Postpartum depression pills

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Use of antidepressants for the treatment of postpartum depression

Review question

In this Cochrane review, we wanted to know how effective antidepressants work in treating women with postpartum depression.

Why is this important?

Postpartum depression is depression that begins within 12 months of the birth of a child. Postpartum depression affects many women. Postpartum depression can have serious short and long term consequences for the mother, the baby and the family as a whole.

There are several ways to treat postpartum depression. Treatment for depression may include antidepressants, psychotherapy, support, or counseling. The type of treatment offered depends on the severity of the depression, other conditions, and the woman's choice. In general, pregnant women or women who are breastfeeding are often concerned about the potential adverse effects of antidepressants on their baby.

It is important to know if antidepressants can be an effective and acceptable treatment for women with postpartum depression.

What we did

In May 2020, we searched for studies on antidepressant treatment for women with postpartum depression. We looked for randomized controlled trials in which treatments were randomly assigned to participants. These studies provide the most reliable evidence.

We included 11 studies involving 1016 women. The studies compared antidepressants with placebo, conventional treatments (watch and wait, regular visits with a care coordinator), psychological interventions (therapy), psychosocial interventions (peer support or counseling), any other medication or other type of antidepressant, and complementary medicine (food supplements).

Eight of these studies were conducted in high-income English-speaking countries. The duration of treatment ranged from 4 to 24 weeks.

The outcome we focused on was the effectiveness of the treatment (how well the treatment worked). Efficacy was measured by the number of people who responded well to treatment or no longer met the criteria for depression at the end of treatment (remission). We also looked at whether women and/or their children experienced adverse effects of treatment.

What did we find?

We found that women receiving antidepressants may respond slightly better to treatment and have less postpartum depression than women receiving placebo. The number of adverse effects experienced by women was similar between the groups. There have been few studies comparing antidepressants with other treatments. The most commonly studied were antidepressants from the group "SSRIs" (selective serotonin reuptake inhibitors).


Only a few eligible studies were identified in this review. There is some evidence that antidepressants may work better than placebo in women with postpartum depression. There is insufficient evidence to compare antidepressants with other treatments for postpartum depression. Clinicians need to consider evidence from general population studies and existing clinical guidelines, along with the woman's medical history and current symptoms, to make an individual decision about the risks and benefits of treating the woman.

Certainty of evidence

Our certainty (confidence) in the evidence is low. Some results are based on only a few studies with a small number of women in each group. Therefore, we are not sure how reliable these results are. Our conclusions may change if more research is done. Our findings that antidepressants may work better than placebo are similar to those of a large number of studies in the general population.

Translation notes:

Translation: Mikhailova Katerina Dmitrievna. Editing: Yudina Ekaterina Viktorovna. Russian translation project coordination: Cochrane Russia - Cochrane Russia, Cochrane Geographic Group Associated to Cochrane Nordic. For questions related to this translation, please contact us at: [email protected]

Newest cure for postpartum depression - expert material, Lahta Clinic

19In March 2019, the US Food and Drug Administration (FDA) approved the first drug specifically designed for the treatment of postpartum depression.

How exactly does the drug work and how does it differ from other antidepressants?

The drug, called brexanolone (trade name Zulresso), is intended for intravenous administration - only in medical facilities and under the supervision of a doctor - for a total duration of 60 hours (two and a half days), the FDA said in a statement.

“Brexanolone is different from any other antidepressant,” says Dr. Christina Deligiannidis , director of women's behavioral health at Zucker's Hillside Hospital in New York, USA, who took part in clinical trials of the drug that ended with its official approval.

The drug is a synthetic version of allopregnanolone, a steroid normally produced by the human body. It is a breakdown product of the sex hormone progesterone, which is secreted by the brain and ovaries, as well as the placenta during pregnancy. It is known that the level of allopregnanolone in the blood increases during gestation (pregnancy) and falls rapidly after childbirth. It is believed that fluctuations in the concentration of allopregnanolone can trigger changes in brain activity, which in turn affect the development of anxiety and depression in some women, according to Sage Therapeutics Inc., the manufacturer of brexanolone.

“The mechanism of the therapeutic effect of brexanolone in postpartum depression is still unclear. The drug is believed to modify the body's response to stress, which is abnormal in women with postpartum depression, says Christina Deligiannidis to Live Science. “The active substance binds to GABA receptors, which play an important role in many brain functions.”

Such binding may lead to a reversal or "reset" of brain activity, leading to the development of symptoms of postpartum depression, according to Sage Therapeutics Inc.

“Brexanolone works differently than other antidepressants,” continues K. Deligiannidis . – As a rule, such drugs do not interact with GABA receptors. The exception is the class of benzodiazepines, sometimes called tranquilizers, but they bind to a different type of GABA receptor than brexanolone and perform a different function.”

The study of the pharmacological properties of brexanolone revealed its ability to bring quick and effective results. Two clinical trials involving about 250 women with postpartum depression showed that within 60 hours, half of the patients taking brexanolone got rid of clinically significant symptoms of depression, compared with 25 percent of women receiving placebo (the severity of depression was assessed using known scales and questionnaires). Brexanolone's rapid action remains one of the main questions so far, says C. Deligiannidis because other antidepressants sometimes have to be taken for weeks without much improvement.

The effects of one drop of brexanolone lasted at least 30 days, which was the maximum period for which women in the study were monitored. With the beginning of the mass use of the drug, the duration of the effect will be specified. But even a month-long improvement in the postpartum depression clinic gives the doctor the opportunity to start other types of treatment, for example, to conduct a course of verbal psychotherapy.

Due to the fact that drowsiness and sudden fainting were accompanied by some women taking brexanolone, the FDA decision specifically stipulates the obligatory condition for monitoring patients receiving the drug.

Sage Therapeutics is developing another drug for the treatment of postpartum depression, which is planned to be available in tablet form, intended for single daily use.

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