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Antidepressant Treatment for Postnatal Depression This is a repository copy of Antidepressant treatment for postnatal depression. White Rose Research Online URL for this paper: https://eprints.whiterose.ac.uk/163986/ Version: Published Version Article: Brown, Jennifer Valeska Elli orcid.org/0000-0003-0943-5177, Wilson, Claire A., Ayre, Karyn et al. (5 more authors) (2020) Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews. CD013560. ISSN 1469-493X https://doi.org/10.1002/14651858.CD013560 Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ Cochrane Library Cochrane Database of Systematic Reviews Antidepressant treatment for postnatal depression (Protocol) Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD013560. DOI: 10.1002/14651858.CD013560. www.cochranelibrary.com Antidepressant treatment for postnatal depression (Protocol) Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews T A B L E O F C O N T E N T S HEADER......................................................................................................................................................................................................... 1 ABSTRACT..................................................................................................................................................................................................... 1 BACKGROUND.............................................................................................................................................................................................. 2 OBJECTIVES.................................................................................................................................................................................................. 3 METHODS..................................................................................................................................................................................................... 3 ACKNOWLEDGEMENTS................................................................................................................................................................................ 8 REFERENCES................................................................................................................................................................................................ 9 APPENDICES................................................................................................................................................................................................. 11 CONTRIBUTIONS OF AUTHORS................................................................................................................................................................... 16 DECLARATIONS OF INTEREST..................................................................................................................................................................... 16 SOURCES OF SUPPORT............................................................................................................................................................................... 16 Antidepressant treatment for postnatal depression (Protocol) i Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews [Intervention Protocol] Antidepressant treatment for postnatal depression Jennifer Valeska Elli Brown1,2, Claire A Wilson3, Karyn Ayre3, Emily South4, Emma Molyneaux3, Kylee Trevillion3, Louise M Howard3, Hind Khalifeh3 1Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK. 2Cochrane Common Mental Disorders, University of York, York, UK. 3Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 4Centre for Reviews and Dissemination, University of York, York, UK Contact address: Hind Khalifeh, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. [email protected]. Editorial group: Cochrane Common Mental Disorders Group. Publication status and date: New, published in Issue 3, 2020. Citation: Brown JVE, Wilson CA, Ayre K, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H. Antidepressant treatment for postnatal depression. Cochrane Database of Systematic Reviews 2020, Issue 3. Art. No.: CD013560. DOI: 10.1002/14651858.CD013560. Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. A B S T R A C T This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness and safety of antidepressant drugs in comparison with any other treatment (psychological, psychosocial, or pharmacological), placebo, or treatment as usual for PND. Antidepressant treatment for postnatal depression (Protocol) 1 Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Cochrane Trusted evidence. Informed decisions. Library Better health. Cochrane Database of Systematic Reviews B A C K G R O U N D Most women with postpartum depression recover within a few months but about 30% of episodes last beyond the first postpartum Description of the condition year (Goodman 2004). Women who have had PND also have a high risk (about 40%) of both postnatal and non-postnatal relapse Postnatal depression (PND), which is depression that occurs aFer (Cooper 1995; Wisner 2004). a woman has given birth, is an important and common disorder that can have short- and long-term adverse impacts on the mother, It is important to distinguish postpartum depression from less her child, and the family as a whole (Howard 2014a; Stein 2014). severe short-lived conditions, such as the 'baby blues' which occurs Perinatal suicide, which is closely linked to PND, is an important in around 50% of women and resolves spontaneously within a few contributor to maternal mortality (Grigoriadis 2017; Khalifeh 2016). days (Howard 2014a; Stewart 2019). On the other end of severity PND is associated with impaired maternal-infant attachment, spectrum, it is important to recognise the severe psychiatric and with internalising and externalising problems in children of emergency of postpartum psychosis, a rare condition affecting 1 mothers who have PND, particularly where the depression is to 2 women per 1000 in the general population, where admission severe and persistent and there are familial co-morbidities (Stein is recommended to mitigate risks to mother and baby (Jones 2014). PND has a similar epidemiology and clinical presentation 2014). Clinically, PND is oFen co-morbid with other conditions, to depression in the general population (Howard 2014a; Stewart particularly anxiety disorders (Stewart 2019). 2019). It is characterised by persistent low mood and loss of pleasure or interests, occurring with associated symptoms such Description of the intervention as changes in appetite and energy levels, disturbed sleep, and low self-confidence (Howard 2014a; WHO 2018). The 11th revision UK national perinatal guidance recommends treatment for PND of the International Classification for Diseases (ICD-11) and the within a stepped-care model, with antidepressant treatment being recommended for women with more severe depression, 5th revision of the Diagnostic and Statistical Manual of Mental with or without combined treatment with psychological therapy Disorders (DSM-5) recommend the use of generic (non-perinatal) (McAllister-Williams 2017; NICE 2014). The guidance emphasises mood disorder diagnostic categories for depression occurring in the higher threshold for antidepressant use in the perinatal period the postnatal period, in recognition of the absence for clear (given the uncertain risks of medication use during pregnancy and evidence of a distinct postnatal depressive clinical syndrome (APA whilst breastfeeding, see below), and the importance of taking into 2013; O'Hara 2013; WHO 2018). However, they allow for the use of a account the woman’s preferences, illness severity, past response secondary perinatal diagnostic category (in ICD-11) or specifier (in to treatment, and relative benefits and risks of different treatment DSM-5) for depression occurring in pregnancy or within four to six options for mother and baby (Howard 2014b). Antidepressant weeks aFer childbirth. drugs are commonly divided into the classes of specific serotonin In the UK and
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