Comparative Efficacy of Interventions for the Prevention and Treatment of Postpartum Depression: A Bayesian Network Meta-analysis.

Postpartum depression (PPD) is a highly prevalent but under-reported and undertreated disorder that affects mothers and infants alike. The management of PPD has to be thoughtfully catered to limit the exposure of infants to harmful drugs. This network meta-analysis (NMA) was conducted to assess the efficacy of pharmacological interventions for the prevention and treatment of PPD. We searched PubMed/MEDLINE, EMBASE, Scopus, Google Scholar, Cochrane databases and clinical trial registries to find studies to be included, and data were extracted. Random effects Bayesian NMA was performed using Markov chain Monte Carlo simulations. A network graph was built, the rank probability of each treatment was determined, and the surface under the cumulative rank probability curve was calculated. The risk of bias assessment, including publication bias, was assessed. Data from 54 studies, including 7,438 participants, were included for this NMA. No pharmacological intervention demonstrated robust superiority over placebo for the treatment of PPD, though wide credible intervals (CrI) and limited sample sizes preclude definitive conclusions. Trazodone (-1.6; 95% CrI: -2.7 to -0.41) and diphenhydramine (-1.4; 95% CrI: -2.5 to -0.20) are the two treatments that showed an efficacy superior to placebo in the prevention of PPD as seen by symptom severity scores. There was no publication bias, as observed by the funnel plot and Egger's regression test. Based on single small trials, trazodone and diphenhydramine showed statistically superior efficacy to placebo in preventing PPD. Safety considerations in the perinatal and breastfeeding context must be carefully evaluated before these agents are considered in clinical practice.