Antidepressant Prevention of Postnatal Depression (Cochrane Review)_Chinese Journal of Evidence-Based Medicine

Authors：

Howard LM

Institute of Psychiatry,Box PO29, DeCrepigny Park, Denmark Hill ,London UK SE5 8AF;

Corresponding author：

Keywords：

Antidepressant drugs; Postnatal depression; Systematic review; Effectiveness; Safety

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Objectives 　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.
Methods 　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.
Results 　Two trials fullled the inclusion criteria for this review. Both looked at women with a past history of postpartum depression.Nortriptyline (n=26) did not show any benefit over placebo (n=25). Sertraline (n=14) 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.
Conclusions 　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 reect 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.

Citation： Howard LM,Hoffbrand S,Henshaw C,Boath L,Bradley E. Antidepressant Prevention of Postnatal Depression (Cochrane Review). Chinese Journal of Evidence-Based Medicine, 2005, 05(10): 735-742. doi: Copy

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2.	Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
3.	Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
4.	OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
5.	Kumar R,Robson K.A prospective study of emotional disorders in child bearing women[J].British Journal of Psychiatry,1984;144:35-47.
6.	Evans J,Heron J,Francomb H,Oke S,Golding J.Cohort study of depressed mood during pregnancy and after childbirth[J].BMJ,2001;323(7307):257-260.
7.	Rose G.Sick individuals and sick populations[J].International Journal of Epidemiology,1985;14(1):32-39.
8.	Appleby L,Gregoire A,Platz C,Martin P,Kumar R.Screening women for high risk of postnatal depression[J].Journal of Psychosomatic Research,1994;38:539-545.
9.	Austin MP,Lumley J.Antenatal screening for women at risk of post-natal depression[J].Acta Psychiatrica Scandinavica,2002;106:1-8.
10.	Warner R,Appleby L,Whitton A,Faragher B.Demographic and obstetric risk factors for postnatal psychiatric morbidity[J].British Journal of Psychiatry,1996;168:607-611.
11.	Cooper PJ,Murray L,Hooper R,West A.The development and validation of a predictive index for postpartum depression[J].Psychological Medicine,1996;26(3):627-634.
12.	Heath AC,Yonkers KA.Management of Psychiatric Disorders in Pregnancy[M].London:Arnold,2001.
13.	Costei AM,Kozer E,Ho T,Ito S,Koren G.Perinatal outcome following third trimester exposure to paroxetine[J].Archives of Pediatrics and Adolescent Medicine,2002;156(11):1129-1132.
14.	Hendrick V,Stowe ZN,Altshuler L,Hwang S,Lee E,Haynes D.Placental passage of antidepressant medication[J].American Journal of Psychiatry,2003;160(5):993-996.
15.	Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
16.	Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
17.	Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
18.	Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
19.	Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
20.	Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
21.	Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
22.	Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
23.	Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
24.	Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
25.	Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
26.	Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
27.	Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
28.	Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
29.	Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.

1. O’Hara M,Swain AM.Rates and risk of postpartum depression-a meta-analysis[J].International Review of Psychiatry,1996;8(1):37-54.
2. Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
3. Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
4. OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
5. Kumar R,Robson K.A prospective study of emotional disorders in child bearing women[J].British Journal of Psychiatry,1984;144:35-47.
6. Evans J,Heron J,Francomb H,Oke S,Golding J.Cohort study of depressed mood during pregnancy and after childbirth[J].BMJ,2001;323(7307):257-260.
7. Rose G.Sick individuals and sick populations[J].International Journal of Epidemiology,1985;14(1):32-39.
8. Appleby L,Gregoire A,Platz C,Martin P,Kumar R.Screening women for high risk of postnatal depression[J].Journal of Psychosomatic Research,1994;38:539-545.
9. Austin MP,Lumley J.Antenatal screening for women at risk of post-natal depression[J].Acta Psychiatrica Scandinavica,2002;106:1-8.
10. Warner R,Appleby L,Whitton A,Faragher B.Demographic and obstetric risk factors for postnatal psychiatric morbidity[J].British Journal of Psychiatry,1996;168:607-611.
11. Cooper PJ,Murray L,Hooper R,West A.The development and validation of a predictive index for postpartum depression[J].Psychological Medicine,1996;26(3):627-634.
12. Heath AC,Yonkers KA.Management of Psychiatric Disorders in Pregnancy[M].London:Arnold,2001.
13. Costei AM,Kozer E,Ho T,Ito S,Koren G.Perinatal outcome following third trimester exposure to paroxetine[J].Archives of Pediatrics and Adolescent Medicine,2002;156(11):1129-1132.
14. Hendrick V,Stowe ZN,Altshuler L,Hwang S,Lee E,Haynes D.Placental passage of antidepressant medication[J].American Journal of Psychiatry,2003;160(5):993-996.
15. Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
16. Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
17. Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
18. Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
19. Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
20. Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
21. Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
22. Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
23. Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
24. Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
25. Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
26. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
27. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
28. Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
29. Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.

Chinese Journal of Evidence-Based Medicine

Antidepressant Prevention of Postnatal Depression (Cochrane Review)

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