Therapy for Prenatal Depression:Maternal & Fetal Effects

描述(由申请人提供)：历史上，一种未经证实的观点认为怀孕是抵抗抑郁的保护因素。现在的数据与这一观点发生了戏剧性的矛盾。大约10%-15%的孕妇患有抑郁症，这使她们和她们的孩子面临产后抑郁症的有害影响的风险。此外，新的数据表明，甚至在孩子出生之前，产前抑郁也可能对孩子产生不利影响。尽管产前抑郁及其负面后果的患病率很高，但很少有对照研究测试怀孕期间心理治疗的效果。还没有人研究过成功治疗抑郁症对胎儿和新生儿的影响。这项申请是在NIMHR34探索性干预研究机制下提交的，目的是确定对产前抑郁的干预是否可以改善妇女产前和产后的情绪，并改善胎儿和新生儿的功能。具体地说，在一项研究中，80名抑郁症妇女被随机分配到两种治疗方案中的任何一种，以及40名精神健康的孕妇，我们假设抑郁症孕妇接受团体版的人际心理治疗与标准的精神护理相比，将导致：(A)改善产前情绪，(B)减轻产后抑郁，(C)胎儿和新生儿的神经行为 与健康女性后代相似的侧写。在过去的工作中，我们已经表明，抑郁女性的胎儿改变了心率反应，这暗示着未来基于压力的精神病理学的风险。女性的情绪将使用标准评级量表进行评估。当女性接受实验室应激源时，将评估胎儿心率和运动。新生儿心率将在立位挑战期间进行评估。这项研究有可能改变围产期情绪障碍的临床方法，它证明了我们可以(1)在产后抑郁发生之前预防它，(2)通过限制儿童在产前和产后抑郁中的暴露来积极影响他们的发育。

DESCRIPTION (provided by applicant): Historically, an unsubstantiated view held that pregnancy was a protective factor against depression. Data now dramatically contradict this view. Approximately 10-15% of pregnant women are depressed, which puts them -- and their children ---at risk for the deleterious affects of postpartum depression. Moreover, new data indicate that prenatal depression also may adversely affect the child even before birth. Despite the high prevalence rates of prenatal depression and its negative consequences, few controlled studies have tested the efficacy of psychotherapy during pregnancy. None has examined the effects of successfully treated depression on the fetus and newborn. The goal of this application -- submitted under the NIMH R34 mechanism for exploratory intervention research -- is to determine if an intervention for prenatal depression can enhance women's pre- and postpartum moods and improve fetal and newborn functioning. Specifically, in a study of 80 depressed women randomly assigned to either of two treatment options and 40 psychiatrically-healthy pregnant women, we hypothesize that depressed pregnant women treated with a group version of Interpersonal Psychotherapy versus standard psychiatric care will result in: (a) improved prenatal mood, (b) less postpartum depression and (c) fetal and newborn neurobehavioral profiles similar to healthy women's offspring. In past work we have shown that fetuses of depressed women have altered heart rate responses suggestive of risk for future stress-based psychopathology. Women's mood will be assessed using standard rating scales. Fetal heart rate and movement will be assessed while women undergo a laboratory stressor. Newborn heart rate will be assessed during an orthostatic challenge. This study has the potential to alter the clinical approach to perinatal mood disorders by demonstrating that we can (1) prevent postpartum depression before it occurs and (2) positively influence the child's development by limiting their exposure to women's pre- and postpartum depression.