# Management of postnatal depression: A systematic review of clinical practice guidelines

## TL;DR

This paper reviews global guidelines for managing postnatal depression, highlighting gaps in quality and representation from low and middle-income countries.

## Contribution

The study systematically identifies and evaluates clinical practice guidelines for postnatal depression management, emphasizing disparities in guideline development.

## Key findings

- Nineteen clinical practice guidelines were identified, with only one from a low and middle-income country.
- Cognitive-behavioral therapy was the most recommended psychological treatment, and SSRIs were the most common pharmacological intervention.
- Only seven guidelines met the criteria for adequate methodological quality, and only three included patient and public involvement.

## Abstract

Postnatal depression (PND) is the most prevalent mental health disorder during the postpartum period. Evidence suggests that clinical practice guidelines (CPGs) can improve the mental well-being of women affected by PND. This study aimed to identify the CPGs available globally for the management of PND and to summarize their recommendations. A comprehensive search was performed across five electronic databases (MEDLINE, PsycINFO, CINAHL, TRIP, and Epistemonikos) and four guideline-specific websites (GIN, SIGN, NICE, and WHO) to identify the English language CPGs published between 2012 and 2023. The general characteristics of the CPGs, as well as the reported pharmacological and non-pharmacological recommendations, were extracted. The AGREE-II instrument was used to assess the methodological quality. Nineteen CPGs were included in the review, with only one from a low and middle-income country (Lebanon). Cognitive-behavioral therapy (CBT) was the most frequently recommended psychological therapy. Pharmacological interventions were included by 17 CPGs, predominantly Selective Serotonin Reuptake Inhibitors (SSRIs). Only three CPGs incorporated Patient and Public Involvement and Engagement (PPIE) in the form of an advisory group. Seven CPGs matched the criteria for adequate methodological quality by achieving an overall score of ≥70%. The findings highlight limited methodological quality and underrepresentation of LMICs, which may lead to disparities in the management of PND and undermine equitable mental health care.