JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i2.2622 jpsim.v7i2.2622 Original Research The Efficacy of Behavioral Activation Therapy (BAT) and Pharmacologic Intervention in Postpartum Depression: A PHQ-9 Trajectory Analysis Using Protocol-Defined Remission Criteria Zainab Ghulam ghulamzainab46481@import.invalid * Sundas Khudija Nargis Syyeda Eatsham Muhammad Umar Khalid Anum Rajput Nauman Rafi Quid-E-Azam Medical College, Bahawalpur, Pakistan Bahawal Victoria Hospital, Bahawalpur, Pakistan University of the Punjab, Lahore, Pakistan Sahara Medical College, Narowal, Pakistan *Correspondence: Ghulam Zainab (ghulamzainab46481@import.invalid) 03 06 2026 2026 7 2 109 115 09 04 2025 12 04 2026 04 05 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives

To compare and assess the efficacy of pharmacologic treatment and Behavioral Activation Therapy PPD in females diagnosed with postpartum depression.

 Methodology

In this prospective observational study, newly diagnosed females obtained either pharmacological therapy or BAT. PHQ-9 baseline and follow-up scores were used to measure the results. Demographic and clinical history and outcome of treatment were gathered. There was a comparison of descriptive statistics, paired t-tests and between-group comparisons.

 Results

The pharmacological group reported an average decrease of PHQ-9 of 11.2 ± 2.89 to 5.8 ± 2.64 and BAT group reported an average decrease of 10.8 ± 2.65 to 5.29 ± 1.99 at six weeks. The remission, response and partial remission was requested in BAT group, as well as in the two groups. Trends were represented as bar, line and scatter plots.

 Conclusion

Both interventions significantly improved depressive symptoms, with BAT showing a marginally higher remission rate and lower standard deviation. The findings support the inclusion of BAT as a viable first-line non-pharmacologic intervention for PPD, particularly in resource-limited settings or when pharmacotherapy is declined.

 Keywords Postpartum depression Pharmacologic treatment Behavioral Activation Therapy PHQ-9 Mental health Comparative effectiveness Ethics Statement

Ethics committee: Ethics Committee, Quaid-e-Azam Medical College, Bahawalpur, Pakistan. Approval number: 311/DME/QAMC Bahawalpur, dated August 12, 2025.

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