抗抑郁藥預防產后抑郁的系統評價_《中國循證醫學雜志》

作者：

蔡羽嘉譯

關鍵詞：

產后抑郁抗抑郁藥系統評價療效安全性

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目的　評價在預防產后抑郁中,除臨床標準護理外,不同抗抑郁藥物治療的有效性.比較不同抗抑郁藥物與其他抗產后抑郁干預措施如激素、心理治療或社會支持的有效性,以及抗抑郁藥物在母親和胎兒或嬰兒中的不良反應.
方法　檢索在Cochrane抑郁小組、焦慮與神經官能癥小組、Cochrane妊娠和分娩小組中注冊和更新的臨床試驗.在原無抑郁癥的孕婦或在最近6周內妊娠的婦女(即產后抑郁的危險人群)中進行的,與安慰劑或心理治療比較,單用抗抑郁藥或與其他治療聯合的臨床隨機對照研究.試驗報告數據的提取由作者獨立進行.如有可能,向原作者索取缺失的信息,并尋找數據以便進行ITT分析.
結果　本系統評價共納入2個符合納入標準的試驗.研究對象均為曾有產后抑郁病史婦女.Wisner 2001的研究顯示,去甲替林組(n=26)的療效并不優于安慰劑組(n=25).Wisner 2004的研究顯示,舍曲林組(n=14)與安慰劑組(n=8)比較,減少了產后抑郁癥的再次發生,縮短了再次發病的時間.未能對任何一個試驗進行ITT分析.
結論　對于產后立即給與抗抑郁藥預防產后抑郁的確切療效,目前尚無法得出任何結論.因此不推薦在預防產后抑郁時使用.尚需進行抗抑郁藥物與其他預防措施比較的更大規模的試驗來反映臨床實踐情況,調查其對胎兒或嬰兒的不良反應,并評價婦女對在此階段使用抗抑郁藥物的看法.

引用本文： 蔡羽嘉譯. 抗抑郁藥預防產后抑郁的系統評價. 中國循證醫學雜志, 2005, 05(10): 735-742. doi: 復制

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2.	Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
3.	Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
4.	OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
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15.	Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
16.	Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
17.	Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
18.	Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
19.	Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
20.	Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
21.	Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
22.	Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
23.	Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
24.	Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
25.	Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
26.	Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
27.	Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
28.	Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
29.	Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.

1. O’Hara M,Swain AM.Rates and risk of postpartum depression-a meta-analysis[J].International Review of Psychiatry,1996;8(1):37-54.
2. Cox J,Connor Y,Kendell RE.Prospective study of the psychiatric disorders of childbirth[J].British Journal of Psychiatry,1982;140:111-117.
3. Cooper PJ,Murray L.Postnatal depression[J].BMJ,1998;316(7148):1884-1886.
4. OHara M,Zekoski EM,Philipps LH,Wright EJ.Controlled prospective study of postpartum mood disorders:comparison of childbearing and nonchildbearing women[J].Journal of Abnormal Psychology,1990;99(1):3-15.
5. Kumar R,Robson K.A prospective study of emotional disorders in child bearing women[J].British Journal of Psychiatry,1984;144:35-47.
6. Evans J,Heron J,Francomb H,Oke S,Golding J.Cohort study of depressed mood during pregnancy and after childbirth[J].BMJ,2001;323(7307):257-260.
7. Rose G.Sick individuals and sick populations[J].International Journal of Epidemiology,1985;14(1):32-39.
8. Appleby L,Gregoire A,Platz C,Martin P,Kumar R.Screening women for high risk of postnatal depression[J].Journal of Psychosomatic Research,1994;38:539-545.
9. Austin MP,Lumley J.Antenatal screening for women at risk of post-natal depression[J].Acta Psychiatrica Scandinavica,2002;106:1-8.
10. Warner R,Appleby L,Whitton A,Faragher B.Demographic and obstetric risk factors for postnatal psychiatric morbidity[J].British Journal of Psychiatry,1996;168:607-611.
11. Cooper PJ,Murray L,Hooper R,West A.The development and validation of a predictive index for postpartum depression[J].Psychological Medicine,1996;26(3):627-634.
12. Heath AC,Yonkers KA.Management of Psychiatric Disorders in Pregnancy[M].London:Arnold,2001.
13. Costei AM,Kozer E,Ho T,Ito S,Koren G.Perinatal outcome following third trimester exposure to paroxetine[J].Archives of Pediatrics and Adolescent Medicine,2002;156(11):1129-1132.
14. Hendrick V,Stowe ZN,Altshuler L,Hwang S,Lee E,Haynes D.Placental passage of antidepressant medication[J].American Journal of Psychiatry,2003;160(5):993-996.
15. Laine K,Heikkinen T,Ekblad U,Kero P.Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations[J].Archives of General Psychiatry,2003;60(7):720-726.
16. Zeskind PS,Stephens LE.Maternal selective serotonin reuptake inhibitor use during pregnancy and newborn neurobehaviour[J].Pediatrics,2004;113(2):368-375.
17. Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy[J].Archives of Pediatrics and Adolescent Medicine,2004;158(4):312-316.
18. Watson JP,Elliot SA,Rugg AJ,Brough DI.Psychiatric disorder in pregnancy and the first postnatal year[J].British Journal of Psychiatry,1984;144:453-462.
19. Hoffbrand S,Howard L,Crawley H.Anti-depressant drug treatment for postnatal depression[CD/M].In:The Cochrane Library,Issue 2,2001.Oxford:Update Software.
20. Yoshida K,Smith B,Kumar R.Psychotropic drugs in mothers’ milk:a comprehensive review of assay methods,pharmakokinetics and safety of breastfeeding[J].Journal of Psychopharmacology,1999;139:64-80.
21. Dennis CL,Kavanagh J.Psychosocial interventions for preventing postpartum depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
22. Lawrie TA,Herxheimer A,Dalton K.Oestrogens and progestogens for preventing and treating postnatal depression[CD/M].In:The Cochrane Library,Issue 4,2002.Oxford:Update Software.
23. Cox JL,Holden J,Sagovsky R.Detection of postnatal depression:development of the 10-item Edinburgh Postnatal Depression Scale (EPDS)[J].British Journal of Psychiatry,1987;150:782-786.
24. Spitzer R,Endicott J,Robins E.Research Diagnostic Criteria;rationale and reliability[J].Archives of General Psychiatry,1978;35:773-782.
25. Smeeth L,Haines A,Ebrahim S.Numbers needed to treat derived from meta-analyses-sometimes informative,usually misleading[J].BMJ,1999;318(7197):1548-1551.
26. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Findling RL,Rapport D.Prevention of recurrent postpartum depression:a randomized clinical trial[J].Journal of Clinical Psychiatry,2001;62(2):82-86.
27. Wisner KL,Perel JM,Peindl KS,Hanusa BH,Piontek CM,Findling RL.Prevention of postpartum depression:a pilot randomized clinical trial[J].American Journal of Psychiatry,2004;62(2):82-86.
28. Griffin LD,Mellon SH.Selective serotonin reuptake inhibitors directly alter activity of neurosteroidogenic enzymes[J].Proceedings of the National Academy of Sciences,1999;96(23):13512-13517.
29. Geddes JR,Carney SM,Davies C,Furukawa TA,Kupfer DJ,Frank E et al.Relapse prevention with antidepressant drug treatment in depressive disorders:a systematic review[J].Lancet,2003;361:653-651.

《中國循證醫學雜志》

抗抑郁藥預防產后抑郁的系統評價

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《中國循證醫學雜志》

抗抑郁藥預防產后抑郁的系統評價

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

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