Tuesday, July 5th, 2011
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.
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.Add a Comment