Medication of Postpartum Depression and Maternal Outcomes: Evidence from Geographic Variation in Dutch Prescribing

Abstract

Using data on over 420,000 first time Dutch mothers, we examine the effects of postpartum antidepressant use on a wide range of maternal outcomes including further treatment for severe mental illness, labor market outcomes, and family formation. We exploit rules which state that Dutch general practitioners (GPs) must be available to make house calls to their patients. In practice many therefore use postal code boundaries to limit their practices. We instrument a postpartum woman’s receipt of antidepressants with the propensity to prescribe antidepressants to women aged 46 to 65 among GPs in her postal code. Ordinary Least Squares estimates suggest highly negative effects of postpartum treatment with antidepressants, but this is mainly due to selection into treatment. Instrumental variable estimates suggest that the marginal patient treated with postpartum antidepressants is much more likely to continue taking antidepressants long-term, with little evidence of effects on other outcomes.