Antidepressant drug treatment for postnatal depression

Abstract

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 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 effectiveness 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. Other databases (outlined below) were also searched and contacts were 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 could be included in this review, leaving most of the objectives of the review unfulfilled. Appleby et al (1997) reported that Fluoxetine was significantly more effective than placebo and, after an initial session of counselling, as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression. There was no interaction between medication and counselling.

Reviewer's conclusions: Women with postnatal depression can be effectively treated with fluoxetine, which is as effective as a course of cognitive-behavioural counselling in the short-term. However, more trials with a longer follow-up period are needed to compare different antidepressants in the treatment of postnatal depression, and to compare antidepressant treatment with psychosocial interventions. This is an area that has been neglected despite the large public health impact described above.