for the main comparison.
| Selective serotonin reuptake inhibitors (SSRIs) compared with placebo for postnatal depression | ||||||
|
Patient or population: women with postnatal depression Intervention: selective serotonin reuptake inhibitors (SSRIs) Comparison: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Placebo | SSRIs | |||||
|
Response rate at post‐treatment (as defined in individual studies) |
365 per 10001 |
522 per 1000 (369 to 741) |
RR 1.43 (1.01 to 2.03) | 146 (3 studies) | ⊕⊝⊝⊝ very low2, 3,4 | Yonkers 2008: response: CGI‐II ≤ 2 (at 8 weeks) Hantsoo 2013: response: < 10 HAM‐D + at least 50% decrease in HAM‐D score from baseline + CGI ≤ 2 (after 6 weeks of treatment) Bloch 2012: response: > 50% reduction in MADRS or EPDS score during treatment (at 8 weeks) |
|
Remission rate at post‐treatment (as defined in individual studies) |
257 per 10001 |
460 per 1000 (278 to 766) |
RR 1.79 (1.08 to 2.98) | 146 (3 studies) | ⊕⊝⊝⊝ very low2, 3,4 | Yonkers 2008: remission: HAM‐D ≤ 8 (at 8 weeks) Hantsoo 2013: remission: as Hantsoo response above + HAM‐D < 7 Bloch 2012: remission: final score < 10 on the MADRS scale or < 7 on the EPDS (at 8 weeks) |
| *The basis for the assumed risk is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk Ratio; CGI: Clinical Global Improvement; EPDS: Edinburgh Postnatal Depression Scale; HAM‐D: Hamilton Rating Scale for Depression; MADRS: Montgomery‐Åsberg Depression Rating Scale | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1assumed risk calculated as the proportion of women on placebo with the outcome (response or remission) in the three included studies, multiplied by 1000.
2 downgraded due to indirectness (in one of the studies included in the meta‐analysis participants in both arms additionally received brief dynamic psychotherapy).
3downgraded due to risk of bias (incomplete outcome data owing to loss to follow‐up)
4 downgraded due to high imprecision (wide confidence intervals owing to the small number and small samples of included studies)