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  • Evidence Report/Technology Assessment

    Number 216

    Antidepressant Treatment of Depression During Pregnancy and the Postpartum Period

    Evidence-Based Practice

  • Evidence Report/Technology Assessment Number 216

    Antidepressant Treatment of Depression During Pregnancy and the Postpartum Period

    Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov

    Contract No. 290-2007-10057-I

    Prepared by: Pacific Northwest Evidence-based Practice Center Portland, OR

    Investigators: Marian McDonagh, Pharm.D. Annette Matthews, M.D., M.C.R. Carrie Phillipi, M.D., Ph.D. Jillian Romm, R.N., L.C.S.W. Kim Peterson, M.S. Sujata Thakurta, M.P.A.:H.A. Jeanne-Marie Guise, M.D., M.P.H.

    AHRQ Publication No. 14-E003-EF July 2014

  • This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10057-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

    The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

    This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

    This report may periodically be assessed for the urgency to update. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

    This document is in the public domain and may be used and reprinted without special permission. Citation of the source is appreciated.

    Persons using assistive technology may not be able to fully access information in this report. For assistance contact EffectiveHealthCare@ahrq.hhs.gov.

    None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

    Suggested citation: McDonagh M, Matthews A, Phillipi C, Romm J, Peterson K, Thakurta S, Guise J-M. Antidepressant Treatment of Depression During Pregnancy and the Postpartum Period. Evidence Report/Technology Assessment No. 216. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2007-10057-I.) AHRQ Publication No. 14-E003-EF. Rockville, MD: Agency for Healthcare Research and Quality; July 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm. DOI: https://doi.org/10.23970/ AHRQEPCERTA216.

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  • Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based

    Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies.

    Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm.

    AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an email list to learn about new program products and opportunities for input.

    We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to epc@ahrq.hhs.gov.

    Richard G. Kronick, Ph.D. Director Agency for Healthcare Research and Quality

    Stephanie Chang, M.D., M.P.H. Director, EPC Program Center for Outcomes and Evidence Agency for Healthcare Research and Quality

    Yen-pin Chiang, Ph.D. Acting Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality

    Suchitra Iyer, Ph.D. Task Order Officer Center for Outcomes and Evidence Agency for Healthcare Research and Quality

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    mailto:epc@ahrq.hhs.gov

  • Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project: Tracy Dana, M.L.S., for assistance with literature search strategy development; Leah Williams, B.S., for editorial support; Elaine Graham, M.L.S., for assistance with project management; and Gabriel Valles for article retrieval. We would also like to thank our AHRQ Task Order Officer, Suchitra Iyer, Ph.D., and Denise Dougherty, Ph.D., Children’s Health Point of Contact at AHRQ, for their support and guidance in developing this report, and our Associate Editor, Kathleen Lohr, Ph.D., for her review of the report and meaningful comments.

    Technical Expert Panel In designing the review questions and methodology at the outset of this report, the EPC

    consulted several technical and content experts, reflecting a variety of viewpoints relevant to this topic. Technical experts consulted are expected to have divergent and possibly conflicting opinions. This diversity is helpful in achieving a well-rounded report. The study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts.

    Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified.

    The list of Technical Experts who participated in developing this report follows:

    Wendy Davis, Ph.D. Executive Director Postpartum Support International Portland, OR Adrienne Einarson, R.N. Assistant Director of Clinical Services Motherisk Toronto, Canada Cathy Emeis, Ph.D., C.N.M. Assistant Professor & Assistant Program Director for Nurse Midwifery Oregon Health & Science University School of Nursing Portland, OR

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  • RJ Gillespie, M.D., M.H.P.E. Medical Director, Oregon Pediatric Improvement Partnership Portland, OR Kimberly D. Gregory, M.D., M.P.H. Vice Chair, Women's Healthcare Quality and Performance Improvement, Department of Obstetrics and Gynecology Cedars Sinai Medical Center Los Angeles, CA Susan G. Kornstein, M.D. Professor of Psychiatry and Obstetrics/Gynecology Executive Director, Institute for Women's Health Director of Clinical Research, Department of Psychiatry Virginia Commonwealth University Editor-in-Chief, Journal of Women's Health Richmond, VA Evan Myers, M.D., M.P.H. Division of Clinical and Epidemiological Research, Department of Obstetrics and Gynecology Duke Evidence Synthesis Group, Duke Clinical Research Institute Duke University School of Medicine Walter L. Thomas Professor Duke University Medical Center Durham, NC Gail Erlick Robinson, M.D., D.Psych., FRCPC, O.Ont. Director, Women's Mental Health Program University Health Network Professor of Psychiatry and Obstetrics-Gynecology, University of Toronto Toronto, Canada

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  • Barbara Yawn, M.D., M.Sc., FAAFP Director of Research, Olmsted Medical Center Adjunct Professor, Department of Family and Community Health, University of Minnesota Rochester, MN

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  • Peer Reviewers Prior to publication of the final evidence report, EPCs sought input from independent Peer

    Reviewers without financial conflicts of interest. However, the conclusions and synthesis of the scientific literature presented in this report do not necessarily represent the views of individual reviewers.

    Peer Reviewers must disclose any financial conflicts of interest greater than $1