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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.
THANK you for a sane presentation. The flurry and anxiety that will likely ensue after people get wind of the "link" between SSRI's and autism is a shame. I have had two healthy children, both pregnancies while taking a low dose SSRI for anxiety. My OB/midwife team were completely comfortable with it in their practice. I opted for mental health, feeling that my children would most benefit from having a stable and emotionally sound mother. It's personal for everyone, but these inflamed headlines cause such un-necessary worry and blame.
Thank you so much for the plain momma english interpretation.
Thanks for heading off the panic!!
That's what we're here for. Up to the moment info from credible sources!!
Oh man. Thanks for clarifying; just had a mini stroke when I saw your headline and am relieved to see this full explanation and dissection of the study. Thanks, Katherine!
I'd like to point out that the SSRI/Autism study doesn't control for environmental factors either. There was a study that came out in December 2010 that reported children living near freeways were twice as likely to have autism: http://tinyurl.com/3vd2yuy
All the children in the SSRI study were from California, yet there was no control for proximity to a major freeway – California has many freeways. Interestingly, in that same journal as the SSRI study, there was simultaneously an article that stated environmental factors are likely to play some role (full text here: http://tinyurl.com/4xjampy) in autism.
I suffered with horrible depression during my last pregnancy because I was afraid to take medication. And I worry that studies like this will cause many other women to refuse treatment as well. Thank you for balanced perspective on the issue.
If I had to do it over again, I would take the medication during my pregnancy. (I'd like to have another child in the future, and I know that I will not hesitate to seek treatment if necessary.) I believe that the level of depression, insomnia and stress I suffered was more risky to my health and the baby's health than the medicine recommended by my doctor during pregnancy (Zoloft) would have been.
My first pregnancy was joyful. My second pregnancy was a horrible experience, and I am truly lucky that I came through it with a healthy baby.
But studies like this will be exaggerated by the press and will deter women from getting treatment. In fact, I already received a call from a family member telling me that they were glad I "toughed it out" during my pregnancy because the drugs would have "given him autism." The caller meant well but clearly didn't understand the nuances of the study or the severity of what I experienced during my pregnancy.
Depression just isn't something that you can "tough out." If my husband weren't so committed to our marriage, I believe my untreated depression could have destroyed our marriage. And it damaged my health by contributing to an enormous stress-related weight gain during the pregnancy as I attempted to medicate myself with foods.
Thanks for a very helpful article.
As a Family Doctor, Iam always very mindful of how to intepret any new data that is presented to us. I often say that no information is sometimes better than having bad information.
There is a lot of information out there and how to get good information is the key. Bad information can create a lot of anxiety and panic.
There is a particular study that I want to highlight to illustrate how information can be "misintepreted".
There was a study that we reviewed during my study as a medical student. The study showed an association between the risk of leg clots in hospital patients and smoking. It actually showed that the smokers had LESS risk of getting leg clots. So the question is, "Can you conclude that smoking is good at preventing a leg clot". Sounds absurd but this was "true" from the study.
However, on further appraisal, they concluded that there was a "confounding factor". Smokers were not allowed to smoke in the ward so they had to walk outside to have a smoke. So, it was actually the walking and the mobilizing that help to reduce the risk of clots and not the smoking at all.
This highlights that you have to look at a study closely in order to get a "true picture". Intepreting studies can be like looking at the clouds sometimes. You can see what you want to see, so be careful.
Dr Vin
Family Doctor Australia http://www.doyouhavedepression.blogspot.com
As a woman who suffered terrible anxiety during pregnancy and a teacher of children with Autism for nearly 20 years, I have a master's degree as well, I can tell you that if you look there is an article coming out every other day on causes of Autism. the plain fact is we DO NOT know what causes Autism. I am not a researcher but I know this disorder and it makes me angry when someone has the gall to publish an article that really says "We don't know" and causes panic, the link between vaccines and autism is a perfect example.
Please take care of yourselves. As it was stated before by Dr. Shaila Misri, there is no such thing as non-exposure. Meaning the fetus is exposed to the symptoms or the medication.
I think it would be important to look at postnatal burden of illness as a factor in this kind of study as well. It may well be that mothers whose depression or anxiety is severe enough to require SSRI treatment during the first trimester of pregnancy may also have postnatal symptoms which may interfere with normal mother/infant bonding, and that may contribute to the development of ASD in children. There is adequate evidence that maternal depression is a significant risk factor for children on a number of levels.
"As it was stated before by Dr. Shaila Misri, there is no such thing as non-exposure. Meaning the fetus is exposed to the symptoms or the medication."
Yes! This is what pushed me over the edge and convinced me the meds were the best decision for me, my baby, and my family. Yes, yes, yes!!!
I imagine lots of mamas have had mini-strokes over the last day or so seeing the story in USA Today or on CNN or elsewhere.
Glad to see you weighing in with your own experience. I think people are, understandably, very keen on finding the cause of autism, so the minute any kind of research comes out that suggests some sort of correlation people jump all over it.
Not only that, Susan, but birth defects and other disorders also happen without any prenatal exposure to a mom's medication or a mom's illness. They occur in the general population, period.
Thank you for this…I was going to e-mail you and see if you would address this, and you did! 🙂