Kimberly A. Yonkers, MD; Haiqun Lin, PhD; Heather B. Howell, MSW, LCSW; A. Christopher Heath, MD; and Lee S. Cohen, MD
Objective: Approximately 6% to 8% of postpartum women suffer
from major depressive disorder (MDD), but only a few controlled trials have
investigated the efficacy of pharmacologic treatments. The current study
determined the relative efficacy of paroxetine compared to placebo in the
treatment of acute postpartum MDD.
Method: This was an 8-week, multicenter, parallel,
placebo-controlled trial of paroxetine for treatment of postpartum depression.
Subjects were eligible if they had an onset of DSM-IV MDD after, but within 3
months of, delivery and had a minimum score of 16 on the 17-item Hamilton
Rating Scale for Depression (HAM-D-17) at intake. Seventy women were randomly
assigned to either immediate-release paroxetine or matching placebo, and 31
completed the trial. Subjects were reassessed with the HAM-D-17, the Inventory
of Depressive Symptomatology-Self-Report (IDS-SR) form and the Clinical Global
Impressions (CGI) scales. The study was conducted between 1997 and 2004.
Results: Both groups improved over time and did not differ
significantly on the HAM-D-17 or IDS-SR at follow-up. However,
greater improvement in overall mean ± SD clinical severity was found for the
paroxetine (Clinical Global Impressions-Severity of Illness [CGI-S] score = 1.8
± 1.4) compared with the control group (CGI-S score = 3.1 ± 1.4; p = .05). The
paroxetine group also had a significantly higher rate of remission, compared to
the placebo group (37% vs. 15%, odds ratio = 3.5, 95% CI = 1.1 to 11.5). The
rate of adverse effects did not differ significantly between groups.
Conclusion: Study results were limited by lower than expected
enrollment and higher than anticipated attrition. Nonetheless, paroxetine
treatment was associated with a significantly higher rate of remission among
women with postpartum onset of MDD.
J Clin Psychiatry 2008;69(4):659-665
© Copyright 2008 Physicians Postgraduate Press, Inc.