The prevalence of autism spectrum disorders (ASD) is on the rise, but researchers are still searching for explanations as to why. A new study out today in JAMA Pediatrics , linking the use of antidepressants during pregnancy to an increased risk of autism in children, is just another brick in a path toward understanding risk factors associated with autism in general, said Dr. Bryan King, program director of Seattle Children’s Autism Center and Professor of psychiatry and behavioral sciences at the University of Washington, but it’s not the answer.
King sat down with On the Pulse to answer questions about the study.
What should individuals take away from this new research?
This report is best viewed as another indication that prenatal development is likely to be an important area of focus for our understanding of factors that may contribute to the development of autism. This study does not provide a definitive answer as to whether antidepressants cause or even increase the risk for autism.
Are antidepressants safe for pregnant women?
There have been half a dozen studies that have used similar methods to try to determine whether there is a risk signal associated with the use of antidepressants in pregnancy. Not all have found a signal, and those that have report around a 1% increase in autism births in exposed children. This study is reporting about 0.5%. That is, for every 200 mothers who continue their antidepressants through pregnancy, there may be one additional child born with autism.
On the other hand, depression is a serious illness. It’s important to underscore that if untreated or inadequately treated, depression is associated with many other risks including poor nutrition, poor sleep and fatigue, significant stress, risk for alcohol or substance use, and even suicide. Many of these risks are significant for the developing fetus and can have lasting developmental consequences.
Should women wean off antidepressants when they find out they’re pregnant?
It is important, perhaps most important, to consider on an individual basis in discussion with a health care provider whether the risks of going off of an effective treatment are balanced by the benefit of potentially avoiding a relatively rare risk for autism.
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.
Study results have been mixed. Should this influence women to not to take antidepressants while pregnant?
It is important to remember that the findings from these studies are indeed mixed. Taken together and looking only at autism risk, the consistent finding is that if there is a risk signal that can be attributed to antidepressants during pregnancy, that it is quite small.
I don’t think that in and of itself this study will or should fundamentally influence whether women decide to take antidepressants when they are depressed or at risk for depression during pregnancy. The drugs already carry warnings and the bar is already set very high. Paradoxically, the findings could actually provide some additional reassurance for women with depression and their health care providers who are trying to navigate a path forward between a rock and hard place.
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