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Antidepressant treatment for postnatal depression.

Emma Molyneaux1, Louise M Howard, Helen R McGeown

  • 1Health Service and Population Research Department, The Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO31 De Crespigny Park, London, UK, SE5 8AF.

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Selective serotonin reuptake inhibitors (SSRIs) show higher response and remission rates than placebo for postnatal depression. However, evidence quality is very low due to small sample sizes and risk of bias.

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Area of Science:

  • Perinatal mental health
  • Pharmacological interventions
  • Evidence-based medicine

Background:

  • Postnatal depression impacts maternal, infant, and family well-being.
  • Current treatments primarily involve social support and psychological interventions.
  • The efficacy and safety of antidepressants for postnatal depression remain unclear.

Purpose of the Study:

  • To assess antidepressant effectiveness versus other treatments, placebo, or usual care for postnatal depression.
  • To update previous reviews on this topic.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) up to July 2014.
  • Included RCTs comparing antidepressants with other treatments, placebo, or usual care.
  • Data extraction and meta-analysis of comparable studies.

Main Results:

  • Six trials with 596 participants were included.
  • Selective serotonin reuptake inhibitors (SSRIs) showed higher response/remission rates than placebo (RR 1.43-1.79), but evidence quality was very low.
  • No significant differences in side effects were found, but data on infant effects were limited.

Conclusions:

  • Evidence for antidepressant effectiveness in postnatal depression is limited by small sample sizes and high risk of bias.
  • Insufficient evidence exists to compare antidepressants with psychological treatments or to determine optimal antidepressant choice.
  • More large-scale RCTs are needed, focusing on infant outcomes and breastfeeding safety.