TABLE 1:
Randomized Controlled Trials of Antidepressants in the Acute Treatment of Postpartum Depression
| Study | Intervention | Trial duration | Total sample size | Summary of findings |
|---|---|---|---|---|
| Appleby et al. (1997)[70] | Fluoxetine, placebo, with each group added to either 1 or 6 counseling sessions | 12 weeks | 87 | There was additional benefit from six counseling sessions or adding fluoxetine, but no detected advantage to adding both or one counseling session. |
| Misri et al. (2004)[69] | Paroxetine alone, paroxetine plus cognitive behavioral therapy (CBT) | 12 weeks | 35 | Paroxetine monotherapy group and paroxetine plus CBT group were efficacious, but there was no additional benefit derived from the addition of the CBT. |
| Wisner et al. (2006) [68] | Sertraline, Nortriptyline | 8 week comparative with 16 week continuation phase | 109 | There were no significant differences in response or remission between the two antidepressants at 4, 8, and 24 weeks postpartum. |
| Yonkers et al. (2008) [67] | Paroxetine, placebo | 8 weeks | 70 | Paroxetine showed significantly higher remission rates versus placebo (37% compared to 15%). The paroxetine group did not show significantly higher response rates than placebo (43% compared to 31%). |
| Sharp et al. (2010) [66] | Various antidepressants (mostly selective serotonin reuptake inhibitors), supportive counseling | 18 weeks | 254 | At 4 weeks postpartum, participants receiving antidepressants showed significant symptom resolution, however at 18 weeks postpartum there was no significant difference between those receiving antidepressants and those receiving supportive counseling. |
| Bloch et al. (2012) [65] | Sertraline, placebo, with each group added to brief psychodynamic therapy | 8 weeks | 40 | Sertraline did not add additional benefit to brief psychodynamic therapy. |
| Hantsoo et al. (2014) [64] | Sertraline, placebo | 6 weeks | 38 | The benefits of sertraline were more pronounced when PPD onset was within 4 weeks of childbirth. |
| Milgrom et al. (2015) [63] | Sertraline, specialized CBT program | 12 weeks | 45 | Specialized CBT program for PPD was superior as monotherapy when compared with sertraline. The trial is unique in that it included a statistically independent evaluation of CBT monotherapy for PPD compared to both antidepressant and combination therapy. |
| Kashani et al. (2017) [217] | Fluoxetine, saffron | 6 weeks | 68 | The response rates were not significantly different between the two groups. |