Although antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are recommended for the treatment of postpartum depression (PPD), many women do not seek or take antidepressants to treat PPD. While we have data supporting the efficacy of SSRIs and the SNRI, venlafaxine, for the treatment of postpartum depression, we have no data on long-term maternal and child outcomes after SSRI treatment of PPD.
Based on data in adult populations not treated with antidepressants except postpartum, we would expect to see improvements in functioning in mothers treated with antidepressants.
Does Maternal Antidepressant Treatment Improve Child Outcomes?
Using longitudinal data from the Norwegian Mother, Father and Child Cohort Study, researchers examined whether postpartum SSRI treatment moderated adverse outcomes associated with postpartum depression in mothers during the first five years of the child’s life.
In this cohort study, women were recruited at weeks 17 to 18 of pregnancy and followed prospectively for five years postpartum. Postpartum depression was defined as a score of 7 or greater on the 6-item version of the Edinburgh Postnatal Depression Scale. Maternal outcomes included self-reported depressive symptoms and relationship satisfaction from delivery to 5 years postpartum. Child outcomes included mother-reported internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development up to 5 years of age.
Among the 61,081 mother-child dyads, 8,671 (14.2%) (mean [SD] age, 29.93 [4.76] years) met the criteria for a diagnosis of PPD. A total of 177 women with PPD (2.0%; mean [SD] age, 30.20 [5.01] years) received SSRI treatment postpartum.
This was a naturalistic study, so there were notable differences between women who chose to use SSRIs for PPD versus those who did not. For example, factors associated with not using SSRIs are included lower parity (OR, 0.74; 95% CI, 0.59-0.92) and lower educational level (OR, 0.84; 95% CI, 0.71-0.99). Factors associated with SSRI use for PPD included more severe depressive symptoms during pregnancy (OR, 1.25; 95% CI, 1.13-1.36) and lifetime history of depression (OR, 6 .98; 95% CI, 4.92-9.98). Eighty of 177 women (45%) in the SSRI-treated PPD group had taken SSRIs during pregnancy compared with only 352 of 8,494 (4%) in the non-SSRI-treated PPD group.
Adverse Outcomes in Women with PPD Ameliorated by SSRI Therapy
More severe PPD symptoms were associated with a range of adverse maternal and child outcomes. However, treatment of PPD with an SSRI reduced the association between PPD and adverse outcomes, including maternal relationship satisfaction and maternal depressive symptoms at 6, 18, and 36 months and 5 years postpartum. In addition, treatment of PPD with an SSRI was associated with a reduced risk of externalizing problems and attention-deficit/hyperactivity disorder in children up to 5 years of age.
The results of this large prospective cohort study are consistent with previous studies and confirm that PPD symptoms are associated with worse maternal and child outcomes, including recurrent maternal depression, lower relationship satisfaction, and externalizing problems and ADHD symptoms to the children. However, this study also shows that SSRI treatment in the postpartum period was associated with a reduced risk of PPD-related maternal mental health problems and child externalizing behaviors during the first five years of the child’s life.
This study is notable for finding that only 2% of women with PPD were treated with an antidepressant. This report does not include data on the frequency of non-pharmacological treatment, including psychotherapy. We would expect that women with milder depressive symptoms might choose psychotherapy. It is possible that many women in this cohort had more significant symptoms but did not seek or were unable to receive psychotherapy or medication. It is also possible that the women received psychotherapy, but it did not appear to moderate the risk for negative PPD-related outcomes in their children. Although some types of psychotherapy have been shown to be effective in reducing maternal depressive symptoms, we have no data on the outcomes of children of women receiving psychotherapy.
The other important thing this study shows is the long-term benefits of SSRI treatment. benefits were seen up to five years postpartum. Many questions remain. However, this study highlights the need for more aggressive management of mothers with PPD. In this study, only 2% of women with PPD were treated with an SSRI. We don’t know exactly what kind of intervention the remaining women with PPD received. Presumably some of these women received psychotherapy. What we do know is that 98% of women with PPD were not treated with an antidepressant, and these women and their children had worse outcomes than their non-depressed or antidepressant counterparts.
These findings suggest that postpartum SSRI therapy may have short- and long-term benefits for women with postpartum depression and their offspring. This study provides valuable information for clinicians and women with postpartum depression making treatment decisions. Previous studies have documented that SSRI antidepressants are effective for the treatment of PPD. This study shows that treating PPD with SSRIs has long-term benefits for the mother—lower risk of recurrent depression, improved relationship quality—and long-term benefits for the child—reduced risk of externalizing ADHD symptoms and signs.
Ruta Nonacs, MD PhD
bibliographical references
Liu C, Ystrom E, McAdams TA. Long-term maternal and child outcomes after postnatal SSRI therapy. JAMA Network Open. 2023 Aug 1;6(8):e2331270.
