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SSRI treatment in postnatal depression linked to improved maternal and child outcomes

The use of postnatal selective serotonin reuptake inhibitor (SSRI) treatment is associated with a lower risk of postnatal depression-associated maternal mental health problems and child externalising behaviours, up to five years after childbirth, according to a recent study.

Published in the journal JAMA Network Open, the study sought to examine whether postnatal SSRI treatment moderated postnatal depression-associated maternal and child outcomes across early childhood years.

The UK and Norwegian researchers used longitudinal data from the Norwegian Mother, Father and Child Cohort Study, which recruited women during weeks 17 to 18 of their pregnancy and prospectively followed them after childbirth.

Mothers were asked to report any medications they had taken at postpartum month six. As SSRIs are commonly used for postnatal depression, the study focused exclusively on this class of drugs.

The outcomes of interest were self-reported maternal depression symptomology and relationship satisfaction from childbirth to five years after giving birth. In addition, child outcomes included emotional and behavioural problems such as internalising and externalising behaviours, attention deficit hyperactivity disorder (ADHD) symptoms, together with motor and language development at ages 18 months, three and five years.

Postnatal depression SSRI use

A total of 61,081 mother-child dyads met the criteria for a postnatal depression diagnosis. The analysis revealed that the severity was associated with higher levels of maternal depression across postpartum years 1.5 to five. There was also poorer relationship satisfaction between postpartum month six and year three.

Furthermore, postnatal depression severity was associated with higher levels of child internalising and externalising behaviours as measured across ages 18 months to five years, poorer motor and language development at years 18 months and three, as well as and ADHD symptoms at age five years.

In further analysis, the researchers observed postnatal SSRI treatment moderated associations between postnatal depression and maternal depression at postpartum year 1.5 and year five, together with better relationship satisfaction at both six months and three years after birth.

However, postnatal SSRI use also moderated the associations between postnatal depression and child externalising behaviours at ages 18 months and five years, as well as ADHD at age five years.

Dr Tom McAdams, senior author of the study and Wellcome Trust senior research fellow at King’s Institute of Psychiatry, Psychology and Neuroscience, said: ‘Postnatal depression is under-recognised and under-treated. 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.

‘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.‘

SSRIs are designed to increase levels of the neurotransmitter serotonin, though, in recent years, this purported mode of action has been questioned.

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