Antidepressant treatment for post-natal depression
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 23 APR 2001
Assessed as up-to-date: 11 JAN 2001
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Hoffbrand SE, Howard L, Crawley H. Antidepressant treatment for post-natal depression. Cochrane Database of Systematic Reviews 2001, Issue 2. Art. No.: CD002018. DOI: 10.1002/14651858.CD002018.
- Publication Status: Edited (no change to conclusions)
- Published Online: 23 APR 2001
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 by social support and psychological interventions. It is not known whether antidepressants are an effective and safe choice for treatment of this disorder.
To evaluate the effectiveness of different antidepressant drugs and compare their effectivess with other forms of treatment.
To assess any adverse effects of antidepressants in the mother or the nursing baby.
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. Contact was made with pharmaceutical companies and experts in the field.
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.
Only one trial, Appleby 1997, could be included in this review, leaving all the objectives of the review unfulfilled. The authors reported that fluoxetine was, after an initial session of counselling, as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression. The clinical interview schedule (CIS-R) geometric mean score at 12 weeks for fluoxetine plus 1 session of counselling was 11.1 (95% confidence interval (C.I) 6.9-17.6) and for placebo plus 6 sessions of counselling was 13.0 (95% C.I 9.2-18.1).
It is not possible to make any recommendations for antidepressant treatment in postnatal depression from this single small trial. More trials are needed, with larger sample sizes and longer follow-up periods, to compare different antidepressants in the treatment of postnatal depression, to compare antidepressant treatment with psychosocial interventions and to assess adverse effects of antidepressants. Treatment of postnatal depression is an area that has been neglected despite the large public health impact described above.
Plain language summary
Antidepressants for post-natal depression
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. It is not known whether antidepressants are an effective and safe choice for treatment of this disorder. This review was therefore undertaken to evaluate the effectiveness of different antidepressants and compare their effectiveness with other forms of treatment. One small randomised controlled trial was identified which looked at the antidepressant fluoxetine and cognitive-behavioural counselling in the treatment of postnatal depression. It is not possible to draw conclusions from this. More trials are needed to investigate the effectiveness of antidepressants and their place in treatment of postnatal depression, particularly in breastfeeding women.
資料由文獻回顧者獨立從試驗報告中擷取.遺漏的資料如果可能的話從研究者那裡取得.收集資料以進行意圖治療(intention to treat)
只有一個試驗可被納入此文獻回顧,其他皆不符合文獻回顧主題.此試驗的作者報告第一次諮商後,接受fluoxetine,在整個產後憂鬱症的治療病程中與認知行為治療一樣有效.12週的fluoxetine治療加上一次的諮商,其clinical interview schedule(CISR)平均分數是11.1(95% confidence interval (C.I) 6.9 – 17.6).安慰劑加上六次的諮商分數是13.0(95% C.I 9.2 – 18.1).
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。