Intervention Review

Antidepressant prevention of postnatal depression

  1. Louise Howard1,*,
  2. Sara E Hoffbrand2,
  3. Carol Henshaw3,
  4. Liz Boath4,
  5. Eleanor Bradley4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 20 APR 2005

Assessed as up-to-date: 10 JUN 2007

DOI: 10.1002/14651858.CD004363.pub2


How to Cite

Howard L, Hoffbrand SE, Henshaw C, Boath L, Bradley E. Antidepressant prevention of postnatal depression. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004363. DOI: 10.1002/14651858.CD004363.pub2.

Author Information

  1. 1

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

  2. 2

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

  3. 3

    Keele University, School of Medicine, Newcatle-under-Lyme, UK

  4. 4

    Staffordshire University, Centre for Health Policy and Practice, Stafford, UK

*Louise Howard, Institute of Psychiatry, King's College London, Box PO 29, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. spjelmh@iop.kcl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 APR 2005

SEARCH

 

Abstract

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

Background

Postnatal depression is a common and important complication of childbearing. Untreated depression can lead to potentially negative effects on the foetus and infant, in addition to serious morbidity for the mother. The use of antidepressants during pregnancy for prevention of postnatal depression is unclear, due to the possibility of adverse effects on the mother and developing foetus, and the difficulty of reliably identifying the women who would go on to develop postnatal depression.

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.

Search methods

CCDANCTR-Studies and CCDANCTR-References were searched on 11-6-2007.

Selection criteria

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 collection and analysis

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.

Main results

Two trials involving a total of 73 participants fulfilled 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.

Authors' 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 reflect clinical practice, and examine adverse effects for the foetus and infant, as well as assess women's attitudes to the use of antidepressants at this time.

 

Plain language summary

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

Antidepressant prevention of postnatal depression

Postnatal depression is a common and important disorder with negative implications for the mother, the infant and the wider family. Women who are not depressed, but at high risk of postnatal depression, such as those with a previous history of a postpartum mood disorder, may wish to consider antidepressant prevention during pregnancy or early postpartum. This review addresses the effectiveness of such treatment. Only two small trials met the criteria for inclusion. Both trials used medication immediately postpartum. The drugs were nortriptyline, a tricylic antidepressant (TCA) and sertraline, a selective serotonin reuptake inhibitor (SSRI). Both drugs were compared only to placebo. Nortripyline was not shown to have any benefit over placebo; there was some evidence that sertraline was effective both in reducing the incidence of recurrent postpartum depression and in increasing the time to recurrence. However, both trials involved only very small numbers of women and did not use intention to treat analyses. There is, therefore, no clear evidence for the use of these antidepressants in the prevention of postnatal depression.

 

摘要

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

背景

抗憂鬱藥物預防產後憂鬱症

產後憂鬱症是分娩常見且重要的併發症.憂鬱症沒有治療,不僅對母親本身也會對胎兒和嬰兒產生不良影響.婦女在懷孕期間要不要使用抗鬱劑來預防產後憂鬱症還不清楚,主要原因在於懷孕期間使用藥物可能對母親及發育中的胎兒會產生副作用,另外,我們也很難去預測母親未來是否會出現產後憂鬱症。

目標

評估不同抗鬱劑,對於預防產後憂鬱的療效。比較不同抗鬱劑以及其它方式(如荷爾蒙、心理或社會支持)對於產後憂鬱症的療效。評估抗鬱劑對母親或胎兒/嬰兒的任何副作用。

搜尋策略

2007年11月6日搜尋CCDANCTRStudies以及CCDANCTRReferences

選擇標準

隨機試驗,對象是無憂鬱症孕婦或生產後6週內的產婦(也就是處於產後憂鬱症風險的婦女)比較抗鬱劑(單獨或合併其他治療方式)安慰劑或心理社會處遇的療效。

資料收集與分析

本回顧的作者們獨立由試驗報告中擷取資料,可能的話則向研究者詢問報告中遺漏的資料,資料的取得,以能進行"intention to treat"analysis 為原則。

主要結論

2個試驗共73位受試者符合納入標準.此兩個試驗的受試者都有產後憂鬱症病史. Nortriptyline(n = 26)沒有比安慰劑(n = 25)好. Sertraline (n = 14)與安慰劑(n = 8)相比,減低產後憂鬱症的再發以及再發的時間。兩試驗都沒有進行Intentiontotreat analyses

作者結論

對於產後馬上給予抗鬱劑來預防產後憂鬱症的療效還沒有辦法下結論。因此,在缺乏明確證據的情況下,並不建議對產後憂鬱症作預防性的治療。我們需要更大型的研究來比較抗鬱劑與其它預防性治療的效果,以反應臨床所需,同時也應檢視對胎兒及嬰兒可能造成的副作用以及母親對於使用抗鬱劑的態度。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

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

總結

抗鬱劑預防產後憂鬱症:產後憂鬱症是懷孕常見的重要疾病,對母親,嬰兒和家人產生負面影響.目前沒有憂鬱症但屬於產後憂鬱症高危險群的婦女(有產後憂鬱症病史者)可能會想在懷孕時或生產完後使用抗憂鬱藥物來預防.本回顧著眼於療效的評估。只有兩個試驗符合納入標準.兩者都在產後馬上給藥.使用藥物為nortriptyline(一種三環類抗抗憂鬱藥)和sertraline(SSRI).兩種藥都拿來與安慰劑相比,Nortriptyline沒有比安慰劑好,有一些證據顯示Sertraline可以減低產後憂鬱再發率和延緩再發.但兩試驗樣本都很小,以致於無法作intention to treat analyses 因此,關於使用抗鬱劑來預防產後憂鬱症還缺乏明確的證據。