A comprehensive review into different options to help pregnant women with depression has shown that approaches such as yoga and omega-3 supplementation are as effective as psychological therapies.
Globally, nearly one in three pregnant women experience depression with most receiving no treatment. When they do get support, they're often steered towards talking therapies such as cognitive behavioural therapy (CBT) or mindfulness as the default option.
A review of 115 clinical trials, covering more than 12,000 participants across 30 countries, found that treatments such as yoga, massage, omega-3 supplements and bright light therapy, are broadly as effective at reducing depression symptoms in pregnancy as talking therapies, such as CBT. This points to the importance of social support and increased connection for improving depression in pregnancy, as all these types of interventions offer some element of that.
The study, led by King's College London and published today in Archives of Women's Mental Health, is the first to bring together all the trial evidence on treatments for depression in pregnancy, across every type and format, under a common framework. It was conducted as part of HappyMums, a European Consortium led by the University of Milan, focusing on improving mental health support for women during pregnancy and after birth.
This is the most comprehensive analysis of treatments for depression in pregnancy ever conducted, and the findings should prompt a rethink of how we support women during this critical period. The evidence is clear that there is no single best approach. What matters is that women have access to a range of options, and that clinicians feel equipped to offer them.
Professor Carmine Pariante, Professor of Biological Psychiatry
For women on a waiting list for mental health support, or those who struggle to access it, non-psychological approaches such as yoga or omega-3 supplements represent a legitimate treatment option rather than a stopgap.
The researchers caution that the studies varied considerably in their design, sample sizes and how they measured results, which means the findings should be read with some care. Even so, the researchers say the findings point to a clear practical use: non-psychological approaches could offer a way of coping with long waiting times for care, without ruling out other forms of treatment alongside them.
The study also found that digital and online interventions, such as apps and telephone-based support, were as effective as face-to-face treatment. For a condition affecting women who may be unable to travel, or who face long waiting times for in-person care, it is a finding with important implications for how antenatal depression is managed.
Despite antidepressants being widely prescribed for depression outside pregnancy, the researchers found no randomised controlled trials of pharmaceutical treatment for antenatal depression. This means that for one of the most common mental health conditions in pregnancy, the evidence for drug treatment relies on indirect evidence rather than trials conducted in pregnancy itself, reflecting long-standing caution around testing medication in pregnant populations.
NICE guidelines do recommend antidepressants for moderate to severe depression in pregnancy, and evidence from outside formal pregnancy trials suggests they can be safe and effective, but the researchers say trials are still needed, particularly for those who cannot access or engage with other forms of support.
Depression in pregnancy is common, but it is not inevitable, and it is treatable. What this review shows is that the options available to women are broader than many people realise. A yoga class, music therapy, or an online programme may not sound like clinical treatment, but the evidence suggests they can make a real difference, and for many women they may be easier (and quicker) to access than a course of therapy.
Riddhi Laijawala, Trial Manager & PhD Student
Depression in pregnancy affects an estimated 28.5% of pregnant people worldwide. Despite this, only around one in five of those affected receives appropriate and timely treatment. Given the impact this can have on both parent and child, the team behind the study say closing that treatment gap should be a priority for health systems everywhere.
The study, "The evidence base of interventions to treat antenatal depression: a meta-analysis of randomised controlled trials," is published in Archives of Women's Mental Health.
