April 14, 2009

Publication: Forum

Date: Wednesday, April 8, 2009 Page: 83

Reviewer: Nicholas O'Keeffe

Headline: Women's health Clinical Review Service

Women's views and experiences of anti depressants as a treatment for postnatal depression: a qualitative study. Turner K et a). Family Practice 2008; 25(6): 450-455. fampra.oxfordjournals.org

Synopsis: The purpose of this study was to ascertain attitudes towards antidepressants among women who had been treated for post-natal depression.

The women involved were participants in the RESPOND trial, a randomised controlled trial comparing antidepressants with non-directive counselling in post-natal depression, with women recruited from 77 GP practices. The women were interviewed after their participation in the trial had ended, and after their child had reached the age of one. Twenty-seven interviews were conducted in total. At the outset of the study, most participants (20) preferred the idea of counselling to taking antidepressants. This appeared to be mostly due to an aversion to taking anti-depressants rather than a particular desire for counselling.

Fears described included fear of addiction, and fear of being drowsy and unable to properly care for their child. Ability to access a GP was also a factor in influencing some patients' decision to take antidepressants. During the trial, those women who were randomised to counselling had the choice to take antidepressants. Some who initially preferred counselling changed their minds, as they felt the counselling did not help, or their views towards antidepressants changed due to advice from their health practitioner or GP. Some found the counselling helpful, but once they left the study were not happy with counselling provided through their GP.

In some cases the practicality of having a young child made it difficult to attend regularly for counselling. Of the 16 participants who took antidepressants, 11 reported benefits. Not all women who took antidepressants found them beneficial, and even among those who did, some remained concerned about taking them. Some women stopped taking their medication without discussing it with their doctor due to these concerns.

GP commentary: An excellent qualitative study, with some excellent insights into post-natal depression and patients' attitudes to treatment. Useful to anyone treating women with post-natal depression. The variety of attitudes and responses to treatment is very interesting, as well as how advice from health practitioners affects women's attitudes to the treatment.