Nortripyline for the prevention of postnatal depression

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

Control: placebo

Postnatal depression (17 weeks)

RR 0.96
(0.36 to 2.59)

51
(1 study)

⊕⊝⊝⊝
very low^2,3

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

51
(1 study)

⊕⊝⊝⊝
very low^2,3

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 low^2,3

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)

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

Establishment or continuation of breastfeeding (17 weeks)

*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.

Sertraline for the prevention of postnatal depression

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

Comparison: placebo

Postnatal depression (17 weeks)

RR 0.14
(0.02 to 1.07)

22
(1 study)

⊕⊝⊝⊝
very low^2,3

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

22
(1 study)

⊕⊝⊝⊝
very low^2,3

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 low^2,3

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)

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

Establishment or continuation of breastfeeding (17 weeks)

*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.