Antidepressant treatment for postnatal depression

Selective serotonin reuptake inhibitors (SSRIs) may be effective for postnatal depression compared to placebo.

Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear risk of incomplete outcome data and selective reporting) and by imprecise results (few patients and outcome events).

Comment: The recommendation attaches a relatively high value on mother and baby wellbeing.

Summary

A Cochrane review included 6 studies with a total of 596 subjects. Four studies compared selective serotonin reuptake inhibitors (SSRIs) with placebo (2 using sertraline, 1 paroxetine and 1 fluoxetine; 233 participants in total). In two of these studies both groups also received psychological therapy. Pooled risk ratios showed that women randomised to SSRIs had higher rates of response and remission than those randomised to placebo; the fourth study did not report data on response or remission. One study (n=254) compared antidepressant treatment with treatment as usual (for the first 4 weeks) followed by listening visits. The study found significantly higher rates of improvement in the antidepressant group than treatment-as-usual group after the first 4 weeks, but no difference between antidepressants and listening visits at the later follow-up. In addition, one study comparing sertraline with nortriptyline found no difference in effectiveness (n=109). Side effects were experienced by a substantial proportion of women, but there was no evidence of a meaningful difference in the number of adverse effects between treatment arms in any study. There were very limited data on adverse effects experienced by breastfed infants, with no long-term follow-up.

Clinical comments

Date of latest search: 11 July 2014

Ədəbiyyat

1. Molyneaux E, Howard LM, McGeown HR et al. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2014;(9):CD002018.