Antidepressants for post-natal depression

Hoffbrand SE, Howard L, Crawley H

Published Online:

January 21, 2009

Postnatal depression is a common disorder, which can have profound short and long term effects on maternal morbidity, the new infant and the family as a whole. It is not known whether antidepressants are an effective and safe choice for treatment of this disorder. This review was therefore undertaken to evaluate the effectiveness of different antidepressants and compare their effectiveness with other forms of treatment. One small randomised controlled trial was identified which looked at the antidepressant fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. It is not possible to draw conclusions from this. More trials are needed to investigate the effectiveness of antidepressants and their place in treatment of postnatal depression, particularly in breastfeeding women.

Abstract (click to read)

Background:

Postnatal depression is a common disorder, which can have profound short and long term effects on maternal morbidity, the new infant and the family as a whole. Social factors appear to be particularly important in the aetiology and prognosis of postnatal depression and treatment is often largely by social support and psychological interventions. It is not known whether antidepressants are an effective and safe choice for treatment of this disorder.

Objectives:

To evaluate the effectiveness of different antidepressant drugs and compare their effectivess with other forms of treatment.
To assess any adverse effects of antidepressants in the mother or the nursing baby.

Search strategy:

The registers of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group were searched. Contact was made with pharmaceutical companies and experts in the field.

Selection criteria:

All trials were considered in which women with depression in the first six months postpartum were randomised to receive antidepressants alone or in combination with another treatment, or to receive any other treatment including placebo.

Data collection and analysis:

Data was extracted independently from the trial reports by the reviewers. Missing information was requested from investigators wherever possible. Data was sought to allow an "intention to treat" analysis.

Main results:

Only one trial, Appleby 1997, could be included in this review, leaving all the objectives of the review unfulfilled. The authors reported that fluoxetine was, after an initial session of counselling, as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression. The clinical interview schedule (CIS-R) geometric mean score at 12 weeks for fluoxetine plus 1 session of counselling was 11.1 (95% confidence interval (C.I) 6.9-17.6) and for placebo plus 6 sessions of counselling was 13.0 (95% C.I 9.2-18.1).

Authors' conclusions:

It is not possible to make any recommendations for antidepressant treatment in postnatal depression from this single small trial. More trials are needed, with larger sample sizes and longer follow-up periods, to compare different antidepressants in the treatment of postnatal depression, to compare antidepressant treatment with psychosocial interventions and to assess adverse effects of antidepressants. Treatment of postnatal depression is an area that has been neglected despite the large public health impact described above.

This record should be cited as:

Hoffbrand SE, Howard L, Crawley H. Antidepressant treatment for post-natal depression. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002018. DOI: 10.1002/14651858.CD002018

Assessed as up to date:

January 12, 2001

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Primary Review Group:

Depression, Anxiety and Neurosis Group

Health topics:

Mental health > Depression > Depressive disorders & major depression

Pregnancy & childbirth > Care after childbirth > Unhappiness after childbirth

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Antidepressants for post-natal depression

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