Underutilized antidepressant treatment for postnatal depression associated with improved child outcomes at age five

New research led by the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King's College London has found that selective serotonin reuptake inhibitor (SSRI) treatment for postnatal depression is associated with improvements in child behavior up to five years after childbirth.

Up to 15% of women experience postnatal depression which has been shown to be associated with poor outcomes for mothers' and their children.

Researchers at King's IoPPN, in collaboration with the University of Oslo, analyzed data from over 61,000 mothers and their children recruited during pregnancy from the Norwegian Mother, Father and Child Cohort Study. The researchers investigated how postnatal SSRI treatment modified the negative outcomes associated with postnatal depression in mothers and their children.

The study, published in JAMA Network Open, found that SSRI treatment for postnatal depression was associated with better outcomes up to five years after childbirth than mothers with postnatal depression who did not take SSRIs. These included reduced child behavioral difficulties (such as conduct problems and antisocial behavior), child ADHD symptoms and maternal depression, as well as improved satisfaction in partner relationships.

The findings suggest that SSRI treatment could bring mid- to long-term benefits to women with postnatal depression and their children by reducing the risk of several negative outcomes that are associated with postnatal depression.

Dr. Kate Liu, Research Associate at King's IoPPN and first author of the study, said, "Postnatal depression is a common psychiatric disorder that affects 10 to 15% of women in the first year after childbirth. In the UK however, only 3% of women with postnatal depression receive SSRI treatment. This is likely due to a lack of awareness of postnatal depression, alongside concerns about the long-term impact that taking antidepressant medications in the postnatal period may have on child outcomes."

"Our study found no evidence suggesting that postnatal SSRI treatment conferred an increased risk for child development. In fact, we found that postnatal SSRI treatment reduced maternal depression and child behavioral difficulties that are associated with postnatal depression."

Of the 61,081 mothers recruited in week 17–18 of pregnancy, 8,671 met the diagnostic criteria for postnatal depression at six months postpartum and 177 of these received postnatal SSRI treatment. Mother and child outcomes, including maternal depression and child emotional and behavioral difficulties, were measured when the child was ages 1.5, three and five. Maternal reported partner relationship satisfaction was measured at six months, 1.5 years and three years postpartum.

Researchers found that more severe postnatal depression was associated with higher levels of future maternal depression, poorer partner relationship satisfaction, higher levels of child emotional and behavioral difficulties, poorer motor and language development and increased ADHD symptoms.

Postnatal SSRI treatment mitigated the association between postnatal depression and maternal depression at 1.5 and five years postpartum, child behavioral difficulties at ages 1.5 and five years, ADHD symptoms at age five, and relationship satisfaction across all measured timepoints. In addition, postnatal SSRI treatment mitigated the negative association between postnatal depression symptoms and maternal depression at five years postpartum even when the level of postnatal depression did not meet the researchers' diagnostic threshold.

Dr. Tom McAdams, Wellcome Trust Senior Research Fellow at King's IoPPN and senior author of the study, said, "Postnatal depression is under-recognized and undertreated. 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, behavioral problems or motor and language delay."