Treatment of PPD with SSRIs: Long-Term Benefits for Both Mother and Child

Although antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are recommended for the treatment of postpartum depression (PPD), many women do not pursue or receive antidepressants for the treatment of PPD. While we have data supporting the effectiveness of SSRIs and the SNRI, venlafaxine, for the treatment of postpartum depression, we lack data regarding long-term maternal and child outcomes following treatment of PPD with an SSRI.

Based on data in non-postpartum populations of adults treated with antidepressants, we would expect to see improvements in functioning in mothers treated with antidepressants.

Does antidepressant treatment of the mother improve child outcomes?

Using longitudinal data from the Norwegian Mother, Father and Child Cohort Study, researchers examined whether postpartum SSRI treatment moderated postpartum depression-associated adverse outcomes in mothers across the first five years of the child’s life.

In this cohort study, women were recruited at weeks 17 to 18 of pregnancy and were followed prospectively for five years after childbirth. 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 childbirth up to 5 years postpartum. Child outcomes included maternal-reported internalizing and externalizing problems, attention-deficit/hyperactivity disorder symptoms, and motor and language development at ages up to 5 years of age. 

Among a total of 61,081 mother-child dyads, 8,671 (14.2%) (mean [SD] age, 29.93 [4.76] years) met the criteria for the diagnosis of PPD. A total of 177 women with PPD (2.0%; mean [SD] age, 30.20 [5.01] years) received postpartum SSRI treatment. 

This was a naturalistic study, so there were notable differences between women who elected to use SSRIs for PPD versus those who did not elect to use them. For example, factors associated with not using an SSRI 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 symptoms of depression 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 the 177 women (45%) in the SSRI-treated PPD group had received SSRIs during pregnancy compared with only 352 of 8,494 (4%) in the non–SSRI-treated PPD group.

Adverse Outcomes in Women with PPD Mitigated with SSRI Treatment

More severe PPD symptoms were associated with a range of adverse maternal and child outcomes. However, treatment of PPD with an SSRI attenuated 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, PPD treatment with an SSRI was associated with decreased 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 depression in the mother, lower relationship satisfaction, and externalizing problems and ADHD symptoms in the children. However, this study also shows that treatment with an SSRI during the postpartum period was associated with a reduced risk of PPD-associated maternal mental health problems and child externalizing behaviors across the first five years of a child’s life. 

This study is notable for the finding that only 2% of women with PPD received treatment with an antidepressant. This report does not include data on the frequency of non-pharmacologic treatment, including psychotherapy. We would expect that women with milder depressive symptoms might opt for psychotherapy; it is likely that many women in this cohort had more significant symptoms but did not seek or were not able to obtain psychotherapy or medication. It is also possible that the women received psychotherapy, but it did not appear to mitigate risk for PPD-associated negative outcomes in their children. Although certain types of psychotherapy have been shown to be effective for reducing depressive symptoms in the mother, we do not have data on child outcomes in women receiving psychotherapy. 

The other important thing this study demonstrates is the long-term benefits of treatment with an SSRI; benefits were seen up until five years postpartum. Many questions remain; however, this study emphasizes the need for more aggressive treatment of mothers with PPD. In this study, only 2% of the women with PPD were treated with an SSRI. We do not know exactly what sort of intervention the rest of the women with PPD received. Presumably some of those women received psychotherapy. What we do know is that 98% of the women with PPD were not treated with an antidepressant, and these women and their children had worse outcomes than their non-depressed or antidepressant treated counterparts. 

These findings suggest that postpartum SSRI treatment may have both 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 who are making decisions regarding treatment. Previous studies have documented that SSRI antidepressants are effective for the treatment of PPD. This study indicates that SSRI treatment of PPD has long-term benefits for the mother–lower risk of recurrent depression, improved quality of relationships–and long-term benefits for the child–decreased risk of externalizing symptoms and ADHD symptoms.

Ruta Nonacs, MD PhD

References

Liu C, Ystrom E, McAdams TA. Long-Term Maternal and Child Outcomes Following Postnatal SSRI Treatment. JAMA Netw Open. 2023 Aug 1;6(8):e2331270.