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Oestrogens and progestins for preventing and treating postpartum depressionDennis C-L, Ross LE, Herxheimer A
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SummaryOestrogens and progestins for preventing and treating postpartum depressionAdditional research needed to evaluate the effect of oestrogens for the prevention and treatment of postpartum depression but synthetic progesterones should not be administered. Postpartum depression is a common complication of childbirth, affecting approximately 13% of women. A hormonal aetiology has long been hypothesised due to the sudden and substantial fluctuations in concentrations of steroid hormones associated with pregnancy and the immediate postpartum period. This review found synthetic progestogens do not prevent the development of postpartum depression and, due to their significant negative effect on maternal mood, their administration in the postpartum period for other clinical indications (e.g., contraception) is questionable. The prophylactic effect of natural progesterone remains unknown. Despite the promising preliminary findings, additional research is also needed before oestrogens can be recommended for the routine treatment of postpartum depression. Its role in the prevention of recurrent postpartum depression has not been rigorously evaluated. Further research is warranted.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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July 26. 1999 AbstractBackgroundPostpartum depression is a common complication of childbirth, affecting approximately 13% of women. A hormonal aetiology has long been hypothesised due to the sudden and substantial fluctuations in concentrations of steroid hormones associated with pregnancy and the immediate postpartum period. There is also convincing evidence that oestrogens, progestins, and related compounds have important central nervous system activity at physiological concentrations. ObjectivesThe primary objective of this review was to assess the effects of oestrogens and progestins, including natural progesterone and synthetic progestogens, compared with placebo or usual antepartum, intrapartum, or postpartum care in the prevention and treatment of postpartum depression. Search strategyWe searched The Cochrane Pregnancy and Childbirth Group trials register (June 2004), the Cochrane Depression Anxiety and Neurosis Group trials register (July 2004), the Cochrane Central Register of Controlled Trials (July 2004), MEDLINE (1966 to 2004), EMBASE (1980 to 2004), and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field. Selection criteriaAll published and unpublished randomised controlled trials comparing an oestrogen and progestin intervention with a placebo or usual antepartum, intrapartum, or postpartum care among pregnant women or new mothers recruited within the first year postpartum. Data collection and analysisTwo review authors participated in the evaluation of methodological quality, data extraction, and data analysis. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Main resultsTwo trials, involving 229 women, met the selection criteria. Norethisterone enanthate, a synthetic progestogen, administered within 48 hours of delivery was associated with a significantly higher risk of developing postpartum depression. Oestrogen therapy was associated with a greater improvement in depression scores than placebo among women with severe depression. Authors' conclusionsSynthetic progestogens should be used with significant caution in the postpartum period. The role of natural progesterone in the prevention and treatment of postpartum depression has yet to be evaluated in a randomised, placebo-controlled trial. Oestrogen therapy may be of modest value for the treatment of severe postpartum depression. Its role in the prevention of recurrent postpartum depression has not been rigorously evaluated. Further research is warranted. |