OBJECTIVES: In clinical practice, postpartum depression (PPD) is often recognized as depression with onset during pregnancy and up to 1 year after childbirth. The objective of this study was to perform a systematic review of the most recent literature to better understand the efficacy and safety of current treatment for women with PPD.

METHODS: A systematic review of Medline, Embase, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and several congresses was conducted according to the PRISMA Statement through February 2017 to identify literature on the treatment of PPD. Disease search terms included "postpartum depression", "postnatal depression", and "peripartum depression". Inclusion criteria included women with PPD aged ≥15 years treated in observational or interventional studies with any pharmacologic therapy.

RESULTS: In total, 889 unique studies were screened by two independent researchers by title and abstract; of these 58 full-text studies were evaluated and 31 were included in this review. In general, evidence supporting the efficacy of pharmacological therapies is limited; in particular, 3 placebo-controlled studies of 303 total patients did not report statistically significant improvements in various depression symptoms scores for nortriptyline or sertraline. In another study of 70 patients with PPD who were randomized to paroxetine or placebo, statistically significant improvements of pharmacologic therapy over placebo were shown for certain outcomes (e.g., proportion achieving remission by week 8, 37% vs. 15%; p = 0.04), whereas other measures of efficacy had borderline or non-significant differences between groups. Overall, evidence supporting the treatment of women with PPD is limited and complicated by variability in the study design and methods used to assess symptoms.

CONCLUSIONS: Several treatments in women with PPD have been studied; however, evidence supporting the efficacy of these therapies is limited.