Pharmacologic Treatment for Postpartum Depression: A Systematic Review

Abstract

During the past decade, the medical community has expressed a growing concern over the high prevalence of postpartum depression and the tragic repercussions of untreated illness. However, many questions persist about the pathogenesis of postpartum depression, the natural course of the illness, and the safety and effectiveness of available treatments. To summarize the data on pharmacologic treatments for postpartum depression, we performed a systematic review of four major databases to identify original research published from 1960-September 2009 that featured pharmacologic treatments for depression detected in women during the 12 months after delivery. Pharmacologic treatments included prescription drugs (antidepressants and hormones), herbal remedies, and dietary supplements. Case reports, studies examining the prevention of postpartum depression, and those including diagnosed episodes of depression preceding the postpartum period (i.e., antepartum onset) were excluded. Treatment randomization or the presence of a control group was not required for inclusion in this review. Fourteen investigations met inclusion criteria. Nine studies examined the effects of prescription antidepressants, two investigated hormones, and three featured omega-3 fatty acid supplementation. Significant heterogeneity was evident in study design and prevented a pooled quantitative analysis of treatment effects. The power of most investigations was limited, and numerous confounding biases were evident. Therapeutic effects were documented for prescription antidepressants and hormone supplementation (estrogen derivatives). Tolerability of the interventions in depressed mothers and breastfed infants was not well described. The effectiveness of omega-3 fatty acids was not evident in postpartum depression trials, although significant limitations in study methodology were apparent. Postpartum depression is a common and serious medical problem, but most cases go undetected and untreated. The need to identify safe, effective, and convenient treatments for postpartum depression is urgent, but the current state of the medical literature describing pharmacologic interventions is not impressive. Preliminary evidence documenting the effectiveness of serotonergic antidepressants and hormone supplementation should serve as an impetus for rigorous controlled investigations in the future.

Trajectories of Depressive Symptoms Over 2 Years Postpartum Among Overweight or Obese Women

“…Women with lower education or poor subjective health status are at the highest risk for a pattern of increasing depressive symptoms during the two years following childbirth; thus, these women should be targets of such screening efforts. Women with PPD may experience symptom reduction from behavioral (Horowitz & Goodman, 2005; Reay, Fisher, Robertson, Adams, & Owen, 2006) or pharmacological treatment (Ng, Hirata, Yeung, Haller, & Finley, 2010). In addition to such clinical interventions, increased social support may benefit women experiencing PPD symptoms (Xie, He, Koszycki, Walker, & Wen, 2009).…”

Group Treatment for Depression in Mothers of Young Children Compared to Standard Individual Therapy

“…Indeed, all antidepressants pass into breast milk, and on principle, all adverse drug reactions of the mother to a particular preparation can also be seen in the breastfed baby [27]. The long-term effects of this have not been studied sufficiently [10,11]. All in all, the safety of the pharmacological treatment of depression in breastfeeding women remains very controversial [28].…”

“…Because all antidepressants are secreted in breast milk and researchers have raised concerns about the effects of antidepressants on infant development [7,8,9,10,11], it is important to evaluate nonpharmacological interventions for breastfeeding mothers suffering from depression.…”

Management of Peripartum Depression: Better, Prevent Than Treat!.

“…Another systematic review also documented that clinical studies in post-partum depression are of high heterogeneity. The 283 study emphasized need for robust larger clinical trials given that serotonergic and hormones hold preliminary promise as pharmacotherapy (Ng et al 2010). With the dearth of well-conducted larger randomized controlled trials, prescribers treating post-partum depression are left with drawing evidences, from trials among general adult population and observational studies.…”