Although pregnancy was once believed to be a time when women were protected from psychiatric distress, the lifetime risk for antenatal major depression is actually estimated to be 10-25%. Antenatal depression is linked to many adverse outcomes, including higher rates of spontaneous abortion, pre-eclampsia, operative delivery, postpartum depression, neonatal growth retardation, pre-term delivery, low birth weight, and delayed developmental milestones for the child. Despite these risks, the majority of depressed pregnant women do not pursue any mental health treatment. In particular, pregnant women have concerns about using antidepressant medications. Because perinatal patients have unique concerns about depression treatment, there is a need to develop specialized approaches for perinatal depression that are not only efficacious, but are also viewed as acceptable, safe, and especially-tailored for pregnant women. This has been further highlighted in NIH PA-06- 376 "Women's Mental Health in Pregnancy and the Postpartum Period," which emphasized that developing a wider range of innovative non-pharmacological interventions for perinatal depression is a current NIMH priority. Prenatal yoga is a good candidate for a treatment that might be efficacious as well as acceptable and safe to pregnant women. Yoga focuses on training the body with the ultimate goal of physical and emotional self transformation. Like other forms of hatha yoga, prenatal yoga involves breath control (pranayama), physical postures (asanas), and meditation (dhyana). Both health-care providers and women view prenatal yoga as safe during pregnancy, and many pregnant women already participate in prenatal yoga classes. There is some preliminary evidence for the efficacy of yoga in treating depression, as well as plausible mechanisms (e.g., promotion of mindfulness and exercise) by which yoga might have an impact on depression. Pregnant women may also appreciate other benefits of yoga, such as decreasing anxiety and improving lower back pain. The overall goals of this treatment development application are: 1) to develop a safe, acceptable, and feasible yoga intervention for antenatal depression and 2) to prepare for an adequately-powered RCT that will enable us to test the efficacy of this intervention in antenatal depression. We will conduct three small clinical trials. First, we will conduct an open trial of prenatal yoga for depression (n = 30), with the primary goal being developing and refining the yoga treatment. We all also conduct a small open trial (n = 10) of supported self- help for depressed pregnant women, with the primary goal being refining this treatment as a stand-alone treatment. Subsequently, we will conduct a pilot randomized clinical trial (n = 30), in which prenatal depressed patients will be randomly assigned to:1) prenatal yoga for depression;2) cognitive therapy;or 3) supported self-help. The primary goal of the pilot RCT will be to refine research procedures and demonstrate feasibility and acceptability of the research design and control treatments. We will then apply for an R01 to conduct an adequately powered RCT with the same research design as the small RCT proposed in this grant.
Depression during pregnancy is a common problem. However, pregnant women often have special concerns about the risks of existing depression treatments (particularly antidepressants) and the majority of depressed pregnant women do not pursue any form of mental health treatment. The purpose of this study is to evaluate yoga as a potential treatment for depression during pregnancy. If shown to be effective, yoga could provide depressed women with an option for treatment that may be more acceptable than existing treatments.