Therapy for Prenatal Depression:Maternal & Fetal Effects

描述（由申请人提供）：从历史上看，一种未经证实的观点认为怀孕是预防抑郁症的保护因素。现在的数据与这一观点大相径庭。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，产前抑郁症甚至在出生前也可能对孩子产生不利影响。尽管产前抑郁症的患病率很高，其负面影响，很少有对照研究测试了心理治疗在怀孕期间的疗效。没有人研究成功治疗抑郁症对胎儿和新生儿的影响。这项申请的目的是根据NIMH R34探索性干预研究机制提交的，目的是确定产前抑郁症的干预是否可以增强妇女产前和产后的情绪，改善胎儿和新生儿的功能。具体来说，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，40名精神健康的孕妇，我们假设，抑郁症孕妇接受人际心理治疗与标准精神病护理相比，将导致：（a）改善产前情绪，（B）减少产后抑郁症，（c）胎儿和新生儿神经行为 与健康女性的后代相似。在过去的工作中，我们已经表明，抑郁症妇女的胎儿改变了心率反应，提示未来的压力为基础的精神病理学的风险。女性的情绪将使用标准评定量表进行评估。胎儿心率和胎动 在女性经历实验室压力源时进行评估。将在立位挑战期间评估新生儿心率。这项研究有可能改变围产期情绪障碍的临床方法，证明我们可以（1）在产后抑郁症发生之前预防它，（2）通过限制妇女的产前和产后抑郁症对儿童的发育产生积极影响。

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.