Prophylactic Use of Postpartum Sertraline to Prevent Postpartum Depression

Eligible women for our study would be identified antepartum from our three obstetrical groups
delivering at Cooper University Hospital: Cooper Faculty Group, Women's Care Center, and
CamCare. Potentially eligible women would be referred to the study coordinator or principal
investigator to discuss the nature of the study. Those women who agreed to the trial would be
further screened with a baseline structured psychiatric evaluation in the third trimester of
the pregnancy to rule-out current depressive illness. If there was no evidence of depression
at the antepartum evaluation, patients delivering a liveborn singleton fetus at 34 0/7 weeks
or greater would be re-evaluated prior to discharge and, if scoring Postpartum Depression scale, would then be enrolled in the trial.

Patients would be assigned to either sertraline 50 mg daily or identical appearing placebo
for 12 weeks. Group allocation would be determined by restricted-randomization technique with
variable block length, with the sequence generated by someone not associated with participant
assignment. Assignment would be kept in sequentially numbered, opaque, sealed envelopes
(SNOSE) in the pharmacy, which would dispense the medication (or placebo). Patients would be
given a 30 day supply on the day of discharge, with refills provided by the study coordinator
(through the pharmacy)for 12 weeks and a four-day supply of 25 mg Sertraline or placebo at
the end of 12 weeks as a taper. Patients would also undergo follow-up blinded structured
psychiatric evaluations at 4 weeks, 8 weeks, and 12 weeks to assess for adverse reaction to
the assigned treatment agent, and for administration of questionnaires/evaluation to assess
for development of depression. Any patient with recognized clinical depression would
immediately be removed from further active participation in the study and referred to our
Cooper Psychiatry department or outside psychiatrist for ongoing evaluation and treatment.
Medication received (Sertraline or Placebo) would necessarily be revealed to Psych only for
purposes of guiding appropriate further treatment.

All women randomized would be analyzed according to group assignment (intent-to-treat).
Demographic information, including patient age, race/ethnicity, gravidity, parity,
gestational age at delivery, infant birth weight, as well as infant weights from standard
Pediatric visits (obtained verbally from the mother)would be recorded and compared using the
Student t-test for normally distributed continuous data, Mann-Whitney U for non-normative
continuous data, and the Chi Square test or Fisher Exact test for categorical data.

A sample size calculation was performed. Based on an anticipated rate of postpartum
depression (PPD) of 30% in the placebo group, we would need 62 subjects in each group to
detect a reduction in PPD to 10% in the sertraline group, with a power of .8 and a Type I
error of .05. Based on the 2200 deliveries occurring annually at Cooper University Hospital,
we anticipate that it would take 2-3 years to recruit 124 subjects into this study.

Inclusion Criteria:

1. Past history of depression or postpartum depression

2. Singleton gestation

3. Delivery > 34 weeks gestation

4. No current clinical evidence of depression

5. Able to read and understand written English language

Exclusion Criteria:

1. Multiple gestation

2. Delivery prior to 34 weeks

3. Delivery outside of Cooper University Hospital

4. Major fetal anomaly or fetal demise

5. Current use of antidepressants

6. Evidence of active depression at antepartum evaluation

7. Edinburgh Postpartum Depression scale of >12 prior to discharge from the hospital

8. Maternal age < 18 years

9. Infant in Neonatal Intensive Care Unit (NICU) at time of patient discharge from
hospital

10. Known or suspected allergy to Sertraline