Yesterday it was widely-reported that a new research study found a link between autism and SSRIs taken by mothers during pregnancy.
SSRIs, if you don’t know, are certain types of antidepressants, and include such name brands as Zoloft, Prozac, Paxil and Luvox. I’ve already heard from some of you with understandable concerns about this news. I know it only adds to the stress all of us experience when making the decision whether and how to be treated with antidepressants if needed during pregnancy.
I reached out to Postpartum Progress Inc. board member Marlene F. Freeman, MD, director of Clinical Services at the MGH Center for Women’s Mental Healthand associate professor of Psychiatry at Harvard University, to help clarify what the study means for us. Here is her response:
“Autism is a very serious condition, and it would be extremely important to know what risk factors are definitely associated with the condition.
A recent article published first online in the Archives of General Psychiatryreported an association between autism and maternal SSRI use during pregnancy. The authors conducted a case controlled study of a Kaiser Permanente database.They found a greater risk of autism spectrum disordersamong children of SSRI users compared to non-usersduring pregnancy.Authors included diagnoses of autism spectrum disorders, maternal lifetime psychiatric diagnoses of mood and anxiety disorders and schizophrenia, and SSRI and other antidepressant prescriptions dispensed during pregnancy in the analyses. Maternal symptoms and burden of illness during pregnancy were not assessed.
The study generates questions for further study, but does not find a cause-and-effect relationship between SSRIs and autism.While previous history of mood and anxiety disorders is factored into the analyses, acute illness during pregnancy is not at all factored in. I believe that this greatly diminishes the value of the article to assess the impact of SSRIsin pregnancy on the risk of autismin children. Current use of SSRIs may be a better indication of acute illness during pregnancy than history of previous diagnoses (as many women will be undertreated during pregnancy due to concerns about fetal exposure, hence leading to a dual exposure of both medication and untreated maternal illness). The possibility that SSRI use may represent acute symptoms or illness is not among the limitationsof the study discussed by its authors. Since the authors state”the combined effect of maternal serotonin transporter geonotype and prenatal stress may contribute to autistic-like behaviors in offspring,” it is disappointing that their study did not control for prenatal maternal stress or burden of illness. Therefore, it is not possible to separate out genetic predisposition and symptoms experienced by mothers during pregnancy — suspected to contribute to risk of autism — from medication exposure in this study.
At this time, we need further research to determine whether maternal anxiety or depression or medication use may increase the risk of autism spectrum disorders, and whether unknown factors associated with maternal mental health conditions or medicine use increase risk. Until risk factors are clearer, women with serious mood and anxiety disorders that do not find relief from non-medication treatments such as psychotherapy should talk about risks/benefits of medicationwith their doctors, and antidepressants are still considered first-line treatment for moderate to severe illness. Women with more mild illness, as before this report, should be encouraged to try psychotherapy first, and perhaps othernon-medication strategies.”
Translated into plain mama English: They don’t know whether it was the treatment (SSRIs), or the illness for which the mom is being treated (antenatal depression/anxiety, or depression/anxiety she has always had), or some genetic factor in the mom that may be related to both autism and the fact that she is vulnerable to depression/anxiety that led to the incidences of autism in the study. Not to mention the women whose children have an autism spectrum disorder who have none of the above.
The authors of the study themselves suggested caution in how their findings are interpreted (from the Archives of General Psychiatry):
“Our results suggest that prenatal exposure to SSRIs, especially during the first trimester, may modestly increase the risk of ASDs [autism spectrum disorders]. The fraction of cases of ASD that may be attributed to use of antidepressants by the mother during pregnancy is less than 3% in our population, and it is reasonable to conclude that prenatal SSRI exposure is very unlikely to be a major risk factor for ASD. Although these findings indicate that maternal treatment with SSRIs during pregnancy may confer some risk to the fetus with regard to neurodevelopment, this potential risk must be balanced with the risk to the mother or fetus of untreated mental health disorders. We recommend that our findings be considered as preliminary and treated with caution …”
So there you have it. I know many of you had seen this news and I wanted you to get the most balanced information possible.