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Antidepressants for preventing postnatal depression.

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Antidepressants show uncertain effectiveness for preventing postnatal depression, with limited evidence from small studies. More research is needed to determine their benefits and risks for mothers and infants.

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Area of Science:

  • Perinatal mental health
  • Psychopharmacology
  • Evidence-based medicine

Background:

  • Postnatal depression affects mothers, infants, and families.
  • Effectiveness and safety of antidepressants for prevention are unclear, especially during breastfeeding.
  • This is an update of a 2005 Cochrane Review.

Purpose of the Study:

  • To assess antidepressant effectiveness for preventing postnatal depression.
  • Comparison against other treatments, placebo, or standard care.

Main Methods:

  • Searched multiple databases (CCMDCTR, CENTRAL, MEDLINE, Embase, PsycINFO, WHO ICTRP, ClinicalTrials.gov) up to February 2018.
  • Included randomized controlled trials (RCTs) for prevention in women within six weeks postpartum.
  • Used standard Cochrane methodological procedures.

Main Results:

  • Two RCTs with 81 participants met criteria; both had a history of postnatal depression.
  • Nortriptyline showed no significant preventive effect versus placebo; one case of mania and constipation reported.
  • Sertraline's effect is uncertain; one case of hypomania and side effects like dizziness and drowsiness noted.
  • Evidence quality is very low due to small sample sizes and potential bias.

Conclusions:

  • Current evidence is insufficient to conclude on antidepressant effectiveness for preventing postnatal depression.
  • Lack of new trials since 2005 highlights the need for larger studies.
  • Future research should compare antidepressants with psychological interventions and assess fetal/infant safety.