***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Women who have suffered from one episode of postpartum-onset major depression ( PPMD ) experience increased risk for recurrence in the year following another birth . METHODS Non-depressed women ( N=51 ) who had at least one past episode of PPMD were recruited during pregnancy . After birth , subjects were assessed prospect ively each week for 20 weeks with the Hamilton Rating Scale for Depression and Research Diagnostic Criteria for recurrence of major depression . Evaluations were carried out at 24 , 36 , and 52 weeks to assess for episodes beyond 20 weeks postpartum . RESULTS The data revealed a clustering of cases , with five of the 21 recurrences ( 24 % ) occurring in the first 2 weeks . Thirteen of the 21 recurrences ( 67 % ) and 19/21 recurrences ( 90 % ) occurred in the first 20 and 28 weeks following birth , respectively . LIMITATIONS Although it is unusual for studies of this type to be prospect i ve , the sample size is relatively small . CONCLUSIONS The 1-year recurrence rate was 21/51 or 41 % , with a clustering of cases near delivery . All recurrences except two occurred by 28 weeks postpartum 1 Abstract 1.1 Background Suicide is a leading cause of perinatal maternal deaths in industrialised countries but there has been little research to investigate prevalence or correlates of postpartum suicidality . The Edinburgh Postnatal Depression Scale is widely used in primary and maternity services to screen for perinatal depressive disorders , and includes a question on suicidal ideation ( question 10 ) . We aim ed to investigate the prevalence , persistence and correlates of suicidal thoughts in postpartum women in the context of a r and omised controlled trial of treatments for postnatal depression.1.2 Methods Women in primary care were sent  postal question naires at 6 weeks postpartum to screen for postnatal depression before recruitment into an RCT . The  Edinburgh Postnatal Depression Scale ( EPDS )  was used to screen for postnatal depression and in those with high levels of symptoms , a home visit with a st and ardised psychiatric interview was carried out using the Clinical Interview Schedule-Revised version ( CIS-R ) . Other socio-demographic and clinical variables were measured , including functioning ( SF12 ) and quality of the marital relationship ( GRIMS ) .  Women who entered the trial were followed up for 18 weeks.1.3 Results 9 % of 4,150 women who completed the EPDS question relating to suicidal ideation reported some suicidal ideation ( including hardly ever ) ; 4 % reported that the thought of harming themselves had occurred to them sometimes or quite often . In women who entered the r and omised trial and completed the EPDS question relating to suicidal ideation ( n = 253 ) , suicidal ideation was associated with younger age , higher parity and higher levels of depressive symptoms in the multivariate analysis . Endorsement of ' yes , quite often ' to question 10 on the EPDS was associated with affirming at least two CIS-R items on suicidality . We found no association between suicidal ideation and SF-12 physical or mental health or the EPDS total score at 18 weeks.1.4 Conclusions Healthcare professionals using the EPDS should be aware of the significant suicidality that is likely to be present in women endorsing ' yes , quite often ' to question 10 of the EPDS . However , suicidal ideation does not appear to predict poor outcomes in women being treated for postnatal depression . Trial registration Current Controlled Trials IS RCT N16479417 BACKGROUND : Postnatal depression is a common disorder , which can have profound short and long term effects on maternal morbidity , the new infant and the family as a whole . Social factors appear to be particularly important in the aetiology and prognosis of postnatal depression and treatment is often largely social support and psychological interventions . It is not known whether antidepressants are an effective and safe choice for treatment of this disorder . OBJECTIVES : To evaluate the effectiveness of different antidepressant drugs  and compare their effectiveness with other forms of treatment . To assess any adverse effects of antidepressants in the mother or the nursing baby . SEARCH STRATEGY : The registers of clinical trials maintained and up date d by the Cochrane Depression , Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group were search ed . Other data bases ( outlined below ) were also search ed and contacts were made with pharmaceutical companies and experts in the field . SELECTION CRITERIA : All trials were considered in which women with depression in the first six months postpartum were r and omised to receive antidepressants alone or in combination with another treatment , or to receive any other treatment including placebo . DATA COLLECTION AND ANALYSIS : Data was extracted independently from the trial reports by the review ers . Missing information was requested from investigators wherever possible . Data was sought to allow an " intention to treat " analysis . MAIN RESULTS : Only one trial could be included in this review , leaving most of the objectives of the review unfulfilled . Appleby et al ( 1997 ) reported that Fluoxetine was significantly more effective than placebo and , after an initial session of counselling , as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression . There was no interaction between medication and counselling . REVIEW ER 'S CONCLUSIONS : Women with postnatal depression can be effectively treated with fluoxetine , which is as effective as a course of cognitive-behavioural counselling in the short-term . However , more trials with a longer follow-up period are needed to compare different antidepressants in the treatment of postnatal depression , and to compare antidepressant treatment with psychosocial interventions .  This is an area that has been neglected despite the large public health impact described above OBJECTIVE The efficacy of antidepressants in the treatment of mild-to-moderate postpartum depression and the possible advantage of the combination of an antidepressant and psychotherapy have not been adequately studied . We hypothesized that psychotherapy and concurrent antidepressant treatment would be more effective than psychotherapy alone in the treatment of postpartum depression . METHOD Women diagnosed with mild-to-moderate severity postpartum depression according to DSM-IV-TR criteria were enrolled in an 8-week , r and omized , double-blind , placebo-controlled study . Participants received 12 sessions of focused brief dynamic psychotherapy ( BDP ) concurrently with 8-week sertraline or placebo treatment , followed by a 4-week open phase . Primary outcomes were depression scores measured by the Montgomery-Asberg Depression Rating Scale ( MADRS ) and remission rates . The study was conducted in a referral center from May 2008 to September 2010 . RESULTS Forty of 42 women r and omized into the study entered the intent-to-treat analysis . A significant time effect for the MADRS was observed ( F4,35 = 21.3 , P < .0001 ) ; however , no time-by-group effect was found for any outcome measure . Response rates were 70 % and 55 % for the drug and placebo groups , respectively , and remission rates were 65 % and 50 % , respectively , with no significant difference between groups . CONCLUSION While both treatment groups improved significantly , the results of the present study did not demonstrate a significant benefit for sertraline over placebo as an add-on treatment to focused BDP in mild-to-moderate postpartum depression . Because of the study 's small sample , the results can not be viewed as definitive , and a much larger study is needed to confirm these results . Furthermore , the promising potential of focused BDP as an intervention in this population should be studied under controlled conditions . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01028482 Difficulties in mother – child interaction are commonly observed in the context of postnatal depression . These difficulties may result in part from the negative cognitive bias present in depression , which may in turn lead to biased negative perceptions of the infant : in particular , these biases encompass the negative appraisal of facial expressions . Given the important role of early mother – child interactions in child development it is vital to investigate potential interventions that might be beneficial in ameliorating the negative cognitive bias . This study aim ed to examine the effects of two different antidepressants ( reboxetine and citalopram ) on the appraisal of infant facial expressions of emotion using a faces rating task , and on attention to infant emotion using an attentional probe . Thirty-nine volunteers were r and omly assigned to a double-blind 7-day intervention with either placebo , citalopram or reboxetine . There were significant positive effects on the appraisal of facial expressions ; participants assigned to the placebo group rated positive faces less positively than those either in the citalopram or in the reboxetine groups . However , there was no evidence that these drugs had an effect on attentional vigilance . If antidepressants are able to help a mother to perceive her infant ’s facial expressions as more positive , this may lead to more positive interactions , thereby potentially mitigating the negative effects of depression on infant development . These findings should be treated with caution until replicated in larger and clinical sample Background In the UK , 8–15 % of women suffer from postnatal depression with long term consequences for maternal mood and child development . Current guidelines state that health visitors and GPs should continue to have a major role in the detection and management of postnatal depression . Previous literature suggests that women are reluctant to disclose symptoms of postnatal depression . This study aim ed to explore general practitioners ' ( GPs ) , health visitors ' and women 's views on the disclosure of symptoms which may indicate postnatal depression in primary care . Methods In-depth interviews with GPs , health visitors and women who were participating in a r and omised controlled trial of anti-depressants versus health visitor delivered non-directive counselling for the treatment of postnatal depression . Interviews were audio-taped and fully transcribed . Thematic analysis with an iterative approach was used , allowing the views of practitioners and patients to be explored and then compared . Results Nineteen GPs , 14 health visitors and 28 women were interviewed . A number of common themes were identified across all three data sets : underst and ing and negotiating the diagnosis of postnatal depression , hindering and facilitating disclosure , and the system of care . Both women and health professionals described postnatal depression in psychosocial terms : an adjustment reaction to change in life circumstances and the reality of motherhood not meeting personal expectations . Women described making a conscious decision about whether or not to disclose their feelings to their GP or health visitor . Health professionals described strategies used to hinder disclosure and described a reluctance to make a diagnosis of postnatal depression , as they had few personal re sources to manage women with postnatal depression themselves , and no services to which to refer women for further treatment . Conclusion To improve disclosure of symptoms in primary care , there should be a move away from question ing why health professionals do not make the diagnosis of depression and in response suggesting that education and training will improve skills and thus improve detection of depression . Improving the detection and management of postnatal depression in primary care requires recognition of the context in which women consult , and system changes that ensure health professionals work in an environment that can facilitate disclosure and that the necessary re sources for management are available . Trail Registration IS RCT N BACKGROUND The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain . We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary -care clinics in Santiago , Chile . METHODS 230 mothers with major depression attending postnatal clinics were r and omly allocated to either a multicomponent intervention ( n=114 ) or usual care ( n=116 ) . The multicomponent intervention involved a psychoeducational group , treatment adherence support , and pharmacotherapy if needed . Usual care included all services normally available in the clinics , including antidepressant drugs , brief psychotherapeutic interventions , medical consultations , or external referral for specialty treatment . The primary outcome measure was the Edinburgh postnatal depression scale ( EPDS ) score at 3 and 6 months after r and omisation . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00518830 . FINDINGS 208 ( 90 % ) of women r and omly assigned to treatment groups completed assessment s. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months ( 8.5 [ 95 % CI 7.2 - 9.7 ] vs 12.8 [ 11.3 - 14.1 ] ) . Although these differences between groups decreased by 6 months , EPDS score remained better in multicomponent intervention group than in usual care group ( 10.9 [ 9.6 - 12.2 ] vs 12.5 [ 11.1 - 13.8 ] ) . The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 ( 95 % CI -6.3 to -2.7 ; p<0.0001 ) . The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group ( multicomponent intervention from 60/101 [ 59 % ; 95 % CI 49 - 69 % ] to 38/106 [ 36 % ; 27 - 46 % ] ; usual care from 18/108 [ 17 % ; 10 - 25 % ] to 11/102 [ 11 % ; 6 - 19 % ] ) . INTERPRETATION Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped , even in low-income setting s , through multicom 
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In addition , one study comparing sertraline with nortriptyline ( a tricyclic antidepressant ) found no difference in effectiveness ( 109 participants ) .Side effects were experienced by a substantial proportion of women , but there was no evidence of a meaningful difference in the number of adverse effects between treatment arms in any study .
Pooled estimates for response and remission found that SSRIs were significantly more effective than placebo for women with postnatal depression .
There is also inadequate evidence on whether the benefits of antidepressants persist beyond eight weeks or whether they have short- or long-term adverse effects on breastfeeding infants .