Where the Science of Psychology Meets the Art of Being Human

Research Links Autism and Antidepressant Use During Pregnancy: What it all means.

1,226 views

Research Links Autism and Antidepressant Use During Pregnancy: What it Means.

In a groundbreaking study involving 145,456 pregnancies, researchers have found that the use of antidepressants during the second and third trimester may be a significant risk factor for autism. Currently around 4-7% of women take antidepressants during pregnancy to ease the debilitating symptoms of depression. Exposure to antidepressants during this critical time could almost double the risk of autism for their unborn babies, but this statistic needs to be understood in context. 

We still aren’t clear on exactly what causes autism but there is robust agreement among researchers and professionals in the area that both genetics and environment are involved. We are aware of certain factors that may make children more vulnerable to autism, and exposure to antidepressants may be one of them.

Autism and Antidepressant Use During Pregnancy. The study.

The study was conducted by the University of Montreal and lead by Professor Anick Bérard, an expert on drug safety during pregnancy.

The researchers examined data from 145,456 pregnancies, which included information from the time of conception up to when the children were 10 years old. Because the data was so detailed, the researchers were able to isolate the specific effect of antidepressants on unborn babies by taking into account other risk factors that have previously been associated with autism including family history, mother’s age, and socio-economic factors (such as poverty).

The researchers then identified the mothers who had filled one or more prescriptions for antidepressants in the second or third trimester of pregnancy.

They then looked at the children in the study who had been diagnosed with childhood autism.

Once they had these two groups, they looked for an association between the two.

Mothers who had been exposed to antidepressants in the second or third trimester had an 87% increased risk of having a child with autism.

Our study has established that taking antidepressants during the second or third trimester of pregnancy almost doubles the risk that the child will be diagnosed with autism by age 7, especially if the mother takes selective serotonin reuptake inhibitors, often known by its acronym SSRIs. –Professor Anick Bérard.

The second and third trimester of pregnancy is a critical time for brain development and seems to be a particularly sensitive window for the effects of antidepressants to spill over to the unborn baby.

A warning: Don’t give up your meds just yet.

For anyone already taking antidepressants, it is critical that any pull back from medication is considered carefully in close consultation with a doctor. Sudden withdrawal from antidepressants can bring about other harmful side-effects, such as a worsening of the symptoms.

Putting it all in context …

Untreated depression has its own consequences. According to the World Health Organisation, depression will be the second leading cause of death by 2020. As well as the risk of suicide, untreated depression can also lead to poor sleep and poor diet, and emotional and physical stress which can also be harmful for a developing baby.

Bérard stresses that people should keep using their medication as needed, but suggests that if pregnancy is a possibility, it would be wise to explore other ways to treat the symptoms during pregnancy. Antidepressants are not the only option when it comes to finding relief from depression, and we are learning more and more about the lifestyle factors that are at least as effective as antidepressants. (See here). As Bérard explains, exercise and therapy have been shown to ease depressive symptoms for women whose depression is in the mild to moderate range, which describes most women who are prescribed antidepressants during pregnancy. 

 Dr. Bryan King, program director of Seattle Children’s Autism Centre emphasised the importance of putting the findings of the study into context,

 for every 200 mothers who continue their antidepressants through pregnancy, there may be one additional child born with autism. -Dr Bryan King.

Berard also makes it clear that the findings from her research are intended to empower women by arming them with information, not scare them. This study is not about trying to convince women with depression to give up their medication, but about giving women the information they need to make the best possible choices for themselves and their babies.

The relationship between antidepressants and autism in this study is an association, not a causal relationship. There may be other factors involved that we are unaware of, such a other risk factors or conditions that need to be present.

‘A further problem with this and other studies is that we don’t know whether the risk signal that is being reported is due to the antidepressant exposure, or whether it reflects a genetic risk from depression. We know that some genes that appear to be associated with depression risk are also associated with autism risk.’ –Dr Bryan King.

Further research is needed to fully understand the relationship between antidepressants and autism and the mechanisms that are at play. In the meantime, it is important to understand the results in context of the broader picture and what it means in terms of the actual risk.

Like this article?

Subscribe to our free newsletter for a weekly round up of our best articles

9 Comments

Jenny

“Mothers who had been exposed to antidepressants in the second or third trimester had an 87% increased risk of having a child with autism.”

I’d like to know where you got your 87% statistic from. This is a HUGE statement to make, no matter how much you “put it in context.” Is it from the study itself? Because the absolute risk increase was 0.5%. There were only 22 children in the study that qualified under its own parameters to be part of the exposed group, which was children who had been exposed to SSRIs during the 2nd and 3rd trimesters of pregnancy.

And that doesn’t include that Dr. Berard has a long standing opposition to the use of SSRIs in general and SSRIs in pregnancy. She’s testified as an expert witness in civil lawsuits against pharmaceutical companies, including a major case involving Zoloft where her testimony was ultimately excluded by the judge for being irresponsible, among other things. No matter what is driving her research, it’s tenable that she a) has an ax to grind and b) is being paid to object to anti-depressants in pregnancy as part of her professional portfolio.

There certainly needs to be more study, but that’s a whale of statement to outright put out there that antidepressant use ups risk of autism by almost 90%.

Reply
Hey Sigmund

Yes, the 87% is from the research study which is hyperlinked in the article. 87% increased risk does not mean an 87% risk of having an autistic child if you use antidepressants. It means 87% above the risk that was already there, which was very small to begin with. This isn’t the first study that has linked the use of antidepressants during pregnancy to autism but it is the biggest. In a study of 966 mother-child pairs, John Hopkins University found that boys with ASD SSRI exposure were nearly 3 times as likely to have been exposed to SSRI’s during pregnancy. They found the greatest risk to be in the first trimester http://www.jhsph.edu/news/news-releases/2014/johns-hopkins-bloomberg-school-of-public-health-researchers-find-association-between-ssri-use-during-pregnancy-and-autism-and-developmental-delays-in-boys.html. A meta analysis published in Neuroscience and Biobehavioral Reviews also found a link between SSRI’s during pregnancy and autism http://www.ncbi.nlm.nih.gov/pubmed/25498856.
The research isn’t about scaring people away from medication, but about giving all of the information available so people can make informed choices. We’re still fleshing out the picture of what causes autism, and there is still a lot we don’t know. Berard herself cautions against people giving up medication because depression has its own risks. We know there are vulnerabilities, possibly there are specific combinations. The use of antidepressants during pregnancy seems to be involved somehow but the exact mechanism is unclear.

Reply
Helen

I must be honest, I find this article disturbing. I’ve worked with children with Autism for almost 20 years and it has been known to me for many of those years that a history of mental illness in a family, e.g. Depression, increases the likelihood of a child being born with Autism. However, to associate the taking of antidepressants during pregnancy, for someone whose ability to function is impaired by depression, with giving their child Autism is cruel especially when the article seems to end with a tagged on proviso that it may just be the genetic disposition. My thoughts are cast back to when Autism was blamed on being a poor mother and the inability to bond with the child. So now we can blame the mother for

I have two children and depression. My oldest son has Autism and I went through his pregnancy with undiagnosed depression. It was only when he was 9 months old that I was placed on medication, which was literally a life-saver for me. I went through my second pregnancy on my medication and my second son does not have autism. I may be 1 in 145000, but I think there may be more to this story.

Reply
Hey Sigmund

Helen, I’m really sorry you have had this reaction to the article. I want you to know that it was never my intention to do this. This research has been talked about quite a bit in the mainstream media and I wanted to bring some context to it. The risk of having a child with autism in the general community is about 1.5% (about 1 in every 68 births) though this figure is an estimate. The risk of having a child with autism when SSRI antidepressants are involved increases this but it is still under 3%. The link between antidepressants and autism is just a risk factor – same as history, mother’s age etc – not a certainty, and the risk factor, I think, is still quite small.

There is absolutely no intention to blame mothers – not from me nor the researchers. Being a mother is hard enough and as a mother myself, I would never want to do that to any other woman. I have depression in my family so I have seen the devastating effects of untreated depression. Even with what I know about the link between anti-deressants and autism, if I had severe depression that I wasn’t able to control through other means (that we are only just starting to become aware of) – having seen first hand what untreated depression can do – I would be open to taking antidepressants during pregnancy. The research world is doing so much work to try to understand autism, and along the way there will be a lot of new information. It’s all part of the process of getting some real answers and possibly working towards finding something that is able to unlock autism and perhaps one day find a cure. I hope this has been able to clarify things a little for you in relation to this research and the intention behind the article.

Reply
Hey Sigmund

Yes, it can feel like that can’t it. There is no known cause of autism and there is no research that has claimed to have discovered the cause. What they find are links between autism and certain things, and possible risk factors, but the exact ways they contribute are unclear.

All we have at the moment are the risk factors which include family history, mother’s age etc. Antidepressant use is just another risk factor which needs to be taken in context. There are plenty of women who have autistic children who didn’t use antidepressants during pregnancy and who have no family history of autism. Similarly, there are women who have many risk factors but whose children don’t have autism. It’s so complicated and there is so much we don’t know, which is why we have to take what we do know and do the best we can with it, starting by putting it in context.

I have not seen any reliable research warning pregnant women off antidepressants, including from the authors of the study. The information is to inform women so they can make choices that are best for them. We deserve to have all of the information so we can make the best choices for ourselves and our babies, provided it is done in a responsible way and delivered in context.

The risk of autism in the general population is about 1.5%. Using SSRI antidepressants increases that risk by 87%, taking the actual risk to under 3%. When there are other risk factors involved, such as family history, particularly if the parents already have a child with autism, that risk may rise even that may not outweigh the benefits of antidepressants. Again, this depends on the factors involved.

It’s important to consider the risk in the context of your own circumstances and other risk factors that may be present. It is very posdible that the benefits that come from the use of antidepressants will outweigh the risks but this will depend on personal circumstances, such as the presence of other known risk factors and the severity of symptoms.

There are a lot of articles in the mainstream media claiming that the study is alarmist, but it was intended to be informative, not alarmist. I hope this had given it more context.

Reply
Rose

Thanks Karen. There is so much information produced about the potential causes of or links to autism – it’s exhausting! Especially as the parent of a child with autism and extra especially when there has been so much misinformation.
I do thank you for your considered responses. You have a great site/blog and I find many of your articles very helpful – so thanks!!

Reply
Michelle Homewood

Hi, my name is Michelle Homewood-I have a beautiful 22yr old daughter that has Autism-i had her when I was 25, was diagnosed Bipolar @ 35, which means I did not have antidepressants or any of those in my system when I was pregnant-HOWEVER, I did have anticonvulsants at the time that I am not on anymore, her father was also Autistic-so genetics also plays a part-i am also developmentally disabled, which I’m quite positive contributes to her handicap-not to say you don’t know what you’re talking about, you do, it just might be wise to research further before pinning the cause on one thing

Reply
Hey Sigmund

Michelle, please read the article again. It clearly explains that we don’t know what causes autism, that there is agreement that genetics and environment are involved, and that antidepressants are one of many vulnerabilities, not a cause.

Reply

Leave a Reply

We’d love to hear what you’re thinking ...

Your email address will not be published. Required fields are marked *

Stay Connected



Contact Me

karen@heysigmund.com














Hey Warrior - A book about anxiety in children.
















Pin It on Pinterest

Share This