Preventing postpartum depression part I: a review of biological interventions.

OBJECTIVE This paper critically reviews the literature to determine the current state of scientific knowledge concerning the prevention of postpartum depression (PPD) from a biological perspective. METHODS The criteria used to evaluate the interventions were derived from the standardized methodology developed by the Canadian Task Force on Preventive Health Care. Databases searched for this review include Medline, PubMed, Cinahl, PsycINFO, Embase, ProQuest, the Cochrane Library, and the World Health Organization Reproductive Health Library. Studies selected were peer-reviewed English-language articles published between January 1, 1966, and December 31, 2003. RESULTS Seven studies that met criteria were examined. These studies focused on evaluating the preventive effect of antidepressant medication, estrogen and progesterone therapy, thyroid therapy, docosahexanoic acid, and calcium supplementation. Although some of these interventions have been examined rigorously for depression unrelated to childbirth, methodological study limitations render intervention efficacy equivocal for PPD; thus, there is limited strong evidence to guide practice or policy recommendations. CONCLUSIONS Despite the recent upsurge of interest in this area, many questions remain unanswered, which has several implications for research.