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What forms of counseling are best and how well do they work?

The report found that women receiving one of two forms of counseling were 39 percent less likely than those who didn’t to develop perinatal depression. One approach involves cognitive behavioral therapy, which helps women navigate their feelings and expectations to create healthy, supportive environments for their children. The other involves interpersonal therapy, including development of coping skills and role-playing exercises to help manage stress and relationship conflicts.

The panel cited two specific programs that have been successful: “Mothers and Babies,” which includes cognitive behavioral therapy in eight to 17 group sessions, with at least two of those sessions after childbirth, and “Reach Out, Stay Strong, Essentials for New Moms” or ROSE, typically delivered in four sessions during pregnancy and one postpartum.

The two programs work with both first-time mothers and women who already have children. They are available in Spanish and focus on low-income women. Both are expanding and testing different ways of delivering their curriculum, which is provided free to clinics and community health agencies.

The panel’s recommendation will require insurance to cover counseling at no cost to women receiving it. Health providers delivering it might have to pay for costs like babysitting and transportation for pregnant women who attend.

What about other prevention methods?

The task force evaluated the strongest research available on possible prevention methods, including physical activity, education, infant sleep advice, yoga, expressive writing, omega-3 fatty acids and antidepressants. In the 50 studies it analyzed, there were hints of promise with a few approaches, including physical activity and three programs in Europe (Britain and the Netherlands) that involved home visits by midwives or other health providers. But the evidence of benefit wasn’t strong enough with anything except counseling.

The panel also looked for any harm that prevention methods could cause. They found negative effects in the two small studies with antidepressants. One study reported instances of dizziness and drowsiness among women who took Zoloft. The other reported that more women taking Pamelor experienced constipation.

That doesn’t mean antidepressants aren’t good at treating actual depression, said a panel member, Karina Davidson, who is senior vice president for research for Northwell Health. After all, that’s what they’re designed for. But the studies so far don’t suggest that these drugs are the best method to prevent pregnancy-related depression before it develops.