiety. Overall, evidence suggests CBT, behavioral activation, and IPT may be more effective than TAU in alleviating depressive symptoms in perinatal populations, though clinical significance may be modest.

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