Table 2.
Study of women receiving an antidepressant prescription in the postpartum period.
| Author, year, support, country | Study design, population | Contraceptive use | Outcome | Results | Quality, strengths, weaknesses |
|---|---|---|---|---|---|
| Roberts, 2017, no funding, U.S. | Retrospective cohort study, analysis of data from Military Health System Management Analysis and Reporting Tool. 75,528 women enrolled postpartum and followed for 12 months. |
Norethindrone-only pills (n=19,883) LNG-IUD (n=3,096) ETG implant (n=2,730) EE/norgestimate pill (n=2,718) EE/norethindrone pill (n=1,675) EE/ETG ring (n=1,404) No hormonal contraception (n=44,022) |
Antidepressant use as identified by pharmacy record of filled prescription of an antidepressant defined using the American Hospital Formulary Service classification code 281604 during 12 months after delivery. Excluded tricyclic antidepressants and serotonin reuptake inhibitors typically prescribed for smoking cessation (Buproprion HCL formulated as Zyban®) or insomnia (Trazodone). | Norethindrone-only pills aHR 0.58 (0.52–0.64) LNG-IUD aHR 1.01 (0.87–1.18) ETG implant aHR 1.22 (1.06–1.41) EE/norgestimate pill aHR 1.02 (0.85–1.22) EE/norethindrone pill aHR 0.88 (0.69–1.13) EE/ETG ring aHR 1.45 (1.16–1.8) |
Quality: poor (high risk of bias, good precision, fair external validity) Strengths: Large cohort using claims data within a relatively closed health care system, with adequate follow-up for outcome (12 months). Groups drawn from the same source population with consistent inclusion and exclusion criteria. Exposure and outcome assessed consistently throughout participants using clear diagnostic codes. Likely a diverse population (though no data presented), and likely adequate power given large sample size (though no power or effect size calculations provided). Excluded prior depression diagnosis or antidepressant use within 24 months prior to delivery. Weaknesses: Significant potential for misclassification of outcome. Failed to adjust for key potential confounders from analysis (e.g. smoking, prior history of postpartum depression, birth complications, or breastfeeding problems). Military cohort with potential for higher rates of comorbid psychiatric conditions (e.g. post-traumatic stress disorder). Unique population with potentially limited generalizability. |
LNG-IUD = levonorgestrel intrauterine device. ETG = etonogestrel. EE = ethinyl estradiol. ICD-9 = International Classification of Disease, Ninth revision. NOS=not otherwise specified. aHR= adjusted hazard ratio. CI = 95% confidence interval.