No abstract

The findings of this prospective, observational study indicate that the recurrence risk is much higher after childbirth than during pregnancy in spite of higher utilization of psychotropic drugs in the postpartum period.

Objective: In spite of the paucity of randomized controlled trials of antidepressants in postpartum depression, these drugs are the most commonly used agents in the pharmacologic treatment of postpartum depression. This article reviews the literature on the efficacy of antidepressants in randomized controlled trials of postpartum depression.Data Sources: Four electronic databases, MEDLINE/PubMed (1966–2013), PsycINFO (1806–2013), EMBASE (1980–2013), and the Cochrane Database of Systematic Reviews, were searched using a combination of the keywords antidepressive agents/therapeutic use, antidepressant drugs, antidepressant agent/drug therapy, depression, postpartum/drug therapy, postpartum depression, and puerperal depression/drug therapy.Study Selection: The reference lists of articles identified were also searched. All relevant articles published in English were included. A total of 124 articles were identified. The efficacy of antidepressants has been studied in 6 randomized controlled trials, of which 3 were placebo-controlled studies.Results: Placebo-controlled randomized data do not support the notion that antidepressants are efficacious in postpartum depression. However, the methodological flaws of studies have to be kept in mind while interpreting the results of these studies.Conclusions: Due to the paucity of controlled data and methodological limitations of studies, the question about the efficacy of antidepressants in postpartum depression cannot be answered unequivocally.

Clinicians view CTOs as providing benefits to their clients but struggle with the coercive nature of these tools.