Pregnancy is often described as the happiest time in a woman’s life. For women who have experienced depression, it can look very different. As the body, hormones, sleep and daily routines are all disrupted at once, depression that had eased may return. On 20 October, researchers from the University of Colorado Boulder published in the international journal Lancet Public Health the results of a trial testing whether a free online mindfulness programme, accessed from home, could prevent relapse.
Eight sessions at home for 500 pregnant women across the US
The study was led by Professor Sona Dimidjian, director of the Renée Crown Wellness Institute at the University of Colorado Boulder, alongside Dr Lee Cohen of the Women’s Mental Health Center at Massachusetts General Hospital. It involved 500 pregnant women recruited from all 50 US states. All had a history of multiple episodes of depression and had taken antidepressants recently or were taking them at the time, but were not depressed when they joined the study. Their average age was 32, and they were around 11 weeks pregnant.
Half the participants received their usual care plus a 12-week online programme called Mindful Mood Balance for Moms; the other half received usual care alone. The programme consisted of eight web-based mindfulness-based cognitive therapy sessions, with audio-guided practices, videos and advice from mothers in similar circumstances and from professionals. Participants learnt mindfulness practices they could do while caring for a newborn, how to respond to self-critical thoughts with self-compassion, and how to spot early signs of depression and plan what to do.
By six months after birth, relapse rates were 44% and 33%
The researchers tracked depressive relapse until six months after birth. In the programme group, 81 of 249 participants (33%) relapsed, compared with 111 of 251 (44%) in the usual-care group. This equated to a 26% lower risk of relapse in the programme group (hazard ratio 0.74).
Depressive symptoms also fell more during the 12-week programme in the programme group. However, across the full period up to six months after birth, there was no meaningful difference in symptom changes between the two groups. In other words, the programme made a difference to preventing relapse, but the difference in symptom scores did not last after it ended. The study was funded by the US National Institutes of Health and the National Institute of Mental Health.
This is not a call to stop taking medication
There is an important point to bear in mind when interpreting these results. In both groups, about three-quarters of participants continued taking antidepressants throughout the study. The programme was not used instead of medication, but as a preventive tool alongside usual care and medication. The developers also said that the programme was intended to prevent relapse, not to treat depression that had already begun during pregnancy or after birth. The difference between people who continued their medication and those who reduced it remains a question for future research.
Professor Dimidjian stressed that expectant and new mothers need to have choices. According to the research team, many pregnant women prefer counselling to medication, and around half reduce or stop taking medication during pregnancy. Even when they want counselling, cost, travel and a shortage of specialists can stand in the way. The team says a free programme that can be accessed from home at a convenient time could help fill that gap. Any changes to medication should always be discussed with the prescribing doctor.
How meditation can complement medical care
The study shows where meditation can fit in. Rather than replacing doctors or medication, mindfulness is becoming an everyday practice that can help people through the long stretches between appointments. It is not easy to get to a meditation centre when pregnancy is making you bigger and sleep is broken up. Practising for a few minutes at a time on a phone or laptop while the baby sleeps offers an approach that fits those realities.
The programme’s focus on self-compassion and recognising early warning signs also gives mothers practical skills for looking after themselves. Expectant mothers who have experienced depression may find it helpful to discuss suitable ways to care for their mental wellbeing with their healthcare team in advance. Meditation is not a demand to cope alone; it is a way to build the capacity to notice how you are feeling while receiving support.
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