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Is it Time to Re-think Antidepressant Use During Pregnancy?

Antidepressant use during pregnancy linked to increased autism risk in boys

A new study has found that antidepressant use during pregnancy could lead to an increased risk of autism in boys.

According to researchers at Johns Hopkins Bloomberg School of Public Health, prenatal exposure to selective serotonin reuptake inhibitors (SSRIs), the most popular class of drugs prescribed for anxiety and depression, may increase the susceptibility to autism spectrum disorder (ASD) and other developmental delays (DD) in boys. SSRI medications include Paxil, Prozac, Zoloft, and Celexa, among others.

While 1 in 68 children in the United States are diagnosed with ASD, the disorder is nearly five times more prevalent in boys than in girls.

In a study of 966 mother-child pairs from the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study, a population-based case-control study based at the University of California at Davis’ MIND Institute, researchers found a strong connection between prenatal SSRI exposure and developmental problems in boys. The data was broken down into three groups: those diagnosed with autism spectrum disorder, those with developmental delays, and those with typical development.

The children of mothers who took SSRIs during pregnancy were more likely to be diagnosed with ASD or other developmental delays during early childhood from ages 2 to 5.

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“We found prenatal SSRI exposure was nearly three times as likely in boys with ASD relative to typical development, with the greatest risk when exposure took place during the first trimester,” said Li-Ching Lee, Ph.D., Sc.M., a psychiatric epidemiologist in the Bloomberg School’s Department of Epidemiology. “SSRI was also elevated among boys with DD, with the strongest exposure effect in the third trimester.”

SSRIs are endorsed by doctors for their high success rate, and while the study’s authors note that maternal depression can carry risks for the fetus, the benefits of using SSRIs during pregnancy should be considered against the potential harm.

Previous studies have suggested alternatives to antidepressant use during pregnancy, including psychotherapy. Cognitive behavioral therapy (CBT) in particular showed the most promise.

“There is overwhelming evidence that CBT is equivalent to antidepressant medication in the treatment of mild to moderate depression and more recent research indicates that it is effective in the treatment of severe depression as well,” researchers from Beth Israel Deaconess Medical Center, Tufts Medical Center and MetroWest Medical Center wrote in a 2012 study published in the journal Human Reproduction.

Lead author Alice Domar, Ph.D, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Executive Director of the Domar Center for Mind/Body Health at Boston IVF, said depressive symptoms prior to and during pregnancy should be taken seriously, and that alternatives to SSRIs may be as or more effective without the risks. Other alternatives include exercise, relaxation training, acupuncture, supplements, and yoga.

"These alternative treatment options may not be appropriate for everyone, still we think it's important for women on an antidepressant who are considering becoming pregnant to have a conversation with their physician about the risks and benefits of continuing to take their medication," Domar said. "Because at this point in time, with no data to indicate an advantage to taking an SSRI during pregnancy, the research all points to increased risk."