Antidepressant treatment for postnatal depression

Introduction: Mother with postnatal depression is not able to adequately respond to the needs of her child. Maternal depression poses a serious health & safety risk for mother and child. They both need treatment with rapid onset of action and minimal influence on the infant. Aim: Discussion of professional boards’ recommendations together with RCT results and clinical observations reffering to nursing depressed women with emphasis on practical aspects and future directions. Methods: Discussion on postnatal depression treatment national guidelines and results from meta-analyses and systematic reviews found in Pubmed and Cochrane databases with "postanatal" or "postpartum" or "puerperium" and "depression" keywords. Selection of articles based on practical aspects of management. Results: Despite its widespread use, the safety and efficacy of SSRIs in postpartum mood disorders have not yet been clearly confirmed. Long-term observation of behaviour and development of children after early exposure to SSRIs up to adulthood is necessary to fully assess the risk of antidepressant treatment in nursing mothers. Conclusions: Pharmacotherapy remains the most accessible method of treating depression in the puerperal period, however, knowledge about the safety of antidepressants during lactation is still insufficient. Individualization of treatment depending on the patient's condition, specific needs, availabity of procedures and mental or physical comorbidity is necessary.

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Depression, depressive symptoms and treatments in women who have recently given birth: UK cohort study

BMJ Open ◽

10.1136/bmjopen-2018-022152 ◽

2018 ◽

Vol 8 (10) ◽

pp. e022152 ◽

Cited By ~ 8

Author(s):

Irene Petersen ◽

Tomi Peltola ◽

Samuel Kaski ◽

Kate R Walters ◽

Sarah Hardoon

Keyword(s):

Primary Care ◽

Cohort Study ◽

Depressive Symptoms ◽

Electronic Health Records ◽

Postnatal Depression ◽

Selective Serotonin Reuptake Inhibitors ◽

Antidepressant Treatment ◽

Health Records ◽

Electronic Health ◽

Ssri Treatment

ObjectivesTo investigate how depression is recognised in the year after child birth and treatment given in clinical practice.DesignCohort study based on UK primary care electronic health records.SettingPrimary care.ParticipantsWomen who have given live birth between 2000 and 2013.OutcomesPrevalence of postnatal depression, depression diagnoses, depressive symptoms, antidepressant and non-pharmacological treatment within a year after birth.ResultsOf 206 517 women, 23 623 (11%) had a record of depressive diagnosis or symptoms in the year after delivery and more than one in eight women received antidepressant treatment. Recording and treatment peaked 6–8 weeks after delivery. Initiation of selective serotonin reuptake inhibitors (SSRI) treatment has become earlier in the more recent years. Thus, the initiation rate of SSRI treatment per 100 pregnancies (95% CI) at 8 weeks were 2.6 (2.5 to 2.8) in 2000–2004, increasing to 3.0 (2.9 to 3.1) in 2005–2009 and 3.8 (3.6 to 3.9) in 2010–2013. The overall rate of initiation of SSRI within the year after delivery, however, has not changed noticeably. A third of the women had at least one record suggestive of depression at any time prior to delivery and of these one in four received SSRI treatment in the year after delivery.Younger women were most likely to have records of depression and depressive symptoms. (Relative risk for postnatal depression: age 15–19: 1.92 (1.76 to 2.10), age 20–24: 1.49 (1.39 to 1.59) versus age 30–34). The risk of depression, postnatal depression and depressive symptoms increased with increasing social deprivation.ConclusionsMore than 1 in 10 women had electronic health records indicating depression diagnoses or depressive symptoms within a year after delivery and more than one in eight women received antidepressant treatment in this period. Women aged below 30 and from the most deprived areas were at highest risk of depression and most likely to receive antidepressant treatment.

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