Selective serotonin reuptake inhibitor effective against postnatal depression

Selective serotonin reuptake inhibitor effective against postnatal depression | Image Credit: © grooveriderz - © grooveriderz - stock.adobe.com.

According to a recent study published in JAMA Network Open, selective serotonin reuptake inhibitor (SSRI) treatment reduces the risks of maternal health problems associated with postnatal depression and child behavioral issues in early years.

Between 10% and 15% of women are impacted by postnatal depression within the first year of childbirth, which increases the risk of depressive episodes in future pregnancies and often leads to higher levels of depression. The offspring of these mothers are at an increased risk of cognitive and behavioral issues. This indicates a need to treat postnatal depression.

Multiple trials have indicated efficacy from antidepressants in treating postnatal depression, with SSRIs being the most desirable method because of improved safety and tolerance compared to other antidepressants. However, there is little data on the long-term outcomes of SSRI use and conflicting data on the efficacy against postnatal depression.

Investigators conducted a study to determine maternal and child outcomes up to year 5 postpartum associated with SSRI treatment. The Norwegian Mother, Father and Child Cohort Study (MoBa) was consulted for data.

Participants in the MoBa study included women who received an ultrasound between weeks 17 and 18 of pregnancy from 1999 to 2008. Families completed questionnaires about child development and maternal health from week 17 of gestation until the end of follow-up.

Women with data on depression symptoms from week 30 of gestation and month 6 of postpartum were included in the current study. Data on self-reported medication use for mental health symptoms was also collected in these women.

Prenatal maternal data included education level, income at week 17 of gestation, and depression history. Maternal depression at week 30 of gestation was evaluated using the 8-item Hopkins Symptom Checklist (SCL-8). 

Depression at 6 months postpartum was evaluated using the 6-item version Edinburgh Postnatal Depression Scale along with continued use of the SCL-8. The Anatomic Therapeutic Classification system was used to determine postnatal medication use, with focus placed on SSRIs.

Maternal outcomes included maternal depression, partner relationship satisfaction, and partner relationship quality. Child outcomes included internalizing behaviors, externalizing behaviors, and motor and language development.

There were 61,081 mother-child dyads with a postnatal diagnosis of depression included in the analysis, 2% of which received postnatal SSRI treatment. Women with postnatal depression had increased rates of lower education level, lower income level, prenatal tobacco use, lifetime depression history, and higher levels of prenatal depression.

SSRI use for treating postnatal depression was more often seen in women with a lower parity, a lower education level, a higher level of prenatal depression, and depression history. Of women who used SSRIs to treat postnatal depression 45% also used them during pregnancy, compared to 4% of the non-SSRI treated postnatal depression group.

Increased maternal depression from years 1.5 to 5 of postpartum and decreased relationship satisfaction from month 6 to year 3 of postpartum were seen in women with increased postnatal depression severity. Children of women with more severe postnatal depression had worse motor and language scores from ages 1.5 to 3 years and increased attention-deficit/hyperactivity (ADHD) symptoms at age 5 years.

SSRI treatment moderated the associations between postnatal depression and maternal depression and relationship satisfaction, as well as with child externalizing behaviors and ADHD. Mothers who used SSRI and did not have postnatal depression also had improved health and relationship outcomes.

These results indicated efficacy from SSRIs against adverse outcomes associated with postnatal depression. Investigators concluded this information is important for understanding long-term outcomes associated with SSRI treatment for postnatal maternal depression.

Reference

Liu C, Ystrom E, McAdams TA. Long-term maternal and child outcomes following postnatal SSRI treatment. JAMA Netw Open. 2023;6(8):e2331270. doi:10.1001/jamanetworkopen.2023.31270