Sertraline Added to Therapy May Fall Short in Postpartum Depression

PARIS – Postpartum depression is such a common problem that it’s surprising there are so few randomized, controlled studies comparing drug therapy versus nondrug treatment options. Many women with postpartum depression don’t seek treatment, some are treated only with psychotherapy because of concerns regarding pharmacotherapy, and others are treated with antidepressants alone.

Israeli investigators conducted a small, randomized, controlled study in 40 women with mild to moderate postpartum depression lasting 6 months or longer. They expected psychotherapy plus the antidepressant sertraline to be more effective than psychotherapy alone, but they were surprised to find no additional benefit from the drug.

Response rates were 70% in women who received both psychotherapy and sertraline and 55% in those who got psychotherapy and a placebo. This was not a statistically significant difference at a P value of 0.33, Dr. Miki Bloch and his associates reported at the annual congress of the European College of Neuropsychopharmacology. The rates of remission after 8 weeks of treatment were 65% in the combination therapy group and 50% in the psychotherapy plus placebo group, which also was not a significant difference at a P value of 0.34, said Dr. Bloch of Tel Aviv (Israel) University.

All patients started 12 consecutive weekly sessions of Malan-based brief focused dynamic psychotherapy by expert psychotherapists, Dr. Bloch said in an interview. At the same time, the women were randomized to receive 50 mg sertraline or a placebo pill for 4 weeks, after which the psychiatrist could choose to increase the dose to 100 mg. After 8 weeks, the drug groups were unblinded and patients could continue open-label drug therapy for 4 weeks if desired.

Two women in the sertraline group developed hypomanic symptoms, but treatment was otherwise well tolerated. Initially, 42 women were enrolled but 2 dropped out during the first week and were not included in the intent-to-treat analysis.

Adding sertraline does not seem to add any benefit to psychotherapy alone, based on this small trial. "While a type 2 error cannot be ruled out, any difference between the groups does not appear to be of clinical significance," Dr. Bloch said.

Prior to this study, Dr. Bloch could find only four randomized and two placebo-controlled studies in the medical literature on antidepressant therapy for postpartum depression. Data comparing pharmacotherapy and psychotherapy for postpartum depression are "virtually lacking," as are studies of the potential efficacy of combining these treatment modalities, he said.

There was no placebo-only comparison in the current study, because it was considered unethical not to offer treatment to women with postpartum depression. Because of this, the investigators could not say that psychotherapy was better than placebo, but the results do suggest that adding sertraline to psychotherapy does not improve upon any effects that psychotherapy might have.

Dr. Bloch said he has no relevant conflicts of interest.

PARIS – Postpartum depression is such a common problem that it’s surprising there are so few randomized, controlled studies comparing drug therapy versus nondrug treatment options. Many women with postpartum depression don’t seek treatment, some are treated only with psychotherapy because of concerns regarding pharmacotherapy, and others are treated with antidepressants alone.

Israeli investigators conducted a small, randomized, controlled study in 40 women with mild to moderate postpartum depression lasting 6 months or longer. They expected psychotherapy plus the antidepressant sertraline to be more effective than psychotherapy alone, but they were surprised to find no additional benefit from the drug.

Response rates were 70% in women who received both psychotherapy and sertraline and 55% in those who got psychotherapy and a placebo. This was not a statistically significant difference at a P value of 0.33, Dr. Miki Bloch and his associates reported at the annual congress of the European College of Neuropsychopharmacology. The rates of remission after 8 weeks of treatment were 65% in the combination therapy group and 50% in the psychotherapy plus placebo group, which also was not a significant difference at a P value of 0.34, said Dr. Bloch of Tel Aviv (Israel) University.

All patients started 12 consecutive weekly sessions of Malan-based brief focused dynamic psychotherapy by expert psychotherapists, Dr. Bloch said in an interview. At the same time, the women were randomized to receive 50 mg sertraline or a placebo pill for 4 weeks, after which the psychiatrist could choose to increase the dose to 100 mg. After 8 weeks, the drug groups were unblinded and patients could continue open-label drug therapy for 4 weeks if desired.

Two women in the sertraline group developed hypomanic symptoms, but treatment was otherwise well tolerated. Initially, 42 women were enrolled but 2 dropped out during the first week and were not included in the intent-to-treat analysis.

Adding sertraline does not seem to add any benefit to psychotherapy alone, based on this small trial. "While a type 2 error cannot be ruled out, any difference between the groups does not appear to be of clinical significance," Dr. Bloch said.

Prior to this study, Dr. Bloch could find only four randomized and two placebo-controlled studies in the medical literature on antidepressant therapy for postpartum depression. Data comparing pharmacotherapy and psychotherapy for postpartum depression are "virtually lacking," as are studies of the potential efficacy of combining these treatment modalities, he said.

There was no placebo-only comparison in the current study, because it was considered unethical not to offer treatment to women with postpartum depression. Because of this, the investigators could not say that psychotherapy was better than placebo, but the results do suggest that adding sertraline to psychotherapy does not improve upon any effects that psychotherapy might have.

Dr. Bloch said he has no relevant conflicts of interest.

PARIS – Postpartum depression is such a common problem that it’s surprising there are so few randomized, controlled studies comparing drug therapy versus nondrug treatment options. Many women with postpartum depression don’t seek treatment, some are treated only with psychotherapy because of concerns regarding pharmacotherapy, and others are treated with antidepressants alone.

Israeli investigators conducted a small, randomized, controlled study in 40 women with mild to moderate postpartum depression lasting 6 months or longer. They expected psychotherapy plus the antidepressant sertraline to be more effective than psychotherapy alone, but they were surprised to find no additional benefit from the drug.

Response rates were 70% in women who received both psychotherapy and sertraline and 55% in those who got psychotherapy and a placebo. This was not a statistically significant difference at a P value of 0.33, Dr. Miki Bloch and his associates reported at the annual congress of the European College of Neuropsychopharmacology. The rates of remission after 8 weeks of treatment were 65% in the combination therapy group and 50% in the psychotherapy plus placebo group, which also was not a significant difference at a P value of 0.34, said Dr. Bloch of Tel Aviv (Israel) University.

All patients started 12 consecutive weekly sessions of Malan-based brief focused dynamic psychotherapy by expert psychotherapists, Dr. Bloch said in an interview. At the same time, the women were randomized to receive 50 mg sertraline or a placebo pill for 4 weeks, after which the psychiatrist could choose to increase the dose to 100 mg. After 8 weeks, the drug groups were unblinded and patients could continue open-label drug therapy for 4 weeks if desired.

Two women in the sertraline group developed hypomanic symptoms, but treatment was otherwise well tolerated. Initially, 42 women were enrolled but 2 dropped out during the first week and were not included in the intent-to-treat analysis.

Adding sertraline does not seem to add any benefit to psychotherapy alone, based on this small trial. "While a type 2 error cannot be ruled out, any difference between the groups does not appear to be of clinical significance," Dr. Bloch said.

Prior to this study, Dr. Bloch could find only four randomized and two placebo-controlled studies in the medical literature on antidepressant therapy for postpartum depression. Data comparing pharmacotherapy and psychotherapy for postpartum depression are "virtually lacking," as are studies of the potential efficacy of combining these treatment modalities, he said.

There was no placebo-only comparison in the current study, because it was considered unethical not to offer treatment to women with postpartum depression. Because of this, the investigators could not say that psychotherapy was better than placebo, but the results do suggest that adding sertraline to psychotherapy does not improve upon any effects that psychotherapy might have.

Dr. Bloch said he has no relevant conflicts of interest.