Sertraline in the treatment of women with postpartum major depression

Abstract

No consensus has yet been reached as to whether or not postpartum depression (PPD) represents a distinct clinical entity. Despite the increasing evidence that gender differences may exist in antidepressant treatment response, there is an absence of studies in women with postpartum onset of major depression. The aim of this study was to assess the clinical efficacy of the selective serotonin reuptake inhibitor (SSRI), sertraline, in the treatment of women with a major depressive episode (MDE) that occurred within 6 months of childbirth using an 8 week, prospective, open-labelled design. Further, we sought to determine if the Edinburgh Postnatal Depression Scale (EPDS) was a useful instrument to monitor the clinical response to drug treatment. Twenty-six postpartum women who fulfilled DSM-IIIR criteria for major depressive episode, non-psychotic, with symptom onset within 6 months postpartum were enrolled in the study. Biweekly assessments included physician and self-rated depression measures. Twenty-one of the women (81%) completed the 8 week study; 20 women exhibited a salutary response as defined by > 50% reduction from baseline in SIGH-D scores (mean reduction = 15.7 points). Fourteen women demonstrated complete symptom remission with recovery of function (SIGH-D < 7, CGI = 1, GAP > 80) upon completion of the 8 week study. Three women experienced significant side effects; these included gastrointestinal disturbance (n =1) and anorgasmia (n = 2). Our results indicate that: (1) sertraline is a highly efficacious and well-tolerated treatment for women with postpartum depression; (2) the EPDS is comparable to the BDI and SIGH-D for monitoring treatment response in women with postpartum onset MDE; (3) PPD (MDE onset within 4 weeks postpartum, as defined by DSM IV) required significantly less medication and tended to respond faster than MDE onset after 4 weeks postpartum; and (4) the rapid response rate underscores the need to conduct placebo-controlled studies in this population. Depression 3:49–55 (1995). © 1995 Wiley-Liss, Inc.