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A Comparison Group Was Also Recruited That Comprised Women With No History ...


A comparison group was also recruited that comprised women with no history of psychopathology, depression (based on the Center for Epidemiological Studies Depression Scale [CES-D]), exposure to chemical or radiation pollution, or severe health problems likely to affect fetal development. This group was randomly selected from among visitors to the author's clinic. Women who had discontinued the use of antidepressants after conception or during the pregnancy were not eligible to participate. Women were also excluded from the comparison group based on the same criteria applied to the Motherisk groups. Outcome data was collected using the CES-D, antenatal and postnatal assessments, neurobehavioural tests (Bayley Scales of Infant Development, McCarthy Scales of Children's Abilities, age-appropriate Achenbach Child Behaviour Checklist), and follow-up testing of the mother (Wechsler Adult Intelligence Scale, and other measures).
A one-way analysis of variance was used to compare outcome measures across the three groups. Correlational and regression tests were used to assess the contribution of confounding variables. Results revealed no group differences in child's global IQ, language development, or behaviour (see Figure 1). The authors concluded, Exposure to tricyclic antidepressants or fluoxetine throughout the gestation period does not appear to adversely affect cognition, language development, or the temperament of preschool and early-school children. Although regression was used to account for the contribution of confounding factors, such as verbal comprehension and expressive language, the variance explained by these variables was not in fact partialled out before testing for group differences. This would have required a multivariate analysis of covariance in which adjustments for covariates are built into the analysis. More importantly, the observed similarity in outcomes across the three groups may reflect simple or complex interactions with other variables. This issue is discussed in greater detail in Chapter 3.

Figure 1 Cognitive outcomes (mental and psychomotor development, and cognitive abilities) across antidepressant and control groups (Nulman et al, 2002). Differences are not significant.
Wisner et al (2001) performed a double-blind randomised control trial to assess the effect of nortriptyline on the rate of reoccurrence of postpartum depression in non-depressed women who had previously had at least one depressive episode. Women were randomly exposed to nortriptyline or a placebo immediately after childbirth. Outcome data was collected over a 5-month period using the Hamilton Rating Scale for Depression, and Research Diagnostic Criteria for depression. No group differences emerged, suggesting that nortriptyline was no more effective than a placebo in treating PND.

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