SSRIs may lower risk for postnatal depression-associated outcomes for mother and child

Key takeaways:

• Worse maternal depression, child behaviors, relationship satisfaction, motor and language development, and ADHD with postnatal depression.
• SSRIs improved certain postnatal depression-associated outcomes.

Use of postnatal selective serotonin reuptake inhibitors was associated with reduced risks for maternal depression and unfavorable outcomes associated with postnatal depression, researchers reported in JAMA Network Open.

“Data from primary care records in the U.K. have indicated that the prevalence of postnatal depression is 11%, whereas the initiation rate of selective serotonin reuptake inhibitors within 6 months postpartum for postnatal depression is around 3%, suggesting a gap between diagnosis and medication use,” Chaoyu Liu, MD, PhD, from the Social, Genetic and Developmental Psychiatry Centre at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London, and colleagues wrote. “Suboptimal treatment is harmful because poorly controlled postnatal depression has been associated with many negative outcomes in mothers and offspring.”

Liu and colleagues conducted a large prospective cohort study of 61,081 mother-child groups using longitudinal data from the Norwegian Mother, Father and Child Cohort Study. All mothers 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 seven or greater on the six-item version of the Edinburgh Postnatal Depression Scale, and researchers used the Hopkins Symptom Checklist as a continuous indicator of postnatal depressive symptoms at 6 months postpartum. All participants self-reported postnatal selective serotonin reuptake inhibitor (SSRI) treatment at 6 months postpartum.

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, ADHD symptoms, and motor and language development at age 1.5, 3 and 5 years reported by their mother.

Overall, 14.2% of mother-child groups (mean age, 29.93 years) had a postnatal depression diagnosis. Of these, 2% received postnatal SSRI treatment. Postnatal depression severity was linked to higher levels of maternal depression across 1.5 to 5 years postpartum and worse relationship satisfaction from 6 months to 3 years postpartum. Postnatal depression severity was also linked to higher levels of child internalizing and externalizing behaviors at age 1.5 to 5 years, worse motor and language development at age 1.5 and 3 years and ADHD symptoms at age 5 years.

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

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

“While our findings need to be replicated, we believe that they add important information regarding long-term outcomes associated with SSRI use for postnatal maternal depression,” the researchers wrote.