Postnatal depression affects many women in the months after having their baby and one of the early Cochrane Reviews looked at its treatment with antidepressants. The very first version of the review was published in 2001, and the review has been refreshed and updated again, with a new version published in February 2021. Here’s one of the authors, Claire Wilson from King’s College London in the UK, to tell us more.
Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Postnatal depression affects many women in the months after having their baby and one of the early Cochrane Reviews looked at its treatment with antidepressants. The very first version of the review was published in 2001, and the review has been refreshed and updated again, with a new version published in February 2021. Here's one of the authors, Claire Wilson from King's College London in the UK, to tell us more.
Claire: Postnatal depression starts within a year of a woman giving birth and can have serious short- and long-term effects on the mother, her child and wider family. There are several ways to treat it, including antidepressant medication and psychological therapy, with a range of factors influencing treatment decisions. These factors include the severity of the depression and effects on the breastfeeding infant, and, so, to help inform these decisions, our review set out to assess the effectiveness and safety of antidepressants for postnatal depression compared to a range of other treatment options.
We searched for randomised trials because these are the most reliable study for comparing the effects of treatments and were able to include 11 studies involving just over 1000 women. The studies compared antidepressants with placebo, or treatment as usual, which may have been watch and wait or regular visits with a healthcare professional, psychological therapy, psychosocial interventions such as peer support or counselling, other drugs or types of antidepressant or complementary medicines such as nutritional supplements. The length of treatment in the studies ranged from four to 24 weeks and the most commonly studied antidepressants were serotonin specific reuptake inhibitors, called SSRIs for short.
We focused on how well the treatments worked by comparing the number of women who responded well to treatment, known as response, or who no longer met criteria for depression at the end of treatment, known as remission. We also looked at whether women or their babies experienced adverse effects.
The main finding is that women treated with antidepressants may respond slightly better and have less severe postnatal depression than women given a placebo, with similar numbers of unwanted effects in both groups. Unfortunately, though, there were not enough studies comparing antidepressants with other types of treatment for us to know whether these drugs actually perform better or worse than other options.
In summary, we found only a few relevant studies and, although these provide some evidence that antidepressants may work better than a dummy pill for women with postnatal depression, the certainty of the evidence and our confidence in it is low. However, it is reassuring that our finding that antidepressants may work better than a placebo is similar to those from a larger number of studies in the general population. This means that clinicians need to consider study evidence from that general population and current clinical guidelines, along with the woman's illness history and current symptoms, when making an individualised treatment decision with her.
Monaz: Details of the postnatal depression studies and more information on the findings and conclusions of the review are available in its full version. This is available at Cochrane Library dot com, where it will show up in a list of reviews if you search for 'antidepressant treatment for postnatal depression'.