Kate Lui Postnatal depression is a serious  mental health issue that affects about   10-15% of women in the first year after giving  birth. There is a consistent evidence showing   that untreated postnatal depression can have  long-lasting negative consequences on mothers,   such as persistent depression and a higher  risk of future recurrence and even increased   self-harm or suicide risk. In addition to  those, depression can also make bonding   with their children more challenging and  strain the relationship with their partners. But it is not just the mothers who are affected.  Children of mothers with postnatal depression   also face higher risk of having developmental  delays or difficulties, whether it’s physical,   cognitive or psychological. And they’re  also more prone to mental health issues,   like anxiety and depression. Some of those  negative association can still be observed   when the child reach teenage years. So,  given all these evidence on the negative   impacts of untreated postnatal depression,  it is clear that timely intervention make a   big difference and help avoid many of  these negative consequences [pause]. So, as we all agree, prompt and adequate  treatment for postnatal depression is   essential. In general, treatment options  include self-help, talking therapies,   like cognitive behavioural therapies, and  medication. And the choice of treatment   generally depends on the severity of  the depression, patients’ preferences   and their history with mental illness  and previous treatment. For example,   mild cases may benefit from self-help strategies  or talking therapies, while antidepressant are   often offered to cases that more – with  more dep – severe depression [pause]. So, selective serotonin reuptake inhibitors, SSRI,  are a commonly used medication for depression,   as they are well tolerated and they are  effective. And SSRI works by increasing   the level of serotonin in our brain, which  helps improve mood, and studies have shown   significant improvement in postnatal depression  symptoms with SSRI treatment compared to placebo. In our study, we observed similar positive effects  of SSRI treatment for postnatal depression.   We followed families from pregnancy through  the first five years after childbirth and   we found that postnatal SSRI treatment not  only reduced long-term maternal depression,   but it also improved emotional and behavioural  problems of the child. Although we did not   directly investigate the mechanisms, it is  possible that the improved maternal mood   strengthen mother-child bonding and promotes more  positive parenting, which could contribute to the   benefits that we observed. And in fact, improved  mother-child interaction was found to be a key   factor associated with better child developmental  outcomes in previous studies [pause]. This is an important question because  understanding patterns of treatment use,   beliefs and preferences, can help us  directly address barriers that prevent   women with postnatal depression  from accessing appropriate care.   Unfortunately, there’s very limited research on  this topic and studies in the US have shown that   many women with perinatal depression actually  feel more confident in getting advice from   friends or families, or in talking therapies,  than in medication. And the common barriers   that has been reported are limited accessibility  to healthcare professionals, lack of information   on best treatment options and uncertainty  about the benefits and risks of medications. And in the UK, there’s one study  interview women participating in   a clinical trial for postnatal depression  treatment, and they found that initially,   most women actually had a sceptical view towards  SSRI, but through interaction with healthcare   professionals and with other patients, their  perspectives often shifted. And that study also   found that women who took antidepressant in the  trial reported benefits like mood stabilisation   and regaining the energy to manage daily  activities and a sense of normality. These studies highlight two main barriers. One is  structural challenges, and the other is a lack of   knowledge. So, to address these, understanding  the lived experience of patient is crucial,   specifically what they find challenging and what  support they deem most helpful. And Clinicians   should explore each patient’s specific concerns  about treatment and provide psychoeducation   on the cause of postnatal depression to reduce  stigma, and clearly explain treatment options,   including their risk and benefits. And  in addition, like, regular follow-ups   are vital to strengthening continuity of care  and building a strong therapeutic alliance,   which are essential for promoting treatment  adherence and better outcomes [pause]. The findings on the safety of perinatal SSRI  use for children are mixed, but it is worth   noting that even exposure through – to SSRI  through breastmilk is generally low. But we   still have to bear in mind there are – there  have been some case reports of potential side   effects in infants from SSRI exposure through  breastmilk, with symptoms like agitation,   restlessness and difficult – feeding difficulties.  However, these symptoms are on a – are generally   transient and manageable. A Cochrane Review  on SSRI use for postnatal depression in 2021   found none of the studies they included for review  reported adverse event in children, but the author   also acknowledged that data on long-term  child-related outcomes are very limited. And we recognise that the limited evidence on this  topic may contribute to some treatment hesitation,   so to address this, our study followed  children from birth to five-years-old,   examining their emotional, behavioural,  motor and language development, and we   found no evidence that postnatal SSRI use had  a negative impact on these outcome. Of course,   our study has its limitations, so it is  essential for Clinicians to weigh the risk   and benefits of different treatment  options for each individual [pause]. Our study adds valuable insight to the mixed  finding on the safety of perinatal SSRI use   for children. Many early – earlier studies on  postnatal SSRI use and child-related outcomes   have been limited by small sample sizes and  the lack of long-term follow-up. One of our   study’s main strengths is its large  sample size, where we had over 60,000   mother-child pairs in Norway and the fact that  we follow the children up to five-years-of-age.   So, this scope allowed us to address some of  the limitations of previous research. Second,   another challenge in this area of research  is confounding, like socioeconomic status,   which might influence both a mother’s likelihood  of receiving SSRI for her treat – for her   depression and the pat – child’s outcomes. Although randomised controlled trials would   ideally minimise these biases, they aren’t always  ethical in this context. So, to strengthens our   finding, we used a method called propensity score  matching, which helps control for personal and   environmental factors to better approximate a  randomised design. This approach allowed us to   make more confident conclusion with glossaries of  bias. Additionally, we repeated our analysis in   women with more severe depression and controlled  for prenatal SSRI use, and our findings remain   consistent across these tests. Overall, our  study helps advance the understanding by   providing a more robust look at long-term child  outcomes following postnatal SSRI use [pause]. There’s still a lot of work to be done in this  area. For instance, our findings may not be   directly transferrable to other countries, so  replication studies are important. Also, we   did not compare the effects of different types of  SSRIs or other classes of antidepressants, which   can be valuable information for Clinicians and  for patients. And lastly, the mechanism behind the   positive effects of treatment are still unclear.  If we can better understand these pathways,   it could open up more option for targeting and  preventing these long-lasting negative outcomes.