Abstract
Interpersonal psychotherapy is one of two evidence-based formal psychotherapies for perinatal mood disorders. It is a time-limited, non-transference / cognitive-based therapy that focuses on communication and social support and can be easily conducted in a perinatal clinic setting. There is limited patient access to interpersonal psychotherapy in Hong Kong because the therapy is not widely disseminated. This case report aimed to illustrate the principles and techniques of interpersonal sychotherapy in perinatal psychiatry, and to raise interest among mental health professionals in Hong Kong in this evidence-based treatment.
Introduction
Perinatal mood disorders are common. In particular, women of childbearing age are at higher risk of developing depression.1 For major and minor depression, a point
prevalence of 8.5% to 11.0% has been reported during pregnancy and 6.5% to 12.9% during the first-year postpartum.2 In Hong Kong, a prevalence of 6.4% has been reported for antenatal depression, and 1.4% for antenatal anxiety.3 Maternal mental disorders have been shown to be associated with behavioural, developmental, and emotional problems in children.4,5 Nonetheless intervention in postnatal depression, both pharmacological and nonpharmacological, affects child development positively.6
Despite the relative safety7 and efficacy8 of selected antidepressant use for perinatal mood disorders, some mothers are reluctant to take them because of concerns about their effect on the fetus or on breastfeeding. Some patients fail to respond to antidepressants alone and some benefit from a combination of antidepressant and psychological treatment. Thus psychotherapy clearly has a role in the management of perinatal mood disorders.
Both cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) have been shown to be effective in the management of patients with perinatal mood disorders in clinical trials. A Cochrane meta-analysis of the effectiveness of psychological interventions in patients with postnatal depression found benefit for CBT (risk ratio = 0.72, 95% confidence interval [CI] = 0.57-0.90) and for IPT (risk ratio = 0.80, 95% CI = 0.66-0.98) but not for psychodynamic therapy.8 Research also suggests that the 2 therapies are indicated for different patients and they work in different ways.9 Interpersonal psychotherapy is a timelimited, non-transference / cognitive-based therapy that focuses on communication and social support. It embraces a biopsychosocial, cultural, and spiritual model.10 Its treatment focus on interpersonal dispute, role transition, as well as grief and loss issues is particularly appropriate for common problems experienced by women during the perinatal period.
In Hong Kong, CBT is commonly used for the management of perinatal mood disorders while IPT is much less disseminated because of the lack of local training. It is lamentable that patients have limited access to this potentially useful treatment that is one of the two evidencebased psychological interventions currently available for perinatal mood disorders. In our perinatal psychiatric clinic at Pamela Youde Nethersole Eastern Hospital in Hong Kong, around 30.8% of our patients with postnatal depression refuse prescription of an antidepressant. We routinely select suitable patients with perinatal mood disorders for weekly IPT for 12 to 16 weeks. The spectrum of disorders includes perinatal depression, perinatal anxiety disorders, and perinatal adjustment disorders. This case report aimed to disseminate the skill of IPT by illustrating the techniques used on a session-by-session basis in a patient with postnatal anxiety disorder.
