CLINICIAN MANAGED INTERPERSONAL PSYCHOTHERAPY

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DESCRIPTION (Adapted from the Applicant's Abstract): Empirical studies evaluating the effects of acute psychotherapeutic treatment have provided invaluable data demonstrating the efficacy of such treatments for major depression. Under controlled conditions, time-limited manual-based psychotherapies are efficacious in bringing about remission of depressive symptoms. Such efficacy studies, however, have several limitations. First, though the treatments are efficacious in laboratory settings, the effectiveness of such treatments, efficacy studies are limited by their lack of external validity. Second, though the acute effects of time-limited treatments for depression are impressive, the improvement is often not maintained, and recurrence of symptoms is common. Our proposed research project is an empirical investigation of the effectiveness of Clinician-Managed Interpersonal Psychotherapy (CM-IPT) for postpartum depression, a treatment based on the manual of Klerman et al (1) and refined for a community setting. Timing and frequency of sessions will be determined collaboratively by the therapist and patient rather than arbitrarily specified by manualized directives. We will evaluate the effectiveness of 12 sessions of CM-IPT delivered over the course of a year compared to "standard" IPT for postpartum depression, a treatment which we have previously demonstrated to be efficacious compared to a waiting list control condition. Standard IPT will require that 2 sessions of IPT be delivered in the first 12 weeks after treatment assignment. The first major aim of this research application is to evaluate the longitudinal effectiveness of CM-IPT for postpartum depression compared to standard IPT. We predict that CM-IPT will be associated with lower cumulative levels of depressive symptoms and lower rates of depression over the first year than standard IPT. The second major aim of this research application is to demonstrate the acute effectiveness of CM-IPT for postpartum depression. We will compare CM-IPT and standard IPT at 12 weeks after treatment assignment (the conclusion of standard IPT treatment), at which time we expect the two treatments to be clinically equivalent. Our study, which uniquely combines the best elements of both efficacy and effectiveness research, will lead to more effective treatment for depressed postpartum women in the community.