The treatment of postnatal depression: a comprehensive literature review

The aim of this comprehensive review was to identify and critically review all published studies of the treatment of postnatal depression, including those who would be excluded from systematic reviews because of their stringent inclusion criteria. A search of the electronic databases Medline, PsychLit, Sociofile, CINAHL, COPAC and that of published books held by the British Library was carried out in 2000, using the key words: postnatal depression; postpartum depression; puerperal depression; and treatment. The search strategy was limited to English language references using human subjects from 1964 to 2000. A very broad definition of postnatal depression was used and papers were included if they had clearly defined their main purpose as the treatment, as opposed to the prevention, of postnatal depression. Studies of postpartum blues and puerperal psychosis were excluded. This search strategy identified 30 articles. Copies of relevant papers were obtained and the authors independently read and critiqued the published articles using critical appraisal criteria designed specifically for this narrative review. The reviews were combined, clarification was sought from authors and disagreements were discussed until agreement was reached. Treatment approaches were categorized as: pharmacological; psychological & psychodynamic; pharmacological & psychological; social support & relaxation; and hormonal. The methodological limitations of these studies means that the efficacy of these treatment approaches have not been clearly established and there is very little good evidence available on which to make policy or practice recommendations; thus, further work in this area is warranted.