Predictors of response to antidepressants in women with postpartum depression: a systematic review
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REVIEW ARTICLE
Predictors of response to antidepressants in women with postpartum depression: a systematic review Verinder Sharma 1,2 & Mustaq Khan 1 & Christine Baczynski 2 & Isabel Boate 3,4 Received: 25 March 2020 / Accepted: 8 June 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Antidepressants are the mainstay of drug treatment for moderate or severe postpartum depression. Knowledge of predictors of response could help optimize treatment and reduce the adverse consequences of postpartum depression. The purpose of this systematic review was to ascertain predictors of response or remission to antidepressant treatment in women with postpartum depression. The electronic databases of MEDLINE/PubMed, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, and Evidence-based Medicine Reviews were searched through December 2019. The search was limited to studies published in the English language. Reference lists of articles that met the inclusion criteria were also searched. We identified some predictors of response and remission that could potentially assist in the optimization of drug treatment of postpartum depression; however, caution is needed to apply these findings in clinical practice due to the heterogeneous nature of postpartum depression. The results of our review highlight the urgent need to identify predictors of response, non-response, or remission to antidepressants in women with postpartum depression. Keywords Predictors . Antidepressants . Postpartum . Depression . Response
Introduction Postpartum depression is the most common medical complication of childbearing that affects approximately 14% of women in the first few weeks after delivery (Wisner et al. 2013). Although its prevalence is similar to that of nonpostpartum depression in the general female population (Centers for Disease Control and Prevention 2017), untreated postpartum depression has potentially long-term adverse consequences for the woman, her child, and her family (Field 2010; Netsi et al. 2018). Postpartum depression affects several caregiving activities including feeding practices, sleep routines, well child visits, and vaccinations (Field 2010). It is also * Verinder Sharma [email protected] 1
University of Western Ontario, London, Canada
2
Parkwood Institute, Mental Health Care Building, Stn B, P.O. Box 5777, London, ON N6A 4V2, Canada
3
University of Ottawa, Ottawa, Canada
4
The Ottawa Hospital, Ottawa, Canada
a leading cause of maternal mortality due to suicide (Grigoriadis et al. 2017). The symptom profile of postpartum depression is similar to symptoms of non-postpartum depression, but may include anxiety features, mood swings, excessive concern regarding the child’s health, feelings of inadequacy as a mother, and fear of harming the baby (Kettunen et al. 2014). Antidepressants—particularly selective serotonin reuptake inhibitors (SSRIs)—are the mainstay of drug treatment for postpartum depression. The National Institute for Health and Care Excellence (NICE) guideline recommends antidepres
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