Antidepressants and autism

Women who take common antidepressants while pregnant have a slightly higher risk of their children developing autism, or autism spectrum disorder (ASD).

This study was just released by JAMA Pediatrics.

Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.

SSRIs, or selective serotonin reuptake inhibitors, include Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva) and Sertraline (Zoloft).

They are by far the most commonly prescribed antidepressants. Overall, 10% of Americans take antidepressants, more women than men.

And I recently posted about a report from the Journal of Clinical Psychology that said 69% of patients taking an antidepressant don’t meet the criteria for major depressive disorder!

Again, the increased risk is very small, although still considered statistically significant. Other types of antidepressants did not show the same increased risk.

The mental health experts believe the benefits of treating depression outweigh the tiny risk of autism, and I won’t argue with that. My concern is the number of woman, including pregnant women, who are being treated with antidepressants when their depression might be better managed with non-drug therapies, such as cognitive behavior training (CBT) or counseling.

This study is not perfect and it is not the last word on whether SSRI depressants are safe to take during pregnancy. The authors said “further research is necessary,” and other reviewers have pointed out alternative theories and limitations:

“Kids of parents with depression and anxiety are at higher risk of presenting with different types of behaviors that could be mislabeled or misconstrued as ASD.”

Other limitations acknowledged by the authors are the study’s use of prescription-filling data for antidepressants, which may not reflect actual use. They also noted that they lacked data on maternal lifestyle, such as smoking or body mass index, as noted that the cohort was predominantly of lower socioeconomic status, which may limit the generalizability of the findings.

But it’s a good reminder that no drug is 100% safe, and no one has perfect knowledge about the possible side effects and harms of any drug. I’ve said many times on this blog that it is the patient’s responsibility to ask questions of the doctor: Do I really need this drug? Why? What are the benefits? What are the risks? What are my alternatives? (And don’t forget “How much does it cost?”)

Be informed and confident that the benefits of any drug outweigh the risks.

Pregnant women need to be especially careful, because they are treating their babies as well as themselves.

Sláinte,

Frugal Nurse

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