Abstract
Postnatal depression is a common and important complication of childbearing. Untreated depression can lead to potentially negative effects on the foetus and infant, in addition to serious morbidity for the mother. The use of antidepressants during pregnancy for prevention of postnatal depression is unclear, due to the possibility of adverse effects on the mother and developing foetus, and the difficulty of reliably identifying the women who would go on to develop postnatal depression. To evaluate the effectiveness of different antidepressant drugs in addition to standard clinical care in the prevention of postnatal depression. To compare the effectiveness of different antidepressant drugs and with any other form of intervention for postnatal depression i.e. hormonal, psychological or social support. To assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant. The register of clinical trials maintained and updated by the Cochrane Depression, Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group. Randomised studies of antidepressants alone or in combination with another treatment, compared with placebo or a psychosocial intervention in non-depressed pregnant women or women who had given birth in the previous six weeks (i.e. women at risk of postnatal depression) Data were extracted independently from the trial reports by the authors. Missing information was requested from investigators wherever possible. Data were sought to allow an "intention to treat" analysis. Two trials fulfilled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression. Nortriptyline (n=26) (Wisner 2001) did not show any benefit over placebo (n=25). Sertraline (n=14) Wisner 2004 reduced the recurrence of postnatal depression and the time to recurrence when compared with placebo (n=8). Intention to treat analyses were not carried out in either trial. It is not possible to draw any clear conclusions about the effectiveness of antidepressants given immediately postpartum in preventing postnatal depression and, therefore, cannot be recommended for prophylaxis of postnatal depression, due to the lack of clear evidence. Larger trials are needed which also include comparisons of antidepressant drugs with other prophylactic treatments to reflect clinical practice, and examine adverse effects for the foetus and infant, as well as assess womens' attitudes to the use of antidepressants at this time.
Highlights
We sought to discover whether antidepressant drugs are effective in the prevention of postnatal depression, to compare the effectiveness of different antidepressant drugs, with or without any other form of prevention for postnatal depression, i.e. hormonal treatment and psychological or social support, and to assess any adverse effects of antidepressant drugs in either the mother or the foetus/infant
The second trial [8] reported that sertraline was more effective than placebo in preventing a recurrence of postpartum major depression
The second small trial found some evidence that sertraline was effective in preventing postnatal depression, but only 25 women were recruited in total and the data were not subjected to an intentionto-treat analysis
Summary
Postnatal depression (PND) occurs in 10 to 15 percent of mothers [1] and is the commonest complication of childbearing. The morbidity of PND for the mother and its potentially negative associations with neonatal and child development and on other family members are well established [2,3,4]. The antenatal period and early puerperium are opportune times to implement interventions to prevent PND because mothers are in frequent contact with health professionals. It is increasingly recognised that some women who are diagnosed with depression postnatally have been depressed during the antenatal period [5,6], so it is important to detect and treat symptoms of depression antenatally to reduce the incidence of PND. We have recently carried out a Cochrane review of antidepressant prevention of postnatal depression (see Text S1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
