Prevention of Recurrent Postpartum Depression: A Randomized Clinical Trial

Background: Women who have suffered oneepisode of postpartum-onset major depression (PPMD) comprise ahigh-risk group for subsequent episodes. We conducted adouble-blind, randomized clinical trial to test the efficacy ofnortriptyline in the prevention of recurrent PPMD.

Method: Nondepressed women who had at least onepast episode of PPMD (Research Diagnostic Criteria) wererecruited during pregnancy. Subjects were randomly assigned tonortriptyline or placebo. Treatment began immediately postpartum.Each subject was assessed for 20 sequential weeks with theHamilton Rating Scale for Depression and Research DiagnosticCriteria for recurrence of major depression.

Results: No difference was found in the rate ofrecurrence in women treated with nortriptyline compared withthose treated with placebo. Of 26 subjects who took nortriptylinepreventively, 6 (0.23, 95% exact confidence interval [CI] = 0.09to 0.44) suffered recurrences. Of 25 subjects who took placebo, 6(0.24, 95% exact CI = 0.09 to 0.45) suffered recurrence (Fisherexact p = 1.00).

Conclusion: Nortriptyline did not conferadditional preventive efficacy beyond that of placebo. The rateof recurrence of PPMD (one fourth of women) was unacceptablyhigh.