Treatment of postpartum depression, part 1: A critical review of biological interventions

Background: While postpartum depression is a major health issue for many women from diverse cultures, this affective condition often remains undiagnosed and untreated. The objective of this article is to critically review the literature to determine the current state of scientific knowledge related to the treatment of postpartum depression from a biological perspective. Method: Databases searched for this review included MEDLINE, PubMed, CINAHL, PsycINFO, EMBASE, ProQuest, the Cochrane Library, and the WHO Reproductive Health Library from 1966 to 2003. The search terms used were postpartum/postnatal depression and randomized controlled/clinical trials in various combinations. Published peer-reviewed articles in English from 1990 to 2003 were chosen for review, although select earlier studies were also included based on good methodological quality and/or the absence of more recent work. The criteria used to evaluate the interventions were based on the standardized methodology developed by the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care. Results: Nine studies that met study criteria were examined. The interventions studied included antidepressant medication, estrogen therapy, critically timed sleep deprivation, and bright light therapy. Although some of these interventions have been better studied for depression unrelated to childbirth, methodological limitations render their efficacy equivocal for postpartum depression with limited strong evidence available to guide practice or policy recommendations. Conclusions: Despite the recent upsurge of interest in this area, many questions remain unanswered, resulting in diverse research implications. In view of the lack of randomized controlled trials, psychiatrists who are experts in the treatment of postpartum mood disorders have developed consensus guidelines. These guidelines will require regular updating as better and stronger evidence emerges.