Comment: The quality of evidence is downgraded by study limitations (unclear allocation concealment, unclear risk of incomplete outcome data and selective reporting) and by imprecise results (few patients and outcome events).
Comment: The recommendation attaches a relatively high value on mother and baby wellbeing.
A Cochrane review «Antidepressant treatment for postnatal depression»1 «Brown JVE, Wilson CA, Ayre K et al. Antidepressant treatment for postnatal depression. Cochrane Database Syst Rev 2021;(2):CD013560. »1 included 11 studies with a total of 1016 subjects. Selective serotonin reuptake inhibitors (SSRIs) showed benefit over placebo in response (55% vs 43%; pooled risk ratio (RR) 1.27, 95% CI 0.97 to 1.66); remission (42% vs 27%; RR 1.54, 95% CI 0.99 to 2.41); and reduced depressive symptoms (standardised mean difference (SMD) −0.30, 95% CI −0.55 to −0.05; 4 studies, 251 women), at 5 to 12 weeks' follow-up. 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.