1 Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.
2 Department of Psychiatry, Westmead Hospital, Westmead, NSW, Australia.
Aust N Z J Psychiatry. 2018 Apr;52(4):320-327. doi: 10.1177/0004867418762057. Epub 2018 Mar 5.
Several countries have developed Clinical Practice Guidelines regarding treatment of perinatal depressive symptoms and perinatal use of antidepressant. We aimed to compare guidelines to guide clinicians in best clinical practice.
An extensive search in guideline databases, MEDLINE and PsycINFO was performed. When no guidelines were (publicly) available online, we contacted psychiatric-, obstetric-, perinatal- and mood disorder societies of all first world countries and the five largest second world countries. Only Clinical Practice Guidelines adhering to quality criteria of the Appraisal of Guidelines for Research and Evaluation instrument and including a systematic review of evidence were included. Data extraction focussed on recommendations regarding continuation or withdrawal of antidepressants and preferred treatment in newly depressed patients.
Our initial search resulted in 1094 articles. After first screening, 40 full-text articles were screened. Of these, 24 were excluded for not being an official Clinical Practice Guidelines. In total, 16 Clinical Practice Guidelines were included originating from 12 countries. Eight guidelines were perinatal specific and eight were general guidelines.
During pregnancy, four guidelines advise to continue antidepressants, while there is a lack of evidence supporting this recommendation. Five guidelines do not specifically advise or discourage continuation. For new episodes, guidelines agree on psychotherapy (especially cognitive behavioural therapy) as initial treatment for mild to moderate depression and antidepressants for severe depression, with a preference for sertraline. Paroxetine is not preferred treatment for new episodes but switching antidepressants for ongoing treatment is discouraged (three guidelines). If mothers use antidepressants, observation of the neonate is generally recommended and breastfeeding encouraged.
一些国家已经制定了围产期抑郁症状和围产期使用抗抑郁药的临床实践指南。我们旨在比较这些指南，以指导临床医生采取最佳的临床实践。
我们在指南数据库、MEDLINE 和 PsycINFO 中进行了广泛的搜索。当没有在线发布的指南时，我们联系了所有第一世界国家和五个最大的第二世界国家的精神病学、产科、围产期和情绪障碍学会。只有符合评估研究和评估工具质量标准并包括对证据进行系统审查的临床实践指南才被包括在内。数据提取重点关注关于继续或停止使用抗抑郁药以及新出现抑郁患者首选治疗的建议。
我们最初的搜索结果为 1094 篇文章。经过初步筛选，对 40 篇全文文章进行了筛选。其中，24 篇因不符合正式临床实践指南而被排除在外。总共纳入了 16 篇来自 12 个国家的临床实践指南。其中 8 篇是围产期特定的，8 篇是一般指南。
在怀孕期间，有四个指南建议继续使用抗抑郁药，而没有证据支持这一建议。五个指南没有特别建议或不鼓励继续使用。对于新出现的病例，指南一致认为心理治疗（特别是认知行为疗法）是轻度至中度抑郁的初始治疗方法，严重抑郁则使用抗抑郁药，首选舍曲林。帕罗西汀不是新出现病例的首选治疗方法，但不鼓励继续使用抗抑郁药（三个指南）。如果母亲使用抗抑郁药，通常建议观察新生儿并鼓励母乳喂养。
