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Leki przeciwdepresyjne w zapobieganiu depresji poporodowej

Appendices

Appendix 1. CCDANCTR update search ‐ Feb 2018

#1. antidepress* or anti‐depress* or "anti depress*" or MAOI* or RIMA* or “monoamine oxidase inhibit*” or ((serotonin or norepinephrine or noradrenaline or neurotransmitter* or dopamin*) NEAR (uptake or reuptake or re‐uptake or "re uptake")) or SSRI* or SNRI* or NARI* or SARI* or NDRI* or TCA* or tricyclic* or tetracyclic*
#2. Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or (Bupropion or Amfebutamone) or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or (Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine) or Clorgyline or Clovoxamine or (CX157 or Tyrima) or Demexiptiline or Deprenyl or (Desipramine* or Pertofrane) or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS‐233
#3. Escitalopram or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or (Hyperforin or Hypericum or “St John*”) or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or (“Lu AA21004” or Vortioxetine) or "Lu AA24530" or (LY2216684 or Edivoxetine) or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nitroxazepine or Nomifensine or Norfenfluramine or Nortriptylin* or Noxiptilin*
#4. Opipramol or Oxaflozane or Paroxetine or Phenelzine or Pheniprazine or Pipofezine or Pirlindole or Pivagabine or Pizotyline or Propizepine or Protriptylin* or Quinupramine or Reboxetine or Rolipram or Scopolamine or Selegiline or Sertraline or Setiptiline or Teciptiline or Thozalinone or Tianeptin* or Toloxatone or Tranylcypromin* or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Vilazodone or Viqualine or Zalospirone
#5. (#1 or #2 or #3 or #4 or #5)
#6. (depress* or dysthymi* or "adjustment disorder*" or "mood disorder*" or "affective disorder*" or "affective symptoms") AND (postpartum or "post partum" or post‐partum or postnatal or "post natal" or post‐natal or puerper*)
#7. (#5 and #6)

Appendix 2. Earlier searches conducted to June 2007

Earlier searches, conducted for the first version of this review used the following search strategies (to 11‐June‐2007):

1. TheCCDANCTR‐Studies Register was searched using the following controlled search terms:

Diagnosis = Depression, Postpartum
AND
Intervention = (Antidepress* or "Monoamine Oxidase Inhibitors" or "Selective Serotonin Reuptake Inhibitors" or "Tricyclic Drugs" or Acetylcarnitine or Alaproclate or Amersergide or Amiflamine or Amineptine or Amitriptyline or Amoxapine or Befloxatone or Benactyzine or Brofaromine or Bupropion or Butriptyline or Caroxazone or Chlorpoxiten or Cilosamine or Cimoxatone or Citalopram or Clomipramine or Clorgyline or Clorimipramine or Clovoxamine or Deanol or Demexiptiline or Deprenyl or Desipramine or Dibenzipin or Diclofensine or Dothiepin or Doxepin or Duloxetine or Escitalopram or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluparoxan or Fluvoxamine or Idazoxan or Imipramine or Iprindole or Iproniazid or isocarboxazid or Litoxetine or Lofepramine or Maprotiline or Medifoxamine or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nomifensine or Nortriptyline or Noxiptiline or Opipramol or Oxaflozane or Oxaprotiline or Pargyline or Paroxetine or Phenelzine or Piribedil or Pirlindole or Pivagabine or Prosulpride or Protriptyline or Quinupramine or Reboxetine or Rolipram or Sertraline or Setiptiline or SSRI* or Teniloxine or Tetrindole or Thiazesim or Thozalinone or Tianeptine or Toloxatone or Tomoxetine or Tranylcypromine or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Viqualine or Zimeldine)

2. The CCDANCTR‐References Register was searched using a more sensitive set of free‐text terms to identify additional untagged/uncoded reports of RCTs:

Keyword = Depress* or Dysthymi* or "Adjustment Disorder*" or "Mood Disorder*" or "Affective Disorder*" or "Affective Symptoms"
AND
Free‐text = Postpartum or "post partum" or post‐partum or Postnatal or "post natal" or post‐natal
AND
Free‐text = Antidepress* or "Monoamine Oxidase Inhibitors" or "Selective Serotonin Reuptake Inhibitors" or SSRI* or "Tricyclic Drugs" or Acetylcarnitin* or Alaproclat* or Amersergid* or Amiflamin* or Amineptin* or Amitriptylin* or Amoxapin* or Befloxaton* or Benactyzin* or Brofaromin* or Bupropion or Butriptylin* or Caroxazon* or Chlorpoxiten or Cilosamin* or Cimoxaton* or Citalopram or Clomipramin* or Clorgylin* or Clorimipramin* or Clovoxamin* or Deanol or Demexiptilin* or Deprenyl or Desipramin* or Dibenzipin or Diclofensin* or Dothiepin or Doxepin or Duloxetin* or Escitalopram or Etoperidon* or Femoxetin* or Fluotracen or Fluoxetin* or Fluparoxan or Fluvoxamin* or Idazoxan or Imipramin* or Iprindol* or Iproniazid or isocarboxazid or Litoxetin* or Lofepramin* or Maprotilin* or Medifoxamin* or Melitracen or Metapramin* or Mianserin or Milnacipran or Minaprin* or Mirtazapin* or Moclobemid* or Nefazodon* or Nialamid* or Nomifensin* or Nortriptylin* or Noxiptilin* or Opipramol or Oxaflozan* or Oxaprotilin* or Pargylin* or Paroxetin* or Phenelzin* or Piribedil or Pirlindol* or Pivagabin* or Prosulprid* or Protriptylin* or Quinupramin* or Reboxetin* or Rolipram or Sertralin* or Setiptilin* or Teniloxin* or Tetrindol* or Thiazesim or Thozalinon* or Tianeptin* or Toloxaton* or Tomoxetin* or Tranylcypromin* or Trazodon* or Trimipramin* or Venlafaxin* or Viloxazin* or Viqualin* or Zimeldin*

3. The Cochrane Central Register of Controlled Trials (CENTRAL) and the specialised register of the Cochrane Pregnancy and Childbirth Review Group were searched with the following terms: Postnatal or postpartum or puerper*

4. Searches for grey literature included:

  • The HSRProj in the National Library of Medicine, Washington D.C was checked for unpublished trials.

  • References from MIDIRS Midwifery Database was searched.

  • Current Controlled Trials web site: http://www.controlled trials.com/terms2.cfm was examined for ongoing studies.

  • The Science Citation Index was checked for references to all included studies.

  • Conference proceedings were examined where possible (details available from authors on request).

5. Reference lists
The reference lists of all included studies were checked to identify additional studies missed from the original electronic searches (for example unpublished or in‐press citations). Relevant book chapters and their bibliographies were searched (details available from authors on request).

6. Correspondence
Pharmaceutical companies were contacted directly for any relevant unpublished data.
Contact was made with authors of identified trials and with experts in the field including a search for non‐English material (Professor L Appleby, Professor P Boyce, Dr T Brugha, Dr L Cohen, Dr N Glangeaud, Dr S Glasser, Dr M Marks, Dr A Wieck, Professor K Wisner).
Contact with the Marcé Society through the newsletter was made.
Self help groups were contacted (the National Childbirth Trust (NCT), The Association for Postnatal Illness, Postnatal Distress Association of Ireland, Postpartum Support International (PSI) and PaNDA).

Appendix 3. Update searches conducted to February 2018

Database: CENTRAL

Host: Wiley

Data Parameters: Issue 1 of 12, January 2018

Date searched: Tuesday, February 13th 2018

Searched by: Chris Cooper

Hits: 18

Search strategy:

ID Search Hits

#1 (postpartum or post partum or postnatal or post natal or puerper*) 9779

#2 MeSH descriptor: [Antidepressive Agents] explode all trees 5750

#3 (antidepress* or anti depress* or MAOI* or RIMA* or monoamine oxidase inhibit* or ((serotonin or norepinephrine or noradrenaline or nor epinephrine or nor adrenaline or neurotransmitt* or dopamine*) and (uptake or reuptake or "re‐uptake")) or noradrenerg* or antiadrenergic or anti adrenergic or SSRI* or SNRI* or NARI* or SARI* NDRI* or TCA* or tricyclic* or tetracyclic* or heterocyclic* or psychotropic*) .mp. 1080

#4 (Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or Bupropion or Amfebutamone or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine or Clorgyline or Clovoxamine or CX157 or Tyrima or Demexiptiline or Deprenyl or Desipramine* or Pertofrane or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS‐233 or Escitalopram or Esmirtazapine or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or Hyperforin or Hypericum or "St John*" or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or "Lu AA21004" or Vortioxetine or "Lu AA24530" or "LY2216684" or Edivoxetine or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nitroxazepine or Nomifensine or Norfenfluramine or Nortriptylin* or Noxiptilin* or Opipramol or Oxaflozane or Paroxetine or Phenelzine or Pheniprazine or Pipofezine or Pirlindole or Pivagabine or Pizotyline or Propizepine or Protriptylin* or Quinupramine or Reboxetine or Rolipram or Scopolamine or Selegiline or Sertraline or Setiptiline or Teciptiline or Thozalinone or Tianeptin* or Toloxatone or Tranylcypromin* or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Vilazodone or Viqualine or Zalospirone) 22191

#5 #2 or #3 or #4 24723

#6 #1 and #5 252

Notes: CENTRAL only = 18 records in date range 2016‐current

File: GS51 CENTRAL18.txt

Databases: Ovid MEDLINE(R) Epub Ahead of Print, In‐Process & Other Non‐Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R)

Host: OVID

Data Parameters: 1946 to Present

Date Searched: Tuesday, February 13th 2018

Searched by: Chris

Hits: 28

Search strategy:

Search Strategy:

#

Searches

Results

1

exp Antidepressive Agents/

134025

2

exp Neurotransmitter Uptake Inhibitors/

133352

3

exp Monoamine Oxidase Inhibitors/

20964

4

(antidepress* or anti depress* or MAOI* or RIMA* or monoamine oxidase inhibit* or ((serotonin or norepinephrine or noradrenaline or nor epinephrine or nor adrenaline or neurotransmitt* or dopamine*) and (uptake or reuptake or "re‐uptake")) or noradrenerg* or antiadrenergic or anti adrenergic or SSRI* or SNRI* or NARI* or SARI* NDRI* or TCA* or tricyclic* or tetracyclic* or heterocyclic* or psychotropic*).mp.

228950

5

(Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or Bupropion or Amfebutamone or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine or Clorgyline or Clovoxamine or CX157 or Tyrima or Demexiptiline or Deprenyl or Desipramine* or Pertofrane or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS‐233 or Escitalopram or Esmirtazapine or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or Hyperforin or Hypericum or "St John*" or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or "Lu AA21004" or Vortioxetine or "Lu AA24530" or "LY2216684" or Edivoxetine or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nitroxazepine or Nomifensine or Norfenfluramine or Nortriptylin* or Noxiptilin* or Opipramol or Oxaflozane or Paroxetine or Phenelzine or Pheniprazine or Pipofezine or Pirlindole or Pivagabine or Pizotyline or Propizepine or Protriptylin* or Quinupramine or Reboxetine or Rolipram or Scopolamine or Selegiline or Sertraline or Setiptiline or Teciptiline or Thozalinone or Tianeptin* or Toloxatone or Tranylcypromin* or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Vilazodone or Viqualine or Zalospirone).ti,ab,kw.

76654

6

1 or 2 or 3 or 4 or 5

374868

7

Depression, Postpartum/

4532

8

((postpartum or post partum or postnatal or post natal or puerper*) adj3 (depress* or dysthymi* or "adjustment disorder*" or "mood disorder*" or "affective disorder*" or "affective symptom*")).ti,ab,kw.

5566

9

7 or 8

6988

10

randomized controlled trial.pt.

453387

11

controlled clinical trial.pt.

92150

12

(randomized or randomised).ti,ab.

517074

13

(RCT or "at random" or (random* adj3 (administ* or allocat* or assign* or class* or control* or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or recruit* or subsitut* or treat*))).ti,ab,kw.

433913

14

placebo.ab.

186351

15

((singl* or doubl* or tripl* or trebl*) adj3 (blind* or mask* or dummy)).ti,ab,kw.

156034

16

(control* adj3 (trial or study or group*)).ti,ab,kw.

692411

17

(group* adj3 (allocat* or assign* or control* or divide* or division or distribut* or treat*)).ti,ab,kw.

730860

18

trial.ti,ab.

491130

19

10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18

1726074

20

6 and 9 and 19

133

21

(2016* or 2017* or 2018*).yr,dt,ed,ep.

3328698

22

20 and 21

28

Notes: N/A

File: GS51MEDLINE28.txt

Database: Embase

Host: OVID

Data Parameters: 1974 to 2018 February 12

Date searched: Tuesday, February 13th 2018

Searched by: Chris Cooper

Hits: 50

Search strategy:

Search Strategy:

#

Searches

Results

1

exp Antidepressant Agent/

401718

2

Neurotransmitter Uptake Inhibitors/

155

3

exp Monoamine Oxidase Inhibitor/

45668

4

(antidepress* or anti depress* or MAOI* or RIMA* or monoamine oxidase inhibit* or ((serotonin or norepinephrine or noradrenaline or nor epinephrine or nor adrenaline or neurotransmitt* or dopamine*) and (uptake or reuptake or "re‐uptake")) or noradrenerg* or antiadrenergic or anti adrenergic or SSRI* or SNRI* or NARI* or SARI* NDRI* or TCA* or tricyclic* or tetracyclic* or heterocyclic* or psychotropic*).mp.

319952

5

Psychopharmacology/

26480

6

Psychotropic Agent/

27346

7

Serotonin Receptor Affecting Agent/ or Serotonin Uptake Inhibitor/ or Serotonin Noradrenalin Reuptake Inhibitor/ or Triple Reuptake inhibitor/

46515

8

Dopamine Receptor Affecting Agent/ or Dopamine Uptake Inhibitor/

1482

9

Adrenergic Receptor Affecting Agent/ or Noradrenalin Uptake Inhibitor/

3576

10

(Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or Bupropion or Amfebutamone or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine or Clorgyline or Clovoxamine or CX157 or Tyrima or Demexiptiline or Deprenyl or Desipramine* or Pertofrane or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS‐233 or Escitalopram or Esmirtazapine or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or Hyperforin or Hypericum or "St John*" or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or "Lu AA21004" or Vortioxetine or "Lu AA24530" or "LY2216684" or Edivoxetine or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nitroxazepine or Nomifensine or Norfenfluramine or Nortriptylin* or Noxiptilin* or Opipramol or Oxaflozane or Paroxetine or Phenelzine or Pheniprazine or Pipofezine or Pirlindole or Pivagabine or Pizotyline or Propizepine or Protriptylin* or Quinupramine or Reboxetine or Rolipram or Scopolamine or Selegiline or Sertraline or Setiptiline or Teciptiline or Thozalinone or Tianeptin* or Toloxatone or Tranylcypromin* or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Vilazodone or Viqualine or Zalospirone).ti,ab,kw.

100164

11

1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10

572354

12

postnatal depression/

644

13

((postpartum or post partum or postnatal or post natal or puerper*) adj3 (depress* or dysthymi* or "adjustment disorder*" or "mood disorder*" or "affective disorder*" or "affective symptom*")).ti,ab,kw.

7804

14

12 or 13

8082

15

randomized controlled trial.de.

486416

16

randomization.de.

76792

17

placebo.de.

318178

18

placebo?.ti,ab.

266278

19

(randomized or randomised).ti,ab.

725053

20

double blind procedure/

146068

21

(RCT or "at random" or (random* adj3 (administ* or allocat* or assign* or class* or control* or determine* or divide* or division or distribut* or expose* or fashion or number* or place* or recruit* or subsitut* or treat*))).ti,ab,kw.

586635

22

trial.ti.

241798

23

((singl* or doubl* or tripl* or trebl*) adj3 (blind* or mask* or dummy)).ti,ab.

211307

24

(control* adj3 (trial or study or group*)).ti,ab.

954393

25

(group* adj3 (allocat* or assign* or control* or divide* or division or distribut* or treat*)).ti,ab.

1039132

26

15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25

2251280

27

11 and 14 and 26

260

28

(2016* or 2017* or 2018*).yr,dc.

3762342

29

27 and 28

50

Notes: N/A

File: GS51 Embase50.txt

Database: PscyINFO

Host: OVID

Data Parameters: 1806 to February Week 1 2018

Date searched: Tuesday, February 13th 2018

Searched by: Chris Cooper

Hits: 44

Search strategy:

#

Searches

Results

1

exp antidepressant drugs/

36266

2

exp Neurotransmitter Uptake Inhibitors/

13404

3

monoamine oxidase inhibitors/

1391

4

(antidepress* or anti depress* or MAOI* or RIMA* or monoamine oxidase inhibit* or ((serotonin or norepinephrine or noradrenaline or nor epinephrine or nor adrenaline or neurotransmitt* or dopamine*) and (uptake or reuptake or "re‐uptake")) or noradrenerg* or antiadrenergic or anti adrenergic or SSRI* or SNRI* or NARI* or SARI* NDRI* or TCA* or tricyclic* or tetracyclic* or heterocyclic* or psychotropic*).mp.

65272

5

(Agomelatine or Alaproclate or Amoxapine or Amineptine or Amitriptylin* or Amitriptylinoxide or Atomoxetine or Befloxatone or Benactyzine or Binospirone or Brofaromine or Bupropion or Amfebutamone or Butriptyline or Caroxazone or Cianopramine or Cilobamine or Cimoxatone or Citalopram or Chlorimipramin* or Clomipramin* or Chlomipramin* or Clomipramine or Clorgyline or Clovoxamine or CX157 or Tyrima or Demexiptiline or Deprenyl or Desipramine* or Pertofrane or Desvenlafaxine or Dibenzepin or Diclofensine or Dimetacrin* or Dosulepin or Dothiepin or Doxepin or Duloxetine or Desvenlafaxine or DVS‐233 or Escitalopram or Esmirtazapine or Etoperidone or Femoxetine or Fluotracen or Fluoxetine or Fluvoxamine or Hyperforin or Hypericum or "St John*" or Imipramin* or Iprindole or Iproniazid* or Ipsapirone or Isocarboxazid* or Levomilnacipran or Lofepramine* or "Lu AA21004" or Vortioxetine or "Lu AA24530" or "LY2216684" or Edivoxetine or Maprotiline or Melitracen or Metapramine or Mianserin or Milnacipran or Minaprine or Mirtazapine or Moclobemide or Nefazodone or Nialamide or Nitroxazepine or Nomifensine or Norfenfluramine or Nortriptylin* or Noxiptilin* or Opipramol or Oxaflozane or Paroxetine or Phenelzine or Pheniprazine or Pipofezine or Pirlindole or Pivagabine or Pizotyline or Propizepine or Protriptylin* or Quinupramine or Reboxetine or Rolipram or Scopolamine or Selegiline or Sertraline or Setiptiline or Teciptiline or Thozalinone or Tianeptin* or Toloxatone or Tranylcypromin* or Trazodone or Trimipramine or Venlafaxine or Viloxazine or Vilazodone or Viqualine or Zalospirone).ti,ab.

32880

6

1 or 2 or 3 or 4 or 5

83585

7

exp Postpartum Depression/

4151

8

((postpartum or post partum or postnatal or post natal or puerper*) adj3 (depress* or dysthymi* or "adjustment disorder*" or "mood disorder*" or "affective disorder*" or "affective symptom*")).ti,ab.

4586

9

7 or 8

5597

10

6 and 9

370

11

(2016* or 2017* or 2018*).yr,dc,mo.

377668

12

10 and 11

44

Notes: N/A

File: GS51 PsycINFO44.txt

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Nortriptyline versus placebo, outcome: 1.1 Recurrence of postpartum major depressive disorder.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 Nortriptyline versus placebo, outcome: 1.1 Recurrence of postpartum major depressive disorder.

Forest plot of comparison: 2 Sertraline versus placebo, outcome: 2.1 Recurrence of postpartum major depressive disorde.
Figuras y tablas -
Figure 5

Forest plot of comparison: 2 Sertraline versus placebo, outcome: 2.1 Recurrence of postpartum major depressive disorde.

Comparison 1 Nortriptyline versus placebo, Outcome 1 Recurrence of postpartum major depressive disorder.
Figuras y tablas -
Analysis 1.1

Comparison 1 Nortriptyline versus placebo, Outcome 1 Recurrence of postpartum major depressive disorder.

Comparison 2 Sertraline versus placebo, Outcome 1 Recurrence of postpartum major depressive disorde.
Figuras y tablas -
Analysis 2.1

Comparison 2 Sertraline versus placebo, Outcome 1 Recurrence of postpartum major depressive disorde.

Summary of findings for the main comparison. Nortripyline for the prevention of postnatal depression

Nortripyline for the prevention of postnatal depression

Patient or population: women with a history of postnatal depression
Intervention: nortripyline

Control: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Tricyclic antidepressants

Postnatal depression (17 weeks)

240 per 10001

230 per 1000
(86 to 622)

RR 0.96
(0.36 to 2.59)

51
(1 study)

⊕⊝⊝⊝
very low2,3

Adverse effects experienced by mother and/or foetus or nursing baby

51
(1 study)

⊕⊝⊝⊝
very low2,3

1 woman assigned to nortriptyline developed mania within the first week.

Constipation was reported more frequently in the nortriptyline than placebo group (78% among women taking nortriptyline and 22% among women taking placebo; Fischer's exact test P < 0.001). This was the only side effect that was more common among women taking nortriptyline than placebo, but the other side effects assessed and the proportion of women experiencing these side effects was not reported.

Acceptability of treatment (17 weeks)

51
(1 study)

⊕⊝⊝⊝
very low2,3

Acceptability of treatment was not assessed directly but 1 woman was lost to follow‐up from the nortriptyline arm (and 1 women in the nortriptyline arm withdrew after developing mania in the first postpartum week) and 3 withdrew from the placebo arm (owing to side effects, personal reasons and pregnancy).

4 participants declined to take the study drug after randomisation.

Overall maternal satisfaction (17 weeks)

No data available

Improvement in the maternal relationship with the baby (17 weeks)

No data available

Establishment or continuation of breastfeeding (17 weeks)

No data available

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1Assumed risk calculated as the proportion of women on placebo with the outcome (postnatal depression) multiplied by 1000

2Downgraded due to high risk of bias in 1 domain (incomplete outcome data)
3Downgraded twice due to imprecision (only 1 small study available for this comparison)

Figuras y tablas -
Summary of findings for the main comparison. Nortripyline for the prevention of postnatal depression
Summary of findings 2. Sertraline for the prevention of postnatal depression

Sertraline for the prevention of postnatal depression

Patient or population: women with a history of postnatal depression
Intervention: sertraline

Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Selective serotonin reuptake inhibitors

Postnatal depression (17 weeks)

500 per 1000

70 per 1000
(10 to 535)

RR 0.14
(0.02 to 1.07)

22
(1 study)

⊕⊝⊝⊝
very low2,3

Adverse effects experienced by mother and/or fetus or nursing baby

22
(1 study)

⊕⊝⊝⊝
very low2,3

1 woman taking sertraline had a hypomanic episode.

2 side effects (dizziness and drowsiness) were more common among women taking sertraline than women taking placebo.

Acceptability of treatment (17 weeks)

22
(1 study)

⊕⊝⊝⊝
very low2,3

Acceptability of treatment was not assessed directly but no difference was found between the antidepressant and placebo groups in the number of women withdrawing from the study (P = 0.35, Fisher’s exact test).

Overall maternal satisfaction (17 weeks)

No data available

Improvement in the maternal relationship with the baby (17 weeks)

No data available

Establishment or continuation of breastfeeding (17 weeks)

No data available

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: we are very uncertain about the estimate.

1Assumed risk calculated as the proportion of women on placebo with the outcome (postnatal depression) multiplied by 1000

2Downgraded due to high risk of bias in 1 domain (incomplete outcome data)
3Downgraded twice due to imprecision (only 1 small study available for this comparison)

Figuras y tablas -
Summary of findings 2. Sertraline for the prevention of postnatal depression
Comparison 1. Nortriptyline versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence of postpartum major depressive disorder Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figuras y tablas -
Comparison 1. Nortriptyline versus placebo
Comparison 2. Sertraline versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Recurrence of postpartum major depressive disorde Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figuras y tablas -
Comparison 2. Sertraline versus placebo