Rationale Postpartum depression (PMD) occurs in roughly 10% of postpartum women and negatively impacts the mother and her offspring, but there are few placebo-controlled studies of antidepressant treatment in this population. Objectives To compare the selective serotonin reuptake inhibitor (SSRI) sertraline to placebo for treating PMD. Methods This was a single-center, 6-week, randomized double-blind placebo-controlled trial of sertraline with a one-week placebo lead-in. Participants (n=38) were women with depression onset within 3 months of delivery; a subset (n=27) met strict DSM-IV criteria for PMD (onset within 4 weeks of delivery). Participants were prescribed sertraline 50 mg or placebo daily, to a maximum of 200 mg/day. Primary outcome variables were the Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impressions (CGI) scores, which were used to determine rates of response and remission. Results Sertraline produced a significantly greater response rate (59%) than placebo (26%) and a more than 2-fold increased remission rate (53% vs. 21%). Mixed models did not reveal significant group by time effects, although in the subset of women who met DSM-IV criteria, there was a statistically significant group by time effect for the HAM-D, Hamilton Anxiety Rating Scale (HAM-A) and CGI. Conclusions Women with PMD are more likely to have a remission of their depression with sertraline treatment, a finding that is more pronounced in women who have onset of depression within 4 weeks of childbirth. These data support the continued use of 4 weeks for the DSM-5 postpartum onset specifier for major depressive disorder.

The data indicate that while mothers receiving clinical doses of sertraline experience substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers is unaltered. The observations suggest that mothers taking sertraline can breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.

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