Keywords
Network meta-analysis
Cognitive behavioral therapy
Antidepressants
Randomized controlled trials
Submitted : 2026-02-17
Accepted : 2026-03-04
Published : 2026-03-19
Abstract
Objective: To compare the efficacy of different interventions for postpartum depression and to identify the intervention with the highest probability of benefit. Methods: Randomized controlled trials were identified through searches of PubMed, Embase, and Web of Science up to May 2023. The change in depression scores from baseline to post-intervention was extracted and synthesized as standardized mean differences (SMDs) using a frequentist network meta-analysis. Treatments were ranked according to the surface under the cumulative ranking curve (SUCRA). Results: Eight randomized controlled trials involving 641 participants were included. According to the SUCRA rankings, cognitive behavioral therapy (CBT) had the highest probability of being the most effective intervention. CBT did not significantly differ from fluoxetine (SMD 0.19, 95% CI -1.14 to 1.51), saffron (SMD 0.30, 95% CI -0.93 to 1.53), or sertraline (SMD 0.61, 95% CI -0.13 to 1.36), but it was superior to brexanolone (SMD 1.60, 95% CI 0.50 to 2.70) and zuranolone (SMD 1.72, 95% CI 0.61 to 2.84). Brexanolone and zuranolone did not significantly differ from each other (SMD 0.12, 95% CI -0.30 to 0.54), although both were superior to placebo. Conclusion: With the exception of estradiol, all interventions showed greater efficacy than placebo in reducing depressive symptoms. The ranking results suggest that CBT, fluoxetine, saffron, and sertraline may be among the more effective options for postpartum depression; however, these findings should be interpreted cautiously because of the limited number of studies and the scarcity of direct head-to-head comparisons.
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