A shocking new review of prenatal antidepressant use underscores a finding that has repeatedly emerged over the past decade: Although parental stress is strongly associated with child mood disorders, taking antidepressants during pregnancy does not appear to significantly increase a child’s risk of autism.
In an analysis of 37 different studies covering more than 25 million pregnancies, a team of researchers from the University of Hong Kong found that children born to women who took antidepressants during pregnancy were actually more likely to later be diagnosed with autism or attention-deficit/hyperactivity disorder (ADHD).
But when the researchers took into account confounding factors such as a family history of neurodevelopmental problems or pre-existing mental health conditions in the mother, the association disappeared.
The data showed that children born to women with a history of depression were more likely to be diagnosed with autism or ADHD, regardless of whether their mother was taking psychiatric medication. Children were also more likely to be diagnosed with autism and ADHD if their fathers took antidepressants during pregnancy, even if their mothers did not – an association that suggests a genetic link, not a pharmacological one.
I results were published this month in the journal The Lancet.
“Our findings are consistent with current clinical guidelines, which continue to support antidepressant treatment during pregnancy when clinically indicated,” said Dr. Wing-Chung Chang, professor of psychiatry at the University of Hong Kong and senior author of the paper. “Our findings do not provide strong evidence that prenatal exposure to sedatives causes neurodevelopmental disorders.”
The possibility that antidepressant use in pregnancy can contribute to neurodevelopmental conditions has been a source of concern for many expectant parents since at least 2015, the most published Canadian study noted that women who took certain antidepressants later in pregnancy were almost twice as likely to have a child with depression than women who did not take the drugs.
Many studies since then have also identified a correlation between a woman’s use of antidepressants during pregnancy and her child’s later diagnosis of autism, and to a lesser extent, ADHD.
But ending the analysis there overlooked an important difference, the researchers say: it’s possible that the association is actually between neurodevelopmental disorders and depression, not medication.
Autistic people of all ages are much more likely than their neurotypical peers to be diagnosed with mental health conditions such as depression or anxiety. The big one human studies found that autistic adults up to three times as you may have depression compared to non-autistic people.
The causes of mental health symptoms in autistic people are varied and complex, and the challenges of navigating a world designed for a different way of thinking can play an important role. But research has seen multiple genetic profiles again biological methods common in autism and mood disorders, and it is possible that both conditions are at least partly the result of familial genetics.
“The mental health of your family is somewhat statistically associated with your risk of autism,” said Brian K. Lee, a professor of epidemiology and biostatistics at Drexel University.
Neither depression nor autism causes the other. Lee likened their frequent encounters to the pairing of fiery red hair and pale, sun-burnt skin: two desirable traits that can easily exist independently in an individual, but often run together in family trees.
“What the literature has shown us so far is that although it seems that, on the face of it, there seems to be a slightly increased risk of autism in mothers who take antidepressants, when you control for latent depressive disorders that may pass,” said Dr. “This evidence suggests that biological mechanisms that are disrupted in severe stress are also important in autism.”
Erickson-Ridout compared the growing impact of a 2015 Canadian study on mental health care for pregnant women to concerns about vaccines caused by Andrew Wakefield’s retracted 1998 paper that incorrectly linked autism to the measles, mumps and rubella vaccine.
The Canadian study was not as flawed as Wakefield’s paper, although some critics argued at the time that it did not adequately control for confounding factors such as maternal depression.
But its media coverage generally failed to clarify both the low risk of autism – 1.2% of children born to women who took selective serotonin reuptake inhibitors during their second or third trimester were later diagnosed with autism, compared to 0.7% of children in the general population – or to weigh the risk of antidepressant use against the risks of chronic depression.
Its effects are still present today. Last year, the US Food and Drug Administration met a controversial panel on prenatal SSRI use. Nine out of 10 members of the panel were researchers, doctors or psychologists who have questioned the safety of the drugs or criticized the use of antidepressants in general. Among them was Anick Berard, an epidemiologist and lead author of the 2015 Canadian paper.
Suicide of course the second leading cause of maternal mortality in the US, and the first homicide.
Any discussion about the dangers of antidepressants must be weighed against the potential harm of stopping or refusing to treat a potentially dangerous mental health condition, said Dr. Katie Unverferth, a reproductive psychologist and UCLA’s medical director. Maternal Mental Health Program.
“Pregnancy is a very stressful time in the beginning — a lot of new things are happening, and your body is changing, and you want to make sure you’re doing the right thing for you and your growing baby,” says Unverferth. “This study provides more convincing information.”
