Depressão clínica

This review involved a literature search on postpartum depression effects, risk factors and interventions on Pubmed and PsycInfo. Empirical studies, systematic reviews and meta-analyses published in the years 2014-2016 are briefly summarized here. The approximate 10 - 20% postpartum depression prevalence rate and the effects on the mother such as altered connectivity in brain regions, effects on the father (17% depressed) and on the social, behavioural and cognitive problems of the offspring have led to screening mandates that have been effective. In this recent literature, risk factors for postpartum depression have included socio-demographic factors such as low income and social support, being an immigrant, and experiencing a deployment during delivery. Mothers’ early childhood experiences including disorganized attachment, maltreatment and childhood sexual abuse are also risk factors. The most frequently published risk factors in the 2014-16 time period have been prenatal depression, sleep disturbances, elevated cortisol and low levels of oxytocin. With respect to interventions, antidepressants have been rarely studied in contrast to cognitive behavioural therapy, interpersonal therapy, and mother-infant psychotherapy and biochemical interventions including oxytocin. Given the ethical problem of random assignment once treatments are known to be effective, very few randomized controlled trials appear in the literature, and the screening/diagnostic problems have limited the number of prospective longitudinal studies.

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are among the most commonly prescribed medications particularly for patients with depressive disorders. Concerns related to increase risk of suicidality associated with the use of SSRIs were raised since early 1990s. Recent studies show inconclusive and conflicting results about this association. Meta-analysis based on Randomized Controlled Trials (RCTs) in depressive disorders has not been done recently.
Objective: To establish whether there is increased risk of suicidality with the use of SSRIs compared to placebo in the treatment of depressive disorders in adults.
Method and design: Meta-analysis of Randomized Controlled Trials (RCTs).
Data sources: I searched for relevant systematic reviews and RCTs in Medline and Cochrane library database. I checked reference lists of included trials. I included trials from Jan 2000 to September 2016.
Selection criteria: Published systematic reviews of randomised controlled trials comparing SSRIs with placebo in adults diagnosed with a depressive disorder were eligible for inclusion.
Data collection and analysis: One review author selected the trials, assessed their quality. I use random effect meta-analysis. I used Odds Ratio (OR) to summarize dichotomous outcomes.
Results: In the 5 studies identified, 556 suicidal events were detected in 71628 patients treated with SSRI for depressive or other disorders. Pooled OR=0.97(95%CI 0.85-1.1).
Conclusion: These findings support that there is no increased risk of suicidality in adult patients treated with SSRI for depression.