Antidepressants for preventing postnatal depression

Depression is common in the postnatal period and can lead to adverse effects on the infant and wider family, in addition to the morbidity for the mother. It is not clear whether antidepressants are effective for the prevention of postnatal depression and little is known about possible adverse effects for the mother and infant, particularly during breastfeeding. 

In this featured review, the authors examined the evidence to see whether antidepressants can prevent women from experiencing depression in the postnatal period, when compared with any other treatment, sham treatment (placebo), or standard clinical care. The studies identified included only women who had previously experienced postnatal depression, and had a higher risk of experiencing postnatal depression again.

What does the evidence from the review tell us?

The authors only identify two relevant studies, which had small numbers of participants and inconsistent findings, and were conducted by the same research group. Therefore we consider the quality of evidence in this review to be very low. Further studies with larger samples are needed before we can know whether antidepressants can prevent postnatal depression.

No new relevant trials have been completed in the 10 years since the authors last examined this evidence. It may be useful for future medical studies to investigate whether antidepressants can prevent depression during pregnancy as well as during the postnatal period; and whether women who continue to take antidepressants during pregnancy (compared with stopping medication) are less likely to have a relapse of depression at this time.

We also need studies which have longer follow-ups periods; examine outcomes and side effects for both the mother and fetus or breastfeeding infant; and compare antidepressants with other preventative interventions (such as psychological therapies).

Read the review in the Cochrane Library