Prevention of Recurrent Postpartum Depression: A Randomized Clinical Trial
J Clin Psychiatry 2001;62:82-86
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Women who have suffered one
episode of postpartum-onset major depression (PPMD) comprise a
high-risk group for subsequent episodes. We conducted a
double-blind, randomized clinical trial to test the efficacy of
nortriptyline in the prevention of recurrent PPMD.
Method: Nondepressed women who had at least one
past episode of PPMD (Research Diagnostic Criteria) were
recruited during pregnancy. Subjects were randomly assigned to
nortriptyline or placebo. Treatment began immediately postpartum.
Each subject was assessed for 20 sequential weeks with the
Hamilton Rating Scale for Depression and Research Diagnostic
Criteria for recurrence of major depression.
Results: No difference was found in the rate of
recurrence in women treated with nortriptyline compared with
those treated with placebo. Of 26 subjects who took nortriptyline
preventively, 6 (0.23, 95% exact confidence interval [CI] = 0.09
to 0.44) suffered recurrences. Of 25 subjects who took placebo, 6
(0.24, 95% exact CI = 0.09 to 0.45) suffered recurrence (Fisher
exact p = 1.00).
Conclusion: Nortriptyline did not confer
additional preventive efficacy beyond that of placebo. The rate
of recurrence of PPMD (one fourth of women) was unacceptably