系统综述问题
在本Cochrane综述中，我们想知道抗抑郁药对于治疗产后抑郁症女性的效果如何。
（图片来自www.recoveryranch.com）
为什么这很重要
产后抑郁症是指女性在产后12个月内开始出现的抑郁症。很多女性都受此影响。产后抑郁症可对母亲、婴儿和整个家庭产生严重的短期和长期影响。
治疗产后抑郁症有几种方法，包括使用抗抑郁药物、提供心理治疗、给与支持或咨询。采取哪种治疗方法取决于抑郁症的严重程度、其他疾病以及该女性的选择。通常来说，怀孕或哺乳中的女性经常担心抗抑郁药物会对婴儿有潜在的不良影响。
因此了解抗抑郁药物对产后抑郁症的女性是否有效，以及是否可接受，就很重要。
我们做了什么
2020年5月，我们检索了抗抑郁药物治疗产后抑郁症的研究。我们寻找了随机对照试验，在这些试验中，受试者随机接受治疗。这些研究为我们提供了最可靠的证据。
我们纳入了11项研究，包括1016名女性。这些研究比较了抗抑郁药物和安慰剂（仿真药丸）、常规治疗（观察和等待、定期与护理协调员会面）、心理干预(治疗)、心理社会干预(同伴支持或咨询)、任何其他药物或其他类型的抗抑郁药和补充药物（食品补充剂）。
其中8项研究是在以英语为母语的高收入国家进行的。治疗时间从4周到24周不等。
我们关注的结局是治疗效果如何（有效性）。这是通过对治疗反应良好（反应）或在治疗结束时不再符合抑郁标准（缓解）的人数来衡量的。我们还研究了妇女和/或她们的孩子在治疗过程中是否出现了不良反应。
我们发现了什么？
我们发现抗抑郁药物治疗的女性与服用安慰剂的女性相比，效果可能会更好且产后抑郁症的程度也较轻。但这两个组別在治疗中经历不良反应的妇女人数差不多。目前还没有足够的研究将抗抑郁药物与他类型的治疗方法进行比较。最常被研究的抗抑郁症药物是“SSRI”（血清素特异性再摄取抑制剂）。
结论
本综述仅发现了一些相关的研究。一些证据表明抗抑郁药对于患产后抑郁症的女性来说，可能会比仿真药丸更有效。但目前还没有足够的证据将抗抑郁药与其他治疗产后抑郁症的药物进行比较。临床医生需要考虑来自普通人群与当前临床指南的研究证据，并结合该女性的疾病史和当前症状，对其做出个性化的风险-获益治疗决定。
证据质量
证据质量（可信度）为低。有些发现仅基于少数研究，每个治疗组只有少量的女性。因此，我们不确定结果有多可靠。如果进行更多的研究，我们的结论可能会改变。我们研究发现抗抑郁药可能比仿真药丸更有效，这与在普通人群中进行的大量研究的发现相似。
作者结论:
关于抗抑郁药在产后抑郁症管理中的有效性和安全性的证据仍然有限，特别是对于那些患有更严重抑郁症的患者。我们发现有低质量证据表明，SSRI抗抑郁药治疗产后抑郁症可能在反应率和缓解率方面比安慰剂更有效。然而，低质量的证据意味着进一步的研究很可能会对我们的效果估计产生重要影响。我们有必要继续更多地了解抗抑郁药物或其他治疗方法对产后抑郁症是否更有效、对谁有效，以及某些抗抑郁药物是否比其他药物更有效或耐受性更好。
在临床实践中，本综述的发现需要结合关于一般人群中抗抑郁药的广泛文献和围产期临床指导的背景，以便为个体化的风险-获益临床决策提供信息。今后的随机对照试验应侧重于更大的样本、更长的随访时间、与替代治疗方式的比较，并纳入儿童和父母的结局。
作者：Brown JV, Wilson CA, Ayre K, Robertson L, South E, Molyneaux E, Trevillion K, Howard LM, Khalifeh H；译者：田雨；审校：刘琴，重庆医科大学公共卫生与管理学院循证医学中心 Cochrane中国协作网成员单位 The Cochrane China Network Affiliate School of Public Health and Management, Chongqing Medical University；编辑排版：蒋子昀，北京中医药大学循证医学中心
相关文章链接
【Cochrane Plain Language Summary】Antidepressant treatment for postnatal depression
Review question
In this Cochrane Review, we wanted to find out how well antidepressants work for treating women with postnatal depression.
Why this is important
Postnatal depression is depression that starts within 12 months of a woman having a baby. Many women are affected. Postnatal depression can have serious short- and long-term effects on the mother, the baby, and the family as a whole.
There are several ways to treat postnatal depression. These include antidepressant medication, psychological therapy, support or counselling. The type of treatment offered depends on how severe the depression is, other illnesses and the woman's choice. In general, women who are pregnant or breastfeeding are often anxious about the potential unwanted effects of antidepressant medicines on their baby.
It is important to know whether antidepressants could be an effective and acceptable treatment for women with postnatal depression.
What we did
In May 2020, we searched for studies of antidepressants for women with postnatal depression. We looked for randomised controlled trials, in which treatments were given to study participants at random. These studies give the most reliable evidence.
We included 11 studies involving 1016 women. The studies compared antidepressants with placebo (dummy pill), treatment as usual (watch and wait, regular visits with a care co-ordinator), psychological interventions (therapy), psychosocial interventions (peer support or counselling), any other other medicines or another type of antidepressant; and complementary medicine (food supplements).
Eight of the studies were conducted in English-speaking, high-income countries. The length of treatment ranged from four to 24 weeks.
The outcomes we focused on were how well the treatments worked (effectiveness). This was measured by the number of people who responded well to treatment (response) or no longer met criteria for depression at the end of treatment (remission). We also looked at whether women and/or their babies experienced adverse effects with the treatment.
What did we find?
We found that women treated with antidepressants may respond slightly better and have less severe postnatal depression than women given a placebo. The number of unwanted effects experienced by women was similar between groups. There were not enough studies comparing antidepressants with other types of treatment. The most commonly studied antidepressants were from the 'SSRI' (serotonin specific reuptake inhibitor) group.
Conclusions
We found that women treated with antidepressants may respond slightly better and have less severe postnatal depression than women given a placebo. The number of unwanted effects experienced by women was similar between groups. There were not enough studies comparing antidepressants with other types of treatment. The most commonly studied antidepressants were from the 'SSRI' (serotonin specific reuptake inhibitor) group.
Certainty of the evidence
Our certainty (confidence) in the evidence is low. Some findings are based on only a few studies, with a small number of women in each treatment group. Therefore, we are not sure how reliable the results are. Our conclusions may change if more studies are conducted. Our finding that antidepressants may work better than a dummy pill is similar to findings from a larger number of studies in the general population.
Authors' conclusions:
There remains limited evidence regarding the effectiveness and safety of antidepressants in the management of postnatal depression, particularly for those with more severe depression. We found low-certainty evidence that SSRI antidepressants may be more effective in treating postnatal depression than placebo as measured by response and remission rates. However, the low certainty of the evidence suggests that further research is very likely to have an important impact on our effect estimate. There is a continued imperative to better understand whether, and for whom, antidepressants or other treatments are more effective for postnatal depression, and whether some antidepressants are more effective or better tolerated than others.
In clinical practice, the findings of this review need to be contextualised by the extensive broader literature on antidepressants in the general population and perinatal clinical guidance, to inform an individualised risk-benefit clinical decision. Future RCTs should focus on larger samples, longer follow-up, comparisons with alternative treatment modalities and inclusion of child and parenting outcomes.
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