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Short-term antidepressants 'effective for postnatal depression'

By Lilian Anekwe

A short course of antidepressant therapy is more effective than general supportive care for the treatment of postnatal depression, Department of Health-funded research has found.

The RESPOND trial, a randomised controlled trial comparing four-week treatment with antidepressants with supportive care followed by counselling by health visitors, found antidepressants were better, and that by 18 weeks many of the women initially randomised to listening visits were also receiving antidepressants, and more vice versa.

Despite postnatal depression affecting one in every seven new mothers there is little evidence about the risks and benefits of pharmacotherapy.

Researchers recruited 254 women from 77 general practices in England, and randomised them to receive either four weeks of antidepressant therapy, most commonly an SSRI, or a course of four weeks of general supportive care, followed by counselling in the form of listening visits from a specially trained health visitor only.

The primary outcome, measured at four and eighteen weeks after randomisation, was the proportion of women with a score of less than 13 on the Edinburgh Postnatal Depression Scale (EPDS).

At four weeks, 45% of women in the antidepressants group has significant improvements on the Edinburgh Postnatal Depression Scale compared with 20% of women receiving supportive care.

At 18 weeks there was a numerical but not statistical difference between the groups.

The researchers said that their trial design, which allowed women to switch to the alternative intervention at any time after 4 weeks , meant data after 18 weeks was ‘difficult to interpret'.

But they concluded:'There is no statistical support for a benefit of antidepressant at 18 weeks, but the confidence intervals cannot rule out a clinically important benefit.'

Professor Debbie Sharp, professor of primary care at the University of Bristol and a GP in the city, called for greater collaboration between GPs and health visitors to diagnose and support women with postnatal depression.

‘This study has shown that at four weeks, antidepressants were significantly superior to general supportive care.

‘It would appear that commencing women on antidepressants early in the course of the illness is likely to result in the greatest improvement in symptoms.

Dr John Hague, a mental health GPSI in Ipswich, said the finding of some evidence for the use of antidepressants in PND is important and added: ‘The study also highlights the need for "corporate working" with health visitors, which potentially impacts on the detection and management of PND'

Health Technology Assessment 2010; Vol. 14: No. 43

SSRIs were most commonly given to women with PND in the trial NICE guidance on postnatal depression

At a woman's first contact with services in both antenatal and the postnatal care healthcare professionals should ask about:
• Past or present mental illness and severe depression, or a family history of perinatal mental illness
At a woman's first contact with primary care and postnatally (usually at 4 to 6 weeks and 3 to 4 months), GPs should ask two questions to identify possible depression:
• During the past month, have you often been bothered by feeling down, depressed or hopeless?
• During the past month, have you often been bothered by having little interest or pleasure in doing things?
GPs should also consider a third question if the woman answers ‘yes' to either of the initial questions:
• Is this something you feel you need or want help with?

Source: NICE guidance 45, antenatal and postnatal mental health, April 2007

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