Antidepressants And Autism: Too Early For A Take-Home Message?

As reported by my fellow blogger Holly Lebowitz Rossi, a recent study published in the Archives of General Psychiatry suggested a link between use of antidepressants while pregnant and autism spectrum disorder (ASD). As Holly noted, there are important limitations to the study, and hence the clinical implications are not entirely clear.

After reading the research report, my feeling is that this preliminary study flags an important area for researchers to delve into — but the science conducted to date is not at the point of delivering a solid take-home message. Two considerations are especially important.archgenpsychiatry

First, all the analyses were based on information taken from medical records. It would be critical to replicate and extend these findings by directly studying the mothers and their children. Key issues will be getting more precise validation of the timing of antidepressant use, and also conducting diagnostic interviews of the children. As the study authors note, any imprecision in the medical records could skew the findings — and using medical records, while informative, is not the gold standard of this type of research.

Second, the associations, while statistically significant, were small. Consider that 278 of the 298 children whose mothers took antidepressants did not develop ASD. In addition, 50 of the 1507 children whose mothers did not take antidepressants did develop ASD. The study authors suggest that, based on their analyses, about 2% of the cases of ASD in their sample were attributable to use of antidepressants. And the paper also notes a number of other potential confounding issues that further research will have to consider.

Taken together, we would need to see more research that builds on this important initial observation by utilizing more informative measures. Keep in mind that the issue is not just to replicate the finding — it’s possible that a well-designed study could reveal even larger associations between use of antidepressants and ASD. Preliminary studies such as this are very influential in research because they open the door to new ideas and provide a platform for new studies that could provide much better resolution on this issue.

So where does this leave women who are pregnant and suffering from depression? At this point, they will need to rely on the counsel of their physicians, and their own judgement, to try to balance the importance of treating depression with the possibility that using antidepressants could, in some cases, contribute to risk for ASD. The reality is that, as of now, the current research does not provide a definitive answer.

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  1. by Diane Debrovner

    On July 5, 2011 at 9:54 am

    Very helpful, thanks.

  2. by Julia

    On July 5, 2011 at 10:43 am

    Good points. This study also only examined SSRIs, correct? If the evidence does turn out to be conclusive, hopefully other classes of antidepressants will be determined to be “safer” for use during pregnancy in terms of ASD risk.

  3. by Mary Helen Sheriff

    On July 10, 2011 at 8:10 am

    Is it also possible that the connection might be between the depression in the mother and autism rather than the medication? Or were the mothers not using antidepressants also depressed, but merely off their medication?

  4. by Richard Rende

    On July 10, 2011 at 8:27 am

    Mary, this is a very good question. In this study, they statistically controlled for history of depression (and other disorders), particularly in the year before birth, and they still found a significant association. That said, this will be a very important issue to focus on in future research, especially since replication and expansion of this study will be needed before firm conclusions can be drawn. Thanks for bringing attention to this point.

  5. by Tessa Cronin

    On July 20, 2011 at 12:00 pm

    I am a 41 year old Autistic wondering why everyone is trying to find some outside excuse for autism. Autism is not some new disorder, it did not just suddenly show up a few years ago because of some vaccine or pill. Autism is hereditary. I, my son, sister, father, aunt, grandfather and niece all have varying degrees of autism. Read dictionaries from the 1920s to 1950s. Autism is in them, this is long before a medicated America. Stop playing the blame game and learn to live with autism like We have.

  6. by Tessa Cronin

    On July 20, 2011 at 12:05 pm

    By the way, all of the before mentioned relatives are from one side of my family.

  7. by Theresa Heckendorf

    On January 31, 2012 at 4:23 pm

    Thanks for your suggestions.Hope this will work for me in the time to come. It was fun reading this article ! Similar article