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Treatments for postnatal depression assessed

13 October 2010

Giving antidepressants to women with postnatal depression early in the course of the illness is likely to result in the greatest improvement in symptoms, according to new research from Institute of Psychiatry (IoP) at King's and colleagues from the University of Bristol, University of Southampton and University of Manchester.

Postnatal depression is a substantial public health problem affecting around 10 per cent of new mothers.  It can lead to long-term serious consequences for mother, baby, family, friends and colleagues.  Despite its frequency and potential long-term consequences, only about 50 per cent of cases of postnatal depression are detected by health professionals.  However, like other forms of depression, if detected, postnatal depression is easily treatable.

Researchers compared the effectiveness and cost-effectiveness of antidepressant drug therapy with a community-based psychosocial intervention.  A total of 254 women were recruited from 77 general practices in England to receive either an antidepressant prescribed by their GP or counselling (listening visits) from a specially trained research health visitor (HV).

The results show that in the population studied where the prevalence of postnatal depression was just under 10 per cent, antidepressants were significantly superior to general supportive care at four weeks.  There was a lack of evidence for a significant difference between antidepressant therapy and listening visits at 18 weeks as the trial design allowed women to switch groups, or add the alternative intervention at any time after four weeks.

Chief Investigator Professor Debbie Sharp, University of Bristol, said 'Although many women, at least initially, revealed a preference for listening visits, it would appear that starting women on antidepressants early in the course of illness is likely to result in the greatest improvement in symptoms'.

Profs Andre Tylee and Louise Howard, IoP at King's, were Principle Investigators and co-supervisors of the London arm of the trial.

Louise Howard, Professor of Women's Mental Health and Consultant Perinatal Psychiatrist said 'GPs, health visitors and other professionals in primary and secondary care need to agree the care pathway for women who suffer from postnatal depression, not only for the benefit of the mother, but also the child. Treatment should be tailored to the individual needs and preferences of the woman where possible, after ensuring women have been provided with comprehensive information about the different types of treatments.'

Professor of Primary Care Mental Health and academic general practitioner Andre Tylee concludes 'This pragmatic trial confirms the vital role of general practitioners and community health visitors in the management of moderate postnatal depression in the community.'

The study was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme which commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS.  It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 550 issues published to date.

The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training.  Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients.

The publication A pragmatic randomised controlled trial to compare antidepressants with a community-based psychosocial intervention for the treatment of women with postnatal depression: the RESPOND trial can be accessed here:

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