Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear risk of incomplete outcome data and selective reporting) and by imprecise results (few patients and outcome events).
Selective serotonin reuptake inhibitors in addition to psychotherapy are recommended for the treatment of moderate or severe postnatal depression.
Comment: The recommendation attaches a relatively high value on mother and baby wellbeing.
A Cochrane review [Abstract] 1 included 11 studies with a total of 1016 subjects. Selective serotonin reuptake inhibitors (SSRIs) showed benefit over placebo in response (55% vs 43%; pooled risk ratio (RR) 1.27, 95% CI 0.97 to 1.66); remission (42% vs 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) −0.30, 95% CI −0.55 to −0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up.Side effects were experienced by a substantial proportion of women, but there was no evidence of a meaningful difference in the number of adverse effects between treatment arms in any study.
Date of latest search: 24 May 2021
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