目的 　評(píng)價(jià)在預(yù)防產(chǎn)后抑郁中,除臨床標(biāo)準(zhǔn)護(hù)理外,不同抗抑郁藥物治療的有效性.比較不同抗抑郁藥物與其他抗產(chǎn)后抑郁干預(yù)措施如激素、心理治療或社會(huì)支持的有效性,以及抗抑郁藥物在母親和胎兒或嬰兒中的不良反應(yīng).
方法 　檢索在Cochrane抑郁小組、焦慮與神經(jīng)官能癥小組、Cochrane妊娠和分娩小組中注冊(cè)和更新的臨床試驗(yàn).在原無(wú)抑郁癥的孕婦或在最近6周內(nèi)妊娠的婦女(即產(chǎn)后抑郁的危險(xiǎn)人群)中進(jìn)行的,與安慰劑或心理治療比較,單用抗抑郁藥或與其他治療聯(lián)合的臨床隨機(jī)對(duì)照研究.試驗(yàn)報(bào)告數(shù)據(jù)的提取由作者獨(dú)立進(jìn)行.如有可能,向原作者索取缺失的信息,并尋找數(shù)據(jù)以便進(jìn)行ITT分析.
結(jié)果 　本系統(tǒng)評(píng)價(jià)共納入2個(gè)符合納入標(biāo)準(zhǔn)的試驗(yàn).研究對(duì)象均為曾有產(chǎn)后抑郁病史婦女.Wisner 2001的研究顯示,去甲替林組(n=26)的療效并不優(yōu)于安慰劑組(n=25).Wisner 2004的研究顯示,舍曲林組(n=14)與安慰劑組(n=8)比較,減少了產(chǎn)后抑郁癥的再次發(fā)生,縮短了再次發(fā)病的時(shí)間.未能對(duì)任何一個(gè)試驗(yàn)進(jìn)行ITT分析.
結(jié)論 　對(duì)于產(chǎn)后立即給與抗抑郁藥預(yù)防產(chǎn)后抑郁的確切療效,目前尚無(wú)法得出任何結(jié)論.因此不推薦在預(yù)防產(chǎn)后抑郁時(shí)使用.尚需進(jìn)行抗抑郁藥物與其他預(yù)防措施比較的更大規(guī)模的試驗(yàn)來(lái)反映臨床實(shí)踐情況,調(diào)查其對(duì)胎兒或嬰兒的不良反應(yīng),并評(píng)價(jià)婦女對(duì)在此階段使用抗抑郁藥物的看法.

引用本文： 蔡羽嘉 譯. 抗抑郁藥預(yù)防產(chǎn)后抑郁的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2005, 05(10): 735-742. doi: 復(fù)制

1. O’Hara M,Swain AM.Rates and risk of postpartum depression-a meta-analysis[J].International Review of Psychiatry,1996;8(1):37-54.
2. Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
3. Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
4. OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
5. Kumar R,Robson K.A prospective study of emotional disorders in child bearing women[J].British Journal of Psychiatry,1984;144:35-47.
6. Evans J,Heron J,Francomb H,Oke S,Golding J.Cohort study of depressed mood during pregnancy and after childbirth[J].BMJ,2001;323(7307):257-260.
7. Rose G.Sick individuals and sick populations[J].International Journal of Epidemiology,1985;14(1):32-39.
8. Appleby L,Gregoire A,Platz C,Martin P,Kumar R.Screening women for high risk of postnatal depression[J].Journal of Psychosomatic Research,1994;38:539-545.
9. Austin MP,Lumley J.Antenatal screening for women at risk of post-natal depression[J].Acta Psychiatrica Scandinavica,2002;106:1-8.
10. Warner R,Appleby L,Whitton A,Faragher B.Demographic and obstetric risk factors for postnatal psychiatric morbidity[J].British Journal of Psychiatry,1996;168:607-611.
11. Cooper PJ,Murray L,Hooper R,West A.The development and validation of a predictive index for postpartum depression[J].Psychological Medicine,1996;26(3):627-634.
12. Heath AC,Yonkers KA.Management of Psychiatric Disorders in Pregnancy[M].London:Arnold,2001.
13. Costei AM,Kozer E,Ho T,Ito S,Koren G.Perinatal outcome following third trimester exposure to paroxetine[J].Archives of Pediatrics and Adolescent Medicine,2002;156(11):1129-1132.
14. Hendrick V,Stowe ZN,Altshuler L,Hwang S,Lee E,Haynes D.Placental passage of antidepressant medication[J].American Journal of Psychiatry,2003;160(5):993-996.
15. Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
16. Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
17. Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
18. Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
19. Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
20. Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
21. Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
22. Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
23. Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
24. Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
25. Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
26. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
27. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
28. Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
29. Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.
  1. 1. O’Hara M,Swain AM.Rates and risk of postpartum depression-a meta-analysis[J].International Review of Psychiatry,1996;8(1):37-54.
  2. 2. Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
  3. 3. Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
  4. 4. OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
  5. 5. Kumar R,Robson K.A prospective study of emotional disorders in child bearing women[J].British Journal of Psychiatry,1984;144:35-47.
  6. 6. Evans J,Heron J,Francomb H,Oke S,Golding J.Cohort study of depressed mood during pregnancy and after childbirth[J].BMJ,2001;323(7307):257-260.
  7. 7. Rose G.Sick individuals and sick populations[J].International Journal of Epidemiology,1985;14(1):32-39.
  8. 8. Appleby L,Gregoire A,Platz C,Martin P,Kumar R.Screening women for high risk of postnatal depression[J].Journal of Psychosomatic Research,1994;38:539-545.
  9. 9. Austin MP,Lumley J.Antenatal screening for women at risk of post-natal depression[J].Acta Psychiatrica Scandinavica,2002;106:1-8.
  10. 10. Warner R,Appleby L,Whitton A,Faragher B.Demographic and obstetric risk factors for postnatal psychiatric morbidity[J].British Journal of Psychiatry,1996;168:607-611.
  11. 11. Cooper PJ,Murray L,Hooper R,West A.The development and validation of a predictive index for postpartum depression[J].Psychological Medicine,1996;26(3):627-634.
  12. 12. Heath AC,Yonkers KA.Management of Psychiatric Disorders in Pregnancy[M].London:Arnold,2001.
  13. 13. Costei AM,Kozer E,Ho T,Ito S,Koren G.Perinatal outcome following third trimester exposure to paroxetine[J].Archives of Pediatrics and Adolescent Medicine,2002;156(11):1129-1132.
  14. 14. Hendrick V,Stowe ZN,Altshuler L,Hwang S,Lee E,Haynes D.Placental passage of antidepressant medication[J].American Journal of Psychiatry,2003;160(5):993-996.
  15. 15. Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
  16. 16. Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
  17. 17. Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
  18. 18. Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
  19. 19. Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
  20. 20. Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
  21. 21. Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
  22. 22. Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
  23. 23. Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
  24. 24. Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
  25. 25. Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
  26. 26. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
  27. 27. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
  28. 28. Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
  29. 29. Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.