Cooper et al (Reference Cooper, Murray and Wilson2003) reported a randomised trial with mothers with post-partum depression that compared routine primary care, non-directive counselling, cognitive–behavioural therapy (CBT) and psychodynamic therapy and found that psychological therapy improved maternal mood in the short term but the long-term effect was no better than spontaneous remission. The trial was generally well done and the procedures reasonably described. However, the researchers did not, from a cognitive–behavioural perspective, treat maternal depression. Cooper et al describe that treatment used cognitive–behavioural techniques but focused not on depression but on the management of mother–infant interactions.
Several randomised placebo-controlled trials have shown that CBT – when done properly – is an effective treatment for post-partum depression (Reference Holden, Sagovsky and CoxHolden et al, 1989; Reference Appleby, Warner and WhittonAppleby et al, 1997; Reference Chabrol, Teissedre and Saint-JeanChabrol et al, 2002) and for major depressive disorders (Reference Hollon, Haman, Brown, Gotlib and HammenHollon et al, 2002). There is an important relationship between post-partum depression and mother–infant interactions but it is not, by any means, the entirety or even the essence of post-partum depression. Although it is advisable to customise CBT to patients’ circumstances, exclusive use of one focus, such as mother–child interactions, is not a test of the therapy. If the goal is to change depression, one should treat depression. Thus, the title is inaccurate and the discussion of the lack of effect of CBT for maternal depression is misleading.
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