Online mindfulness course lowered depression relapse in 500 pregnant women, 33% against 44%

A woman who has been through depression more than once, and is now well on an antidepressant, faces a hard choice when she becomes pregnant. She can keep taking the medicine, or stop and risk the illness coming back. A large US trial suggests a third route can lower that risk: a self-guided mindfulness course, taken online alongside whatever care she already has.

Researchers from the University of Colorado Boulder and Massachusetts General Hospital enrolled 500 pregnant women with recurrent depression from across the country. Sona Dimidjian led the work, with Lee Cohen as senior author. Half the women were offered a 12-week web program called Mindful Mood Balance for Moms on top of their usual care. By six months after the birth, 33% of them had relapsed into depression, against 44% of the women who had usual care alone. The trial, reported on October 20 in The Lancet Public Health, found that the program also eased day-to-day symptoms while it ran, though not over the whole period.

Why depression relapse in pregnancy is hard to prevent

Depression around pregnancy is common. The US Preventive Services Task Force describes perinatal depression, a depressive disorder during pregnancy or after childbirth, as affecting as many as 1 in 7 women. A recent systematic review puts the figure at nearly 12% of women worldwide. The harm reaches past the mother, too, since the task force warns of adverse short- and long-term effects on the child as well as the woman. Diagnoses also seem to be climbing. The trial team’s study page cites a 2024 study in which postpartum depression diagnosis rates increased from 9.4% in 2010 to 19.0% in 2021, a doubling.

Women who have had depression before carry the highest risk, and many of them are on antidepressants when they conceive. That is where the dilemma bites. In a study led by Cohen two decades ago, pregnant women who had been well on antidepressants were followed through pregnancy. Among the 82 women who maintained their medication throughout, 21 (26%) relapsed, against 44 (68%) of the 65 who stopped it around the time of conception.

Stopping is nonetheless a common wish. According to the trial team’s study page, the majority of pregnant women report a preference to avoid antidepressant use while pregnant, and alternatives with good evidence are scarce. A 2025 review of relapse-prevention options for women with a history of depression found only 10 relevant studies, testing antidepressants taken as a precaution, progesterone, dietary supplements and talking therapies. It judged the drug and supplement studies small and open to bias, and found that newer, higher quality evidence exists for the role of mindfulness and cognitive behavioral therapy in keeping depression away.

What the online mindfulness course for moms involves

Mindfulness-based cognitive therapy, often shortened to MBCT, combines the skills and practices of mindfulness meditation and cognitive-behavioral therapy in a structured course. Its aim is to help people who have been depressed notice the early pull of low mood and respond to it differently, before it hardens into a new episode.

In people with recurrent depression it has a solid track record. An analysis that pooled individual data from nine trials and 1,258 patients found that those who received MBCT had a reduced risk of depressive relapse over about 14 months. Their risk was roughly 30% lower than in people who did not get it, and somewhat lower than with other active treatments, including antidepressants. The pooled data also hinted that more severe symptoms before treatment were associated with a larger effect of MBCT, which may matter for women with more severe symptoms.

Dimidjian’s group then adapted the approach for pregnancy, because, as they wrote at the time, pregnant women with depression histories report a preference for nonpharmacological care, but few evidence-based options exist. In a pilot at two obstetric clinics, 86 such women were randomly assigned to an in-person course or usual care. Those in the course had significantly lower rates of depressive relapse through six months after birth. Their rates of completing sessions and home practice were judged acceptable, and they rated the course more highly than usual care, an early sign that pregnant women would use it.

Group classes with a trained teacher are hard to offer widely, so the next step was software. Zindel Segal, Dimidjian and colleagues built Mindful Mood Balance, an online version for adults with lingering symptoms, delivered in eight sessions over three months with minimal phone or email coaching. In a trial of 460 patients at Kaiser Permanente Colorado, it brought greater reductions in residual depressive symptoms than usual care alone, along with fewer relapses and more people whose depression fully lifted. The pregnancy trial asked whether that software approach would hold up for women facing the particular pressures of pregnancy and a new baby.

Mindful Mood Balance for Moms joins the two lines of work. It is a web-based mindfulness-based cognitive therapy course adapted for pregnancy and the months after birth, taken over 12 weeks without a therapist. The study team says the program is available through the Crown Institute at the University of Colorado Boulder.

How many women relapsed with and without the program

Every woman in the trial had a history of recurrent major depression prior to pregnancy, with at least two past episodes. None was depressed when she joined. All were taking an antidepressant or had taken one within three months of their last period. On average they were 32 years old and about 11 weeks pregnant. They were recruited between March 2019 and July 2020, all through BabyCenter, an online resource community for pregnant moms, and assessed with structured diagnostic interviews until six months after giving birth.

By that point, 81 of the 249 women offered the program (33%) had relapsed, against 44% of the 251 participants in usual care, or 111 women. Put another way, there were about 11 fewer new episodes of depression for every 100 women. Over the whole period the program group’s rate of relapse was about a quarter lower, and the difference held after the researchers allowed for testing more than one main outcome.

Symptoms told a more mixed story. During the 12 weeks of the course, scores on a standard depression questionnaire fell more in the program group than with usual care. Over the full trial, through pregnancy and the first six months after birth, the two groups’ scores ended up close together. That pattern suggests the effect on everyday mood was strongest while the women were actively working through the course.

The authors conclude that the program “resulted in lower risk of relapse compared with usual care”. In their view it could offer “an effective non-pharmacological support option for depression relapse prevention during the perinatal period.”

Limits of the online mindfulness trial

The relapse result cleared the bar for chance, but only just. Its plausible range runs from a sizable drop down to almost no difference, so a smaller benefit, or a larger one, would also fit the data. About one in five women did not complete the later assessments. Only 389 of the 500 (78%) provided data at six months after birth, and missing data can tilt a result either way.

The women knew whether they had been given the program, since they used it themselves, and that knowledge could shape how they described their mood. Everyone kept their usual care, so the trial tested the course as an addition, not as a replacement for medicine or for therapy with a clinician. The women were English-speaking, recruited through a pregnancy website and on or recently off antidepressants. Every participant also needed the presence of an ongoing community provider, so all had someone already overseeing their care. The result may not carry over to women who have never taken medication, or to those who are depressed when they become pregnant.

One question is still open. The trial’s registered plan also set out to explore the specific benefit of MBCT relative to antidepressant discontinuation, that is, whether the course matters most for women who stop their medicine. The main results do not answer that question.

What the result means for pregnant women with a history of depression

The finding fits current guidance more than it changes it. The US Preventive Services Task Force already recommends that women at increased risk, including those with a history of depression, be offered or referred to counseling interventions, such as cognitive behavioral therapy and interpersonal therapy, during pregnancy and after birth. This trial adds a self-guided online form of a related therapy, tested at scale, to the options with randomized evidence behind them.

For women on antidepressants in pregnancy, the program was tested on top of their care, not in place of it. Do not stop or change a prescribed medicine without talking to your doctor. Whether a particular woman needs extra support during pregnancy is assessed with her doctor or midwife.

In this trial an online course meant about 11 fewer relapses for every 100 women, a modest and narrowly measured gain that gives women and their clinicians one more tested option.