SSRI Treatment May Decrease Risk for Postnatal Depression-Associated Outcomes for Mother, Child

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Use of postnatal selective serotonin reuptake inhibitors (SSRIs) was associated with reduced risks for maternal depression and several adverse events related to postnatal depression, according to a new study published in JAMA Network Open.¹

“Data from primary care records in the UK have indicated that the prevalence of postnatal depression is 11%, whereas the initiation rate of SSRIs within 6 months postpartum for postnatal depression is around 3%, suggesting a gap between diagnosis and medication use,” wrote first author Chaoyu Liu, MD, PhD, Institute of Psychiatry, Psychology & Neuroscience at King’s College London, and colleagues.¹

“Suboptimal treatment is harmful because poorly controlled postnatal depression has been associated with many negative outcomes in mothers and offspring,” continued Liu and coauthors. “The current study examined maternal mental health outcomes alongside child developmental outcomes associated with postnatal depression up to postpartum year 5.”¹

Researchers also examined whether postnatal SSRI treatment “moderated any observed associations.”¹

Liu and colleagues conducted the cohort study of 61 081 mother-child dyads using longitudinal data from the Norwegian Mother, Father and Child Cohort Study (MoBa). The MoBa study included women who were recruited during the 17th to 18th week of their pregnancy from 1999 to 2008 with follow-up after childbirth. Researchers defined a postnatal depression diagnosis as a score of ≥7 on the 6-item version of the Edinburgh Postnatal Depression Scale, and they used the Hopkins Symptom Checklist as a continuous indicator of postnatal depressive symptoms at 6 months postpartum. All participants self-reported postnatal SSRI treatment at 6 months postpartum.¹

The primary maternal outcomes were self-reported depression symptomology and relationship satisfaction from childbirth to 5 years postpartum. The primary child outcomes were internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development at age 1.5, 3, and 5 years reported by their mother, according to the study.¹

FINDINGS

Overall, investigators noted that 14.2% (n=8671; mean age, 29.93 years) met the criteria for a postnatal depression diagnosis. Of these, 2.0% (n=177; mean age, 30.20 years) received postnatal SSRI treatment.¹

Postnatal depression severity was associated with higher levels of maternal depression across 1.5 years to 5 years postpartum and worse relationship satisfaction from 6 months to 3 years postpartum. Postnatal depression severity was also associated with higher levels of child internalizing and externalizing behaviors across age 1.5 years to 5 years, worse motor and language development at 1.5 years and 3 years, and ADHD symptoms at age 5 years, according to researchers.¹

Postnatal SSRI treatment was associated with reduced negative associations between postnatal depression and maternal relationship satisfaction at 6 months postpartum (moderation β, 0.13, 95% CI 0.07-0.19), 1.5 years postpartum (β, 0.11, 95% CI 0.05-0.18) and 3 years postpartum (β, 0.12, 95% CI 0.04-0.19) years, and for child ADHD at age 5 years (β, –0.15, 95% CI –0.24 to –0.05) when focusing only on the postnatal depression mother-child groups.¹

Postnatal SSRI treatment also was associated with lessened negative associations between postnatal depression and maternal depression at 1.5 years (moderation β, –0.08, 95% CI, –0.12 to –0.04) and 5 years (β, –0.08, 95% CI –0.14 to –0.02) and relationship satisfaction at 6 months (β, 0.17, 95% CI 0.13-0.21), 1.5 years (β, 0.14, 95% CI 0.09-0.19), and 3 years (β, 0.14, 95% CI 0.08-0.2) postpartum. In addition, postnatal SSRI treatment lessened negative associations between postnatal depression and child externalizing behaviors at 1.5 years (β, –0.08, 95% CI –0.14 to –0.03) and 5 years (β, –0.13, 95% CI –0.21 to –0.06) and ADHD up to 5 years after childbirth (β, –0.17, 95% CI –0.24 to –0.1).¹

“Postnatal depression is under-recognized and undertreated. It's critical that we view it as the severe mental illness that it is and ensure it is treated properly to mitigate some of the associated negative outcomes in mothers, children and wider family,” said senior author Tom McAdams, PhD, Department Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway, in a King’s College London press release.² “Our study found no evidence that SSRI treatment for mothers affected by postnatal depression was linked with an increased risk for childhood emotional difficulties, behavioural problems or motor and language delay.”

References:

1. Liu C, Ystrom E, McAdams TA. Long-term maternal and child outcomes following postnatal SSRI treatment. JAMA Netw Open. 2023;6:e2331270. doi:10.1001/jamanetworkopen.2023.31270

2. Underutilised antidepressant treatment for postnatal depression associated with improved child outcomes at age five. King's College London. News release. August 29, 2023. Accessed September 5, 2023. https://www.kcl.ac.uk/news/underutilised-antidepressant-treatment-for-postnatal-depression-associated-with-improved-child-outcomes-at-age-five