Postnatal depression, to treat or not to treat: Long-term consequences of postnatal selective SSRI treatment on mother and child

Abstract

Background Although selective serotonin reuptake inhibitors (SSRIs) are a recommended intervention for postnatal depression (PND), a lack of evidence regarding the long-term consequences of postnatal SSRI use have resulted in treatment hesitancy. Methods Longitudinal data on a total of 54576 mother-child dyads enrolled in the Norwegian Mother and Child Cohort Study (MoBa) were examined. We used multilevel models to test associations between PND and maternal outcomes (depression and anxiety, relationship satisfaction) and child outcomes (motor and language development, emotional and behavioral problems) from birth to postpartum year 5. We included an interaction term in models to test whether postnatal SSRI treatment moderated the effects of PND. We used a propensity score to control for pre-/antenatal factors that impacted the probability of receiving SSRIs. Results PND was associated with poor maternal mental health outcomes and problems in child emotional and behavioral development. Use of SSRIs mitigated the associations between PND and later maternal depression and child externalizing behaviors up to postpartum year 5. We found no evidence to indicate that postnatal exposure to SSRIs was associated with increased risk of any negative outcomes in women or their offspring. Conclusions SSRIs bring benefits in the long term by attenuating the detrimental associations between PND and subsequent maternal depression and child externalizing behaviors. Our findings provide valuable information for clinicians and women with PND to consider when making decisions regarding treatment.