Intervention Review

Antidepressant treatment for post-natal depression

  1. Sara E Hoffbrand1,*,
  2. Louise Howard2,
  3. Helen Crawley3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 23 APR 2001

Assessed as up-to-date: 11 JAN 2001

DOI: 10.1002/14651858.CD002018

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.

Author Information

  1. 1

    University College London, Department of Primary Care & Poulation Sciences,Royal Free & University College Medical School, London, UK

  2. 2

    King's College London, Institute of Psychiatry, London, UK

  3. 3

    Twyford Surgery, London, UK

*Sara E Hoffbrand, Department of Primary Care & Poulation Sciences,Royal Free & University College Medical School, University College London, The Holborn Union Building, 2nd Floor, Archway Campus, 2nd Floor, Archway Campus, Highgate Hill, London, N19 3UA, UK. s.hoffbrand@ucl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 APR 2001

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

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.

Objectives

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.

Search methods

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.

Selection criteria

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.

Main results

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).

Authors' conclusions

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

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以抗憂鬱劑治療產後憂鬱症

產後憂鬱症是一常見疾病,對母親的發病,新生兒和家庭整體產生深遠的短期及長期影響. 在致病因和預後方面,社會因子似乎特別重要,而且治療通常需要藉由社會支持及心理介入.抗憂鬱劑是否為一有效且安全的治療方式尚不清楚.

目標

評估不同種類的抗憂鬱劑的有效性,也比較抗憂鬱劑和其他治療方式的有效性.評估母親或是接受照顧的嬰孩的抗憂鬱劑副作用

搜尋策略

臨床試驗的登錄是以考科藍憂鬱焦慮和精神官能症團體來維持與更新,並搜尋考科藍懷孕與生育團體.也與藥廠及這個領域的專家接觸.

選擇標準

所有的試驗只要是在產後前六個月罹患憂鬱症,接受單獨抗憂鬱劑治療或是結合其他治療,或是接受其他包括安慰劑的治療方式皆納入.

資料收集與分析

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)

主要結論

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(CISR)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).

作者結論

從這個單一的小型研究不可能推薦用抗憂鬱劑治療產後憂鬱症.需要更多的試驗,更大的樣本數,更長的追蹤時間,以比較不同種類的抗憂鬱劑,比較抗憂鬱劑與心理社會介入,評估抗憂鬱劑的副作用.儘管如上述所提及這是一個大型公共衛生議題,但產後憂鬱症的治療一直以來還是屬於被忽略的一個領域.

翻譯人

本摘要由彰化基督教醫院李冠瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

產後憂鬱症是一常見的疾病,會對母親的發病,新生兒和家庭整體產生深遠的短期及長期影響.抗憂鬱劑是否為一有效且安全的治療方式尚不清楚.此篇文獻回顧因而進行以評估不同總類的抗憂鬱劑的效用,也比較抗憂鬱劑和其他治療方式的效用.找到一小型隨機對照試驗,它是比較fluoxetine和認知行為諮商治療產後憂鬱症的差別.不太可能從此試驗做出結論.需要更多的試驗去評估抗憂鬱劑的效用和治療產後憂鬱症的角色,尤其是有哺乳的婦女.