Antidepressant treatment for postnatal depression

Brown, Jennifer Valeska Elli; Wilson, Claire A; Ayre, Karyn; Robertson, Lindsay; South, Emily; Molyneaux, Emma; Trevillion, Kylee; Howard, Louise M.; Khalifeh, Hind

doi:10.1002/14651858.cd013560.pub2

Cited by 45 publications

(39 citation statements)

References 79 publications

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“…Considering the above, it is necessary to tailor interventions according to heterogeneous symptom profiles, to achieve optimum effectiveness. The Postpartum Depression: Action Toward Causes and Treatment (PACT) Consortium also emphasizes this need for development of personalized interventions, especially considering lower remission rates to currently available pharmacological therapies for PND ( 39 ). Cognitive behavioral therapy (CBT) as compared to other high intensity psychotherapies is evidence based and has shown good effectiveness in PND ( 40 ).…”

Section: Discussionmentioning

confidence: 99%

Does One Treatment Fit All? Effectiveness of a Multicomponent Cognitive Behavioral Therapy Program in Data-Driven Subtypes of Perinatal Depression

Ahmed

Rahman

2021

Front. Psychiatry

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Background: Current diagnostic systems of mental disorders are criticized for their poor validity and reliability, owing to the within disorder heterogeneity and between disorder homogeneity. The issue is important if treatments for mental disorders are to be tailored to individual needs. There is little information in this area on perinatal depression (PND), a highly prevalent condition globally.Aims: i) Quantify heterogeneity attributable to the polythetic diagnostic framework for PND and, ii) present evidence for the effectiveness of a multicomponent and low-intensity cognitive behavioral Thinking Healthy Programme (THP) across the heterogeneous presentations of PND.Methods: This investigation presents secondary analyses of a cluster randomized controlled trial, conducted in Kallar Syedan, Pakistan. A total of 903 pregnant women were randomized to an intervention group receiving the THP intervention or control group receiving enhanced usual care. Principal component analyses and clustering algorithm were utilized to identify heterogenous subtypes of PND. Linear mixed effects models were used to assess effectiveness of the intervention across the identified subtypes of PND.Results: Four different clusters of PND were identified: mixed anxiety-depression, somatic depression, mild depression, and atypical depression. All clinical phenotypes responded well to the THP intervention. Compared to their counterparts in the control group, mothers with mild depression in the treatment group yielded lowest risk ratios 0.24 (95% CI: 0.15 to 0.37), followed by mothers with anxiety-depression 0.50 (95% CI: 0.37 to 0.68), atypical depression 0.51 (95% CI: 0.27 to 0.99) and somatic depression 0.59 (95% CI: 0.42 to 0.83).Conclusion: The Thinking Healthy Programme was found to be effective in reducing severity of depressive symptoms and disability across the four subtypes of PND.

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Section: Discussionmentioning

confidence: 99%

Does One Treatment Fit All? Effectiveness of a Multicomponent Cognitive Behavioral Therapy Program in Data-Driven Subtypes of Perinatal Depression

Ahmed

Rahman

2021

Front. Psychiatry

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“…Antidepressant medication is recommended as a treatment option for moderate-severe PNA ( 4 ). Selected Serotonin Reuptake Inhibitors (SSRIs) are the most commonly prescribed medication option ( 50 ), and the SSRI sertraline is generally considered to have the lowest risk profile ( 45 , 51 ) It has been recognized that there is considerably more established evidence for treating depression in the general population than in a perinatal population ( 52 ) and there is less evidence to support the use of SSRIs for PNA compared to PND ( 53 , 54 ) Similarly to guidance around Generalized Anxiety Disorder (GAD) ( 55 ), the use of benzodiazepine medication is not routinely recommended unless experiencing “severe anxiety and/or agitation ( 4 ).”…”

Section: Discussionmentioning

confidence: 99%

The approach to managing perinatal anxiety: A mini-review

et al. 2022

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Perinatal Anxiety (PNA) is defined as anxiety occurring during pregnancy and up to 12 months post-partum and is estimated to affect up to 20% of women. Risk factors for PNA are multiple and can be classed as psychological, social and biological. PNA negatively impacts on the mother, child and family. PNA is not well-recognized and diagnosis of PNA can be challenging for clinicians. There is currently no validated case-finding or diagnostic test available for PNA. PNA has been less extensively researched than perinatal depression (PND). Clinical guidance currently recommends pharmacological and psychological therapies for the management of women with PNA, however the limited research available suggests that other intervention types may also be effective with some evidence on the effectiveness of non-pharmacological interventions in primary care for PNA. This article provides a mini-review of PNA, summarizing current evidence around PNA including risk factors, the impact of PNA, the process of diagnosis of PNA and focussing predominantly on available management options for PNA.

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“…Findings regarding associations between antenatal exposure to SSRIs and delay in motor and language development and increased emotional problems of children raise concerns about neurodevelopmental consequences associated with postnatal SSRI exposure [16][17][18][19]. In addition, although studies have pointed out that SSRIs recommended in the treatment for PND produce undetectable to very low serum levels in the exposed infants [20,21], data on longitudinal neurodevelopmental effects are lacking [14]. Insufficient evidence on safety for children may lead to hesitancy towards pharmacological treatment in affected women, which potentially increases the risks of poorly controlled PND symptoms, a prolonged disease course, and more functional impairment [22].…”

Section: Introductionmentioning

confidence: 99%

“…The effectiveness of antidepressants in the management of PND has been proven by meta-analysis of data from randomized control trials [14]. Selective serotonin reuptake inhibitors (SSRIs) are often the medication of choice to treat PND due to better safety profiles and tolerance compared to other antidepressants such as tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOi) [15].…”

Section: Introductionmentioning

confidence: 99%

“…Selective serotonin reuptake inhibitors (SSRIs) are often the medication of choice to treat PND due to better safety profiles and tolerance compared to other antidepressants such as tricyclic antidepressants (TCA) and monoamine oxidase inhibitors (MAOi) [15]. However, there is insufficient evidence regarding the long-term consequences of postnatal SSRI use for women and their children [14]. Findings regarding associations between antenatal exposure to SSRIs and delay in motor and language development and increased emotional problems of children raise concerns about neurodevelopmental consequences associated with postnatal SSRI exposure [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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Postnatal depression, to treat or not to treat: Long-term consequences of postnatal selective SSRI treatment on mother and child

Liu

Ystrøm

McAdams

2022

Preprint

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Background Although selective serotonin reuptake inhibitors (SSRIs) are a recommended intervention for postnatal depression (PND), a lack of evidence regarding the long-term consequences of postnatal SSRI use have resulted in treatment hesitancy. Methods Longitudinal data on a total of 54576 mother-child dyads enrolled in the Norwegian Mother and Child Cohort Study (MoBa) were examined. We used multilevel models to test associations between PND and maternal outcomes (depression and anxiety, relationship satisfaction) and child outcomes (motor and language development, emotional and behavioral problems) from birth to postpartum year 5. We included an interaction term in models to test whether postnatal SSRI treatment moderated the effects of PND. We used a propensity score to control for pre-/antenatal factors that impacted the probability of receiving SSRIs. Results PND was associated with poor maternal mental health outcomes and problems in child emotional and behavioral development. Use of SSRIs mitigated the associations between PND and later maternal depression and child externalizing behaviors up to postpartum year 5. We found no evidence to indicate that postnatal exposure to SSRIs was associated with increased risk of any negative outcomes in women or their offspring. Conclusions SSRIs bring benefits in the long term by attenuating the detrimental associations between PND and subsequent maternal depression and child externalizing behaviors. Our findings provide valuable information for clinicians and women with PND to consider when making decisions regarding treatment.

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Antidepressant treatment for postnatal depression

Abstract: This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for PND.

Cited by 45 publications

References 79 publications

Does One Treatment Fit All? Effectiveness of a Multicomponent Cognitive Behavioral Therapy Program in Data-Driven Subtypes of Perinatal Depression

Does One Treatment Fit All? Effectiveness of a Multicomponent Cognitive Behavioral Therapy Program in Data-Driven Subtypes of Perinatal Depression

The approach to managing perinatal anxiety: A mini-review

Postnatal depression, to treat or not to treat: Long-term consequences of postnatal selective SSRI treatment on mother and child

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