Pittsburgh, Aug. 15 -- Two antidepressants commonly used to treat depression in the general population also can effectively and safely treat postpartum depression, according to a University of Pittsburgh School of Medicine-led study published as a lead article in the August issue of the Journal of Clinical Psychopharmacology.
The study is among the first to compare the effectiveness of selective serotonin reuptake inhibitors (SSRIs) and tricyclics, two commonly used classes of antidepressants, in women who experience major depression after childbirth.
"We've been treating postpartum depression based on the assumption that drugs that work for a woman with depression under usual circumstances will work for a woman who experiences depression after giving birth, but there have not been studies that provide scientific proof that this was an effective and safe course of treatment," said Katherine L. Wisner, M.D., M.S., professor of psychiatry and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine. "Treating these women based on that assumption was simply not good enough, and we felt compelled to provide scientific evidence to guide postpartum depression treatment decisions."
In the study, researchers compared the tricyclic nortriptyline and the SSRI sertraline because both drugs were proven effective in treating general depression in women. In addition, previous studies showed the two drugs were acceptable for use in breastfeeding women. Researchers interviewed 420 women who had major depression with postpartum onset at three sites: Pittsburgh, Cleveland and Louisville, Ky. Of those, 109 qualified and chose to participate in the study. They were randomized to receive either nortriptyline or sertraline. A placebo was not used, as researchers felt it would be unethical and dangerous to the mother and her infant to not treat the illness actively. Using common tools for assessment of depression, the investigators evaluated the women for remission of depressive symptoms at four, eight and 24 weeks. The latter evaluation point included only women who had responded after eight weeks. Of the original 109 participants, 95 provided response data at four weeks, 83 provided data at eight weeks, and 29 completed between 20 and 24 weeks of the study.
The proportion of women who responded with a reduction in depressive symptoms, and those who remitted, having few depressive symptoms consistent with wellness, did not significantly differ between the two drugs at any of the study's time points. By week four, 46 percent of the participants taking sertraline had responded and 27 percent remitted, while 56 percent of those taking nortriptyline responded and 30 percent remitted. At eight weeks, 56 percent of the participants on sertraline had a reduction of symptoms and 46 percent had no symptoms, while the participants taking nortriptyline had 69 percent respond and 48 percent remit. Of the 29 participants who remained in the study until 20-24 weeks, 93 percent taking sertraline responded and 73 percent remitted, while 100 percent taking nortriptyline responded and 79 percent remitted. None of these differences were significant by statistical analyses.
Additionally, researchers found that psychosocial functioning improved similarly with use of both drugs. Neither drug proved to be superior to the other in treating aggressive obsessional thoughts. Side-effect burdens were the same, although side effects differed between the drugs. Overall, the majority of women responded to both of the drugs within two to four weeks.
"Conventional wisdom says that it can take six to eight weeks for a person to respond to an antidepressant. Several weeks is simply too long to wait for a response in postpartum depression," said Dr. Wisner. "It's encouraging to see that these women responded quickly and well to the study medications and that now we have scientific proof on which to base our treatment decisions."
Co-authors of the study include Barbara H. Hanusa, Ph.D., James M. Perel, Ph.D., Dorothy K.Y. Sit, M.D., and Eydie Moses-Kolko, M.D., from Women's Behavioral Health CARE at the Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center; Kathleen S. Peindl, Ph.D., department of psychiatry, Duke University Medical Center, Catherine M. Piontek, M.D., Interlink Health Care Communications, Lawrenceville, N.J.; and Robert L. Findline, M.D., department of psychiatry, Case Western Reserve University and University Hospitals Health System, Cleveland.
This study was funded through grants from the National Institute of Mental Health, one of the National Institutes of Health.
The sertraline used in this study was donated by Pfizer, but Pfizer did not provide any direct financial support for the conduct of the study. Dr. Wisner is a member of Pfizer's speaker's bureau and has a grant from Pfizer for a study of ziprasidone pharmacokinetics during pregnancy. Dr. Wisner also is a member of the speaker's bureau for GlaxoSmithKline. She has research funding from the Stanley Medical Research Institute. Full financial disclosures of all the authors can be found in the article, available on request.