title: Selective serotonin reuptake inhibitors (SSRIs) for post-partum depression (PPD): a systematic review of randomized clinical trials.
abstract: BACKGROUND
  The treatment of postpartum depression with selective serotonin reuptake inhibitors (SSRIs) has been claimed to be both efficacious and well tolerated, but no recent systematic reviews have been conducted.
  
  
  METHODS
  A qualitative systematic review of randomized clinical trials on women with postpartum depression comparing SSRIs to placebo and/or other treatments was performed. A comprehensive literature search of online databases, the bibliographies of published articles and grey literature were conducted. Data on efficacy, acceptability and tolerability were extracted and the quality of the trials was assessed.
  
  
  RESULTS
  Six randomised clinical trials, comprising 595 patients, met quality criteria for inclusion in the analysis. Cognitive-behavioural intervention, psychosocial community-based intervention, psychodynamic therapy, cognitive behavioural therapy, a second-generation tricyclic antidepressant and placebo were used as comparisons. All studies demonstrated higher response and remission rates among those treated with SSRIs and greater mean changes on depression scales, although findings were not always statistically significant. Dropout rates were high in three of the trials but similar among treatment and comparison groups. In general, SSRIs were well tolerated and trial quality was good.
  
  
  CONCLUSIONS
  There are few trials, patients included in the trials were not representative of all patients with postpartum depression, dropout rates in three trials were high, and long-term efficacy and tolerability were assessed in only two trials.
  
  
  CONCLUSIONS
  SSRIs appear to be efficacious and well tolerated in the treatment of postpartum depression, but the available evidence fails to demonstrate a clear superiority over other treatments.
authors.affiliation: Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy. Electronic address: decrescenzo.franco@gmail.com.
authors.forename: Franco
authors.initials: F
authors.lastname: De Crescenzo
authors.forename: Federica
authors.initials: F
authors.lastname: Perelli
authors.forename: Marco
authors.initials: M
authors.lastname: Armando
authors.forename: Stefano
authors.initials: S
authors.lastname: Vicari
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D019052:Depression, Postpartum / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Depression; Postpartum; Serotonin uptake inhibitors; Systematic review