Postpartum depression is a common disorder that can have adverse short- and long-term maternal, newborn and family as a whole. Antidepressants are often used as the first treatment option for adults with moderate to severe depression, but there is little evidence of whether antidepressants are an effective and safe for the treatment of this disorder postnatally choice. This review was conducted to evaluate the effectiveness of different antidepressants and to compare its effectiveness with other forms of treatment (eg psychosocial interventions such as peer support, psychological interventions such as cognitive behavioral therapy), placebo or usual treatment.
Who will be interested in this review?
Parents, professionals primary care services working with patients of childbearing age, general practitioners, professionals in the mental health of adults working with patients of childbearing age and professionals perinatal mental health services.
What questions intends to answer this review?
This review is an update of a previous Cochrane review of 2001 found insufficient evidence to draw conclusions about treatment with antidepressants in postpartum depression. Therefore, this update aims to answer the following question:
What are the effects of antidepressants compared with any other treatment, placebo or standard treatment for postpartum depression?
What studies included in the review?
We searched registers of clinical trials were made; Cochrane Depression, Anxiety and Neurosis (Cochrane Depression, Anxiety and Neurosis Group); and databases of the Cochrane Pregnancy and Childbirth (Cochrane Pregnancy and Childbirth Group) to find all high quality studies comparing antidepressants with another form of treatment, since the upper limit of the date of previous searches more recent until July 2014. We contacted pharmaceutical companies and experts in the field was established.
For inclusion in the review, studies had to be randomized controlled trials (trials in which patients were randomly assigned to one of two or more treatment groups) and had to include patients with postpartum depression (onset of depression trials to six months after delivery) not to take any antidepressant medication at the beginning of the trial.
In the review Six trials involving 596 patients were included. Although many of the studies were conducted and reported, there are some areas with significant risk of bias; for example, due to incomplete follow-up (eg in a study over 50% of participants dropped out before the primary outcome measure).
What the evidence of the review say?
The quality of the evidence in this review was assessed very poor quality due to the small number of studies, the risk of bias in included studies (particularly high proportions of participants who dropped out) and the fact that many studies excluded patients with chronic depression (ie long-term) or severe or both. It was possible to combine data from three studies comparing one type of antidepressants called selective frequently used reuptake inhibitors (SSRIs) with placebo. The results showed that patients with postpartum depression who were given SSRIs were more likely to improve or recover than those who received placebo. It was not possible to combine data from studies comparing antidepressants with other treatments or usual treatment due to the very small number of studies identified for these comparisons. There was insufficient evidence to conclude whether, and for whom treatment with antidepressants and psychosocial / psychological are more effective, or if certain antidepressants are more effective or better tolerated (or both) than others. The findings also were limited by the lack of data on long-term monitoring, safety during lactation or results in children.
What should happen next?
It is a need for larger studies and treatment decisions for patients with postpartum depression should use evidence from other sources such as general adult population trials and observational studies of the safety of antidepressants in the postnatal period. Reviewers recommend that future studies in this area include patients with severe postpartum depression, long-term monitoring of psychiatric symptoms and quality of life of mothers who have been treated for postpartum depression. In addition, more evidence on outcomes for neonates, particularly with regard to safety during lactation and the effect of treatment for postpartum depression on the mother's relationship with the infant needed.
Post partum depression treatment
4/
5
Oleh
Unknown
1 komentar:
[…] finds more difficulty than adults when communicate and express their feelings. For this reason, in preschool depression it is manifested by irritability, fatigue, headaches and low overall tone. The child cries […]
Reply