Summary of findings 5. Antidepressants versus any other pharmacological intervention for postnatal depression.
| Antidepressants compared with any other pharmacological intervention for postnatal depression | ||||||
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Patient or population: women of any age, with PND up to 12 months Settings: any Intervention: antidepressant (sertraline) Comparison: any other pharmacological intervention (nortriptyline or estradiol) | ||||||
| Outcomes | Assumed absolute effects* (95% CI) | Relative effect (95% CI) | No of women (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with any other pharmacological intervention | Risk with antidepressant | |||||
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Depression response (acute phase, 5 ≤ 12 weeks) |
600 per 1000 | 588 per 1000 (456 to 762) | RR 0.98 (0.76 to 1.27) | 165 (2 RCTs) |
⊕⊝⊝⊝a,b,c Very low |
Both studies defined response as ≥ 50% reduction in HAM‐D from baseline. |
|
Depression remission (acute phase, 5 ≤ 12 weeks) |
413 per 1000 see comment | 404 per 1000 (281 to 582) | RR 0.98 (0.68 to 1.41) | 165 (2 RCTs) |
⊕⊝⊝⊝a,b,c Very low |
Both studies defined remission as a score ≤ 7 or 8 on the HAM‐D scale. |
| Adverse events | Both studies reported no difference between groups in the overall number of moderate or severe side effects reported using the Asberg Side Effects Rating Scale. However, in one study, some side effects were more common among women who took nortriptyline than women taking sertraline: moderate to severe thirst (P = 0.02), dry mouth (P = 0.001) and constipation (P = 0.05). Other side effects were more common in the sertraline than nortriptyline group: constant or severe headaches (P = 0.05), increased perspiration (P = 0.04) and hot flushes interrupting sleep (P = 0.04) | ‐ | ‐ | ‐ | ‐ | |
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Depression response (early phase, < 5 weeks) |
No significant difference in response (50% reduction in HAM‐D from baseline) between sertraline and nortriptyline at week 4 (P = 0.29) | ‐ | 109 (1 RCT) |
⊕⊕⊝⊝a,b Low |
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Depression remission (early phase, < 5 weeks) |
No significant difference in remission (≤ 7 or 8 on the HAM‐D scale) between sertraline and nortriptyline at week 4 (P = 0.79). | ‐ | 109 (1 RCT) |
⊕⊕⊝⊝a,b Low |
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Depression severity‐ mean HAM‐D scores (acute phase, 5 ≤ 12 weeks) |
The mean HAM‐D score was 10 | MD 0.65 lower (3.18 lower to 1.87 higher) | ‐ | 165 (2 RCTs) |
⊕⊝⊝⊝a,b,c Very low |
Lower mean score = less severe depression |
| Treatment acceptability ‐dropouts | 241 per 1000 | 419 per 1000 (238 to 737) | RR 1.74 (0.99 to 3.06) | 109 (1 RCT) |
⊕⊝⊝⊝a,b,c Very low |
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| Child‐related outcomes | see comment | ‐ | ‐ | ‐ | No study reported this outcome | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) 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; HAM‐D: Hamilton Rating Scale for Depression; MD: mean difference; PND: postnatal depression; RR: risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded one level for high risk of attrition bias in one study. bDowngraded one level for imprecision as the number of participants is less than 400. cDowngraded one level for imprecision as the confidence interval includes no effect and appreciable harm.