Digital mindfulness program cuts depression relapse risk in mothers by 26%

A free, online program developed by University of Colorado Boulder researchers has been shown to reduce risk of depression relapse by double digits among new moms and moms-to-be with a history of depression.

The findings were published Oct. 20 in the journal Lancet Public Health.

"When it comes to mitigating depression relapse, new and expectant moms need to have choices, and for many, there aren't a lot," said first author Sona Dimidjian, a professor in the Department of Psychology and Neuroscience and the director of the Renée Crown Wellness Institute. "This study used the rigorous tools of science to identify a non-pharmacological approach that works."

About one in five women experience major depression during the perinatal period (during pregnancy or up to one year postpartum). For those with a history of depression, the prevalence is as high as 77%.

Antidepressants are the standard treatment for preventing relapse. But studies show that most pregnant women prefer psychotherapy over medication, and about half discontinue or decrease their medication when pregnant.

Due to stigma, expectant moms are often reluctant to seek counseling.

"There is a stereotype that pregnancy is the happiest time in a woman's life. It is for some. But it can also be a time that brings depression, anxiety and stress," Dimidjian said.

Cost, lack of transportation and a shortage of properly trained therapists also hinder access to care.

To help fill the gap, Dimidjian and her colleagues developed Mindful Mood Balance for Moms (MMB for Moms), an eight-session digital offering that teaches mindfulness techniques and cognitive behavioral skills through audio-guided practices, videos and advice from peers and professionals.

To test its efficacy, the research team recruited 500 expectant mothers with a history of depression from all 50 states. All participants had taken antidepressants in the past or were still taking them. At the time of recruitment, none were clinically depressed.

Half participated in MMB for Moms for 12 weeks. The other half continued with usual care. Depression relapse was assessed up to 6 months postpartum.

Those in the MMB for Moms group were 26% less likely to experience a return of their depression. Most also found significant relief of anxiety and stress.

Dimidjian said the program is not intended to "treat" prenatal or postpartum depression. Rather, it provides tools for preventing it -from mindful breathing practices to new ways of thinking to asking for support.

For instance, one session provides mindfulness practices that moms can do with a new infant. Another teaches them to respond to self-judgment with grace and compassion.

Other sessions teach participants to recognize the signs of depression and make a game plan for how to address early warning signs in the moment.

Senior author Dr. Lee Cohen, director of the Ammon-Pinizzotto Center for Women's Health at Massachusetts General Hospital, said the program is not necessarily intended to replace medication. But it could serve as a useful adjunct or alternative depending on an individual's unique needs and preferences.

About three-quarters of participants in both groups remained on antidepressants throughout the study period. Future research will explore differences between participants who stayed on medication and those who did not.

"What we do know now is that for patients looking for a non-pharmacologic alternative to mitigate their risk for recurrence of depression, this program helps," he said.

In future studies, Dimidjian hopes to explore how the program influences moms' parenting and the well-being of their children.

"Our mission at the Crown Institute is to promote the wellness of young people and the adults who support them" she said. "We are committed to understanding how best to support moms and have a positive ripple effect on their children and families."