Correspondence

Postpartum Depression

N Engl J Med 2003; 348:1294March 27, 2003

Article

To the Editor:

The unqualified recommendation by Wisner et al. (July 18 issue)1 that women with postpartum depression should be given antidepressants is inappropriate. Antidepressants should indeed be considered, but many women who have recently given birth prefer not to take medications, and many get better remarkably quickly when given the opportunity to discuss their emotional troubles in psychotherapy.

Wisner et al. devote two pages (nearly half of their article) to drug treatment and only three sentences to psychotherapy. Yet psychotherapy has had a distinguished role in treating this illness for more than 100 years and remains a standard recommendation in psychiatric textbooks and practice. Psychoanalysts such as Freud2 and Gillman3 have emphasized the need for specific interventions to help the patient solve conflicts over taking care of others and being taken care of, which have been magnified by new motherhood. More recently, controlled trials have demonstrated substantial efficacy for even rather minimal supportive psychological interventions.4,5

Lawrence D. Blum, M.D.
2400 Chestnut St., Philadelphia, PA 19103
ldb@lawrenceblum.com

5 References

1. 1

   Wisner KL, Parry BL, Piontek CM. Postpartum depression. N Engl J Med 2002;347:194-199
   Full Text | Web of Science | Medline

2. 2

   A case of successful treatment by hypnotism. In: Strachey J, trans. The standard edition of the complete psychological works of Sigmund Freud. Vol. 1. London: Hogarth Press, 1968:115-28.
   

3. 3

   Gillman RD. Brief psychotherapy: a psychoanalytic view. Am J Psychiatry 1965;122:601-611
   Web of Science | Medline

4. 4

   Wickberg B, Hwang CP. Counselling of postnatal depression: a controlled study on a population based Swedish sample. J Affect Disord 1996;39:209-216
   CrossRef | Web of Science | Medline

5. 5

   Holden JM, Sagovsky R, Cox JL. Counselling in a general practice setting: controlled study of health visitor intervention in treatment of postnatal depression. BMJ 1989;298:223-226
   CrossRef | Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Ian Brockington. (2004) Postpartum psychiatric disorders. The Lancet 363:9405, 303-310
   CrossRef