A CONTROLLED-STUDY OF FLUOXETINE AND COGNITIVE-BEHAVIORAL COUNSELING IN THE TREATMENT OF POSTNATAL DEPRESSION

Objective: To study the effectiveness of fluoxetine and cognitive-beha vioural counselling in depressive illness in postnatal women: to compa re fluoxetine and placebo, six sessions and one session of counselling , and combinations of drugs and counselling. Design: Randomised, contr olled treatment trial, double blind in relation to drug treatment, wit h four treatment cells: fluoxetine or placebo plus one or six sessions of counselling. Subjects: 87 women satisfying criteria for depressive illness 6-8 weeks after childbirth, 61 (70%) of whom completed 12 wee ks of treatment Setting: Community based study in south Manchester. Ma in outcome measures: Psychiatric morbidity after 1, 4, and 12 weeks, m easured as mean scores and 95% confidence limits on the revised clinic al interview schedule, the Edinburgh postnatal depression scale and th e Hamilton depression scale, Results: Highly significant improvement w as seen in all four treatment groups. The improvement in subjects rece iving fluoxetine was significantly greater than in those receiving pla cebo. The improvement after six sessions of counselling was significan tly greater than after a single session, Interaction between counselli ng and fluoxetine was not statistically significant These differences were evident after one week, and improvement in all groups was complet e after four weeks. Conclusions: Both fluoxetine and cognitive-behavio ural counselling given as a course of therapy are effective treatments for non-psychotic depression in postnatal women. After an initial ses sion of counselling, additional benefit results from either fluoxetine or further counselling but there seems to be no advantage in receivin g both, The choice of treatment may therefore be made by the women the mselves.