Antidepressants in Pregnancy and Autism

Antidepressants in Pregnancy: Is Excess Risk for Autism Spectrum Disorder Believable?

In this study the risk for autism spectrum disorder appeared to be higher in those women who used antidepressants (especially SRIs) during late pregnancy; but the question is whether maternal depression (the condition that would lead to treatment with an SRI) was the cause or whether it was the SRI itself.

Researchers from Canada used data from a population-based registry to examine the relationships between maternal antidepressant use during pregnancy and autism spectrum disorders in children.

Among >145,000 full term singleton infants, 0.7% had a diagnosis of ASD sometime between birth and the end of the follow-up period (average follow up of 6 years).

This is the summary of the study:

After accounting for measured potential confounders (maternal sociodemographic characteristics, history of maternal psychiatric and physical conditions, and infant characteristics), maternal antidepressant use during the second or third trimester was associated with increased risk for ASD in offspring (adjusted hazard ratio, 1.9; 95% confidence interval, 1.2–3.0). Risk was most pronounced for women who used selective serotonin re-uptake inhibitors rather than other types of antidepressants, and the findings persisted when the population was restricted to mothers with histories of depression.

COMMENT

Dr. Bryant takes exception to the author’s conclusions –

I am troubled by the authors’ assertion of adjustment “for all potential confounders.” It’s simply not possible outside of a randomized controlled trial (clearly not feasible here) to extricate the effects of a treatment from the potential effects of the condition necessitating treatment. In particular, the study’s methodology could not control for severity of maternal psychiatric disease; confounding by indication is almost certainly at play. In our current healthcare environment, where access to comprehensive mental health treatment can be challenging at best, I will continue to be reluctant to recommend cessation of antidepressant therapies for reproductive-aged women with otherwise poorly controlled depressive disorders.

References

Boukhris T et al. Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatr 2015 Dec 14; [e-pub]. (http://dx.doi.org/10.1001/jamapediatrics.2015.3356)

For more information

Do Maternal Antidepressants Cause Autism

Depression in Pregnancy Affects the Child

Pregnancy and Mental Health

Do Maternal Antidepressants (SRI’s) Cause Autism in Their Children?

Maternal AntidepressantsMaternal Antidepressants.

Two studies have suggested a link between prenatal exposure to antidepressant medication and autism spectrum disorders.  We are pleased to learn: that does not appear to be the case!

Not surprisingly, the studies mentioned above received a lot of attention and created a lot of concern for women taking antidepressant medications, and their partners, who planned to have or grow their families.  Luckily, a larger follow-up study has been released, which addressed the limitations of the earlier research.  The recent study suggested that in fact there was not a significant association between mothers who took antidepressant medications during their pregnancy and the risk of their offspring developing autism spectrum disorders.  This is excellent news for a number of women we see who want to safely manage their mood concerns with medication, while keeping the best interest of their future children in mind.  Please click on the link to review the article in full http://www.ncbi.nlm.nih.gov/pubmed/24255601

Additional research is necessary to better understand the genetic and environmental causes of autism spectrum disorders (ASDs).  For more information about ASDs, please visit the National Institute of Mental Health website at http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml

Autism Spectrum Disorder: An inside look to CATs

Reautismcently there has been discussion about alternative treatments for Autism Spectrum Disorder.  The acronym CAT is used to describe these complimentary and alternative treatments. CAT is a great approach to treatment for individuals that are concerned with potential negative effects of taking medication. Some examples of CATs include melatonin, RDA/RDi multivitamin/mineral, massage therapy, acupuncture, exercise, music therapy, and animal-assisted therapy. CAT treatments have previously been used for kids who are nonverbal that have difficulty communicating. This communication barrier makes it difficult for these individuals to express themselves and share whether a certain medication that is being tried is actually working. CATs make it easier to track the progress of these kids, which can be crucial when choosing the best course of action for treatment.

If interested in trying the CAT approach, it is recommended that the process be taken on in steps.  Trying other treatments like medication and applied behavioral analysis before CATs is highly encouraged. There are also recommended prerequisites to the treatment like a diagnostic evaluation with medical, psychological, and developmental history.

A popular CAT is the use of melatonin and omega-3 fatty acids. These help the body regulate itself and have been shown to help individuals sleep better. Vitamins, probiotics, and enzymes can also be helpful to kids on the Autism spectrum. Often, ASD children are deficient in these nutrients, which may be the root of some of their symptoms.

In addition, more information about ASD is being found with a surge in Neurofeedback research. It is known that EEG abnormalities are associated with ASD, so researchers are working to finding more details about the connection.

What is really striking about the newest ASD findings is that some children seem to outgrow autism. These kids are diagnosed with the disorder in early childhood and then are shown to function normally as they grow older. The reason for this recovery is currently unknown. Some people believe the change is due to excellent early on treatment or the fact that the brain is constantly changing. As of now, there is no clear answer to who will and won’t grow out of it.

For more information about ASD research findings, check out this article:

http://www.psychiatrictimes.com/complementary-and-alternative-treatments-autism-spectrum-disorder/page/0/2?GUID=2F8F4F62-9FC2-45C5-81D3-364723F68E03&rememberme=1&ts=28062013