T A Lawrie1, A Herxheimer, K Dalton. 1. Department of Obstetrics and Gynaecology, University of Stellenbosch, Tygerberg Hospital, PO Box 19164, Tygerberg, Western Cape, South Africa, 7505. lawrie@pixie.co.za
Abstract
BACKGROUND: Postnatal depression, with a prevalence of at least 10%, is probably the most common complication of the puerperium. A deficiency or imbalance of sex hormones has repeatedly been suggested as a cause. OBJECTIVES: The objective of this review was to evaluate the role of oestrogens and progestogens in the prevention and treatment of postnatal depression. SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA: All trials were considered in which pregnant or postpartum women (up to 18 months) were randomised to receive postpartum oestrogen or progestogen or placebo for the treatment or prevention of postnatal depression. DATA COLLECTION AND ANALYSIS: Two published randomised placebo controlled trials were identified for inclusion in the analyses for this review. One study was excluded. MAIN RESULTS:Depot norethisterone enanthate given within 48 hours of delivery and lasting 8-12 weeks was associated with significantly higher postpartum depression scores than placebo. Oestrogen therapy in severely depressed women was associated with a greater improvement in depression scores than placebo. REVIEWER'S CONCLUSIONS: There is no place for synthetic progestogens in the prevention of treatment of postnatal depression. Long-acting norethisterone enanthate is associated with an increased risk of postnatal depression. It and other long-acting progestogen contraceptives should be used with caution in the postnatal period, especially in women with a history of depression. The role of progesterone in the prevention and treatment of postnatal depression has yet to be evaluated in a randomised placebo-controlled trial. Oestrogen therapy may be of modest value at a late stage of severe postnatal depression. Its role in the prevention of recurrent postnatal depression has not been evaluated. Further research on its value is unlikely for ethical reasons.
RCT Entities:
BACKGROUND:Postnatal depression, with a prevalence of at least 10%, is probably the most common complication of the puerperium. A deficiency or imbalance of sex hormones has repeatedly been suggested as a cause. OBJECTIVES: The objective of this review was to evaluate the role of oestrogens and progestogens in the prevention and treatment of postnatal depression. SEARCH STRATEGY: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. SELECTION CRITERIA: All trials were considered in which pregnant or postpartum women (up to 18 months) were randomised to receive postpartum oestrogen or progestogen or placebo for the treatment or prevention of postnatal depression. DATA COLLECTION AND ANALYSIS: Two published randomised placebo controlled trials were identified for inclusion in the analyses for this review. One study was excluded. MAIN RESULTS: Depot norethisterone enanthate given within 48 hours of delivery and lasting 8-12 weeks was associated with significantly higher postpartum depression scores than placebo. Oestrogen therapy in severely depressedwomen was associated with a greater improvement in depression scores than placebo. REVIEWER'S CONCLUSIONS: There is no place for synthetic progestogens in the prevention of treatment of postnatal depression. Long-acting norethisterone enanthate is associated with an increased risk of postnatal depression. It and other long-acting progestogen contraceptives should be used with caution in the postnatal period, especially in women with a history of depression. The role of progesterone in the prevention and treatment of postnatal depression has yet to be evaluated in a randomised placebo-controlled trial. Oestrogen therapy may be of modest value at a late stage of severe postnatal depression. Its role in the prevention of recurrent postnatal depression has not been evaluated. Further research on its value is unlikely for ethical reasons.
Authors: Sharon Sanders; Chris Del Mar; Sarah Purdy; Annelise Spinks; Lisa Tait; Brian McAvoy Journal: Br J Gen Pract Date: 2005-05 Impact factor: 5.386
Authors: Daniela Eser; Cornelius Schüle; Elena Romeo; Thomas C Baghai; Flavia di Michele; Augusto Pasini; Peter Zwanzger; Frank Padberg; Rainer Rupprecht Journal: Psychopharmacology (Berl) Date: 2005-10-25 Impact factor: 4.530