Prevention of recurrent postpartum major depression

Objective: Postpartum depression affects between 10 and 15 percent of new mothers. These mothers are apprehensive about recurrence after later births. This study tested the efficacy of antidepressant medication administered during the postpartum period to prevent a recurrence of postpartum depression among women who had suffered a previous episode. Methods: An open clinical trial was conducted at a university-based outpatient clinic treating pregnant and postpartum women with mood disorders. Study participants were 23 pregnant women who had at least one previous postpartum episode that fit DSM-III-R criteria for nonbipolar major depression without psychotic features. Post- partum monitoring for recurrence of depressive symptoms was compared with postpartum monitoring plus postbirth treatment with either the medication that had been effective for the previous episode or nortriptyline. The first dose was given within 24 hours of birth. The authors assessed recurrence of postpartum major depression by psychiatric examination and use of the Inventory to Diagnose Depression, a reliable self-report instrument. Results: A significantly greater proportion of the women who elected monitoring alone (62.5 percent) suffered recurrence of major depression compared with the women who received monitoring plus medication (6.7 percent) (p = .0086). Conclusions: Prophylactic antidepressant treatment reduced the recurrence of postpartum major depression.