Antidepressant prevention of postnatal depression

Postnatal depression is a common and important disorder with negative implications for the mother, the infant and the wider family. Women who are not depressed, but at high risk of postnatal depression, such as those with a previous history of a postpartum mood disorder, may wish to consider antidepressant prevention during pregnancy or early postpartum. This review addresses the effectiveness of such treatment. Only two small trials met the criteria for inclusion. Both trials used medication immediately postpartum. The drugs were nortriptyline, a tricylic antidepressant (TCA) and sertraline, a selective serotonin reuptake inhibitor (SSRI). Both drugs were compared only to placebo. Nortripyline was not shown to have any benefit over placebo; there was some evidence that sertraline was effective both in reducing the incidence of recurrent postpartum depression and in increasing the time to recurrence. However, both trials involved only very small numbers of women and did not use intention to treat analyses. There is, therefore, no clear evidence for the use of these antidepressants in the prevention of postnatal depression.