A selective serotonin reuptake inhibitor is effective against postpartum depression

A selective serotonin reuptake inhibitor is effective against postpartum depression Image credit: ©grooveriderz – ©grooveriderz – Stock.adobe.com.

According to a recent study published in JAMA Network is openTreatment with selective serotonin reuptake inhibitors (SSRIs) reduces the risk of maternal health problems associated with postpartum depression and behavioral problems in children in the early years.

Between 10% and 15% of women are affected by postpartum depression within the first year of giving birth, 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 increased risk of cognitive and behavioral problems. This points to the need for postpartum depression treatment.

Multiple trials have indicated the effectiveness of antidepressants in the treatment of postpartum depression, with SSRIs being the most preferred method due to improved safety and tolerability compared to other antidepressants. However, there is little data on the long-term outcomes of SSRI use and conflicting data on effectiveness against postpartum depression.

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

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

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

Prenatal data for mothers included education level, income at 17 weeks’ gestation, and history of depression. Maternal depression was assessed at 30 weeks’ gestation using the Hopkins 8-item Symptom Checklist (SCL-8).

Depression was assessed 6 months postpartum using the 6-item version of the Edinburgh Postpartum Depression Scale together with continuous use of the SCL-8 scale. The anatomical therapeutic classification system was used to define postpartum drug use, with an emphasis on selective serotonin reuptake inhibitors (SSRIs).

Outcomes included mothers’ maternal depression, relationship satisfaction with their partner, and relationship quality with their partner. Child outcomes included inner behaviors, outer behaviors, and motor and language development.

There were 61,081 mother-child pairs diagnosed with postpartum depression in the analysis, and 2% of them received SSRI treatment after delivery. Women with postpartum depression had increased rates of lower level of education, lower level of income, prenatal tobacco use, lifetime history of depression, and higher levels of prenatal depression.

SSRI use to treat postpartum depression was more common in women with lower parity, lower level of education, higher level of prenatal depression, and history of depression. Of the women who used an SSRI for postpartum depression, 45% also used it during pregnancy, compared to 4% in the PND group not treated with an SSRI.

An increase in maternal depression from 1.5 to 5 years postpartum and a decrease in relationship satisfaction from month 6 to year 3 postpartum were seen in women with increased severity of postpartum depression. Children of women with more severe postpartum depression had worse motor and language scores from ages 1.5 to 3 and an increase in attention deficit/hyperactivity disorder (ADHD) symptoms at ages 5.

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

These results indicated the effectiveness of SSRIs against adverse outcomes associated with postpartum depression. The authors concluded that this information is important for understanding the long-term outcomes associated with SSRI treatment for maternal postpartum depression.

reference

Liu C, Ystrom E, McAdams TA. Long-term outcomes for mother and child after postpartum SSRI treatment. JAMA Netw is open. 2023;6(8):e2331270. doi:10.1001/jamanetworkopen.2023.31270