Another study has been conducted linking the use of antidepressants during pregnancy with an increased risk of autism in offspring, and was published in the British Medical Journal (BMJ).
This carefully worded study was based on data gathered in Sweden revealing that “in utero exposure to both selective serotonin reuptake inhibitors (SSRI’s) and nonselective monoamine reuptake inhibitors (another type of antidepressant) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability.”
Researchers examined Swedish medical birth registries to identify children diagnosed with autism, as well as mother’s use of antidepressants. The study was a case-control study, which looked at 4,429 cases of autism spectrum disorder and compared these cases to 43,277 matched controls. The researchers found that antidepressant use during pregnancy, with either SSRI’s or nonselective monoamine reuptake inhibitors, was associated with an increased rate of autism spectrum disorders in the offspring. The odds ratio was high (3.34), which indicates that antidepressant use was associated with more than a tripling of risk of autism in the children.
The author notes that all factors included in the study have previously been associated with autism; variables such as family income, parent educational level, maternal and paternal age, as well as maternal region of birth.
This is now the second study within the last two years that linked antidepressant use during pregnancy with an increased incidence of autism in exposed children. An earlier, smaller study in California, also found a small increase in risk. The Sweden-based study did not exclude the possibility that it was the severe depression, rather than the use of antidepressants, that created the association, but the smaller California study (which considered only SSRI’s) found “no increase in risk” for mothers with a history of mental health treatment in the absence of prenatal exposure to SSRI’s.
The author of the current study took a very cautious approach to their findings:
Dr. Adam C. Urato, assistant professor of obstetrics and gynecology at the Tufts University School of Medicine and chairman of the department of obstetrics and gynecology at Metro West Medical Center in Framingham, Massachusetts, said, “It really shouldn’t come as that much of a surprise given that numerous animal studies have shown that exposure during development leads to changes in the brain and changes in behavior—often that mimic autism.” He added, “And why shouldn’t it surprise us that medications that can change brain chemistry and function might alter the development of the brain and behavior?” Dr. Urato argues that the risks of antidepressant use during pregnancy outweigh what he sees as the limited benefits.
As far as autism goes, the first study came out in 2011. Croen, et al showed that SSRI exposure during pregnancy was associated with a doubling of the risk of autism. For first trimester SSRI exposure, the risk was almost quadrupled. Importantly, the study looked at depressed women not on SSRI’s, and in this group there was no increased risk of autism. It was the antidepressant use that was linked to the autism and not the depression.
The current study by Rai, published on April 19th, also shows an increased rate of autism in antidepressant-exposed children. This does not appear to be a result of depression, but rather of the medication. The only two studies in humans that have asked the question: “Is antidepressant use during pregnancy associated with autism?” have found the answer to be a clear “Yes.”
The authors of the recent study explain why they cannot clearly state whether the problem is with the antidepressants or the depression. They state that their study was not a randomized controlled trial (RCT). Only a randomized controlled trial, in which half the women are given antidepressants and the other half a placebo, can most accurately assess causation. This type of trial has never been done with antidepressants during pregnancy and many people feel that such a trial would not be ethical.
Although this is confusing and frustrating, an RCT is not always necessary to presume that a substance is harmful. One perfect example is cigarettes. There was never a RCT conducted on cigarettes, but it has been concluded that they cause harm. In this situation, we can see clearly from the animal studies that exposure to SSRI’s during development leads to changes in the brain and behavior that often mimics the findings in autism.
This is a conundrum. The pregnant women suffering from depression need treatment and care. However, is that treatment worth risking their unborn child’s health? The second study shows evidence that the SSRI antidepressants can injure the developing brain. How can that ever be okay? If these women suffering from depression were told about the increased risks of autism the antidepressant medications cause, would they agree to take it during pregnancy? They certainly would be depressed if their baby was born with a problem they could have avoided. The study suggests that non-drug therapies, such as psychotherapy and exercise, might provide as much benefit, if not more, in treating depression without the risk and worry.
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