Tak­ing an­tide­pres­sants dur­ing preg­nancy ap­pears to raise autism risk: study

The Guardian (Charlottetown) - - CLASSIFIEDS / HEALTH - BY SH­ERYL UBELACKER

Tak­ing an­tide­pres­sants dur­ing preg­nancy - es­pe­cially the class that in­cludes Prozac, Zoloft and Celexa - ap­pears to raise the risk of autism spec­trum dis­or­der in chil­dren, a study sug­gests.

The study by the Univer­sity of Mon­treal found that tak­ing an­tide­pres­sants of any kind while preg­nant some­what boosts the risk that a child will be di­ag­nosed with ASD by age seven.

But the risk dou­bles with drugs known as selec­tive sero­tonin re-up­take in­hibitors, or SSRIs, when they are taken dur­ing the se­cond and third trimesters - the crit­i­cal pe­riod for fe­tal brain de­vel­op­ment, the re­searchers say.

“It is bi­o­log­i­cally plau­si­ble that an­tide­pres­sants (could be) caus­ing autism if used at the time of brain de­vel­op­ment in the womb, as sero­tonin is in­volved in nu­mer­ous pre- and post­na­tal de­vel­op­men­tal pro­cesses, in­clud­ing ... the cre­ation of links be­tween brain cells,” said Anick Ber­ard, a phar­macy pro­fes­sor at the univer­sity and prin­ci­pal in­ves­ti­ga­tor of the study.

“Some classes of an­tide­pres­sants work by in­hibit­ing sero­tonin, which will have a neg­a­tive im­pact on the abil­ity of the brain to fully de­velop and adapt in­utero.”

Autism spec­trum dis­or­der, which in­cludes a num­ber of sep­a­rate di­ag­noses like autism and Asperger’s syn­drome, im­pairs a child’s abil­ity to com­mu­ni­cate and in­ter­act with oth­ers. It may in­clude repet­i­tive be­hav­iours as well as an in­tense fo­cus on a nar­row range of in­ter­ests and ac­tiv­i­ties.

SSRIs are the most com­monly pre­scribed an­tide­pres­sants, with an es­ti­mated six to 10 per cent of preg­nant women be­ing treated for de­pres­sion with the drugs.

Ber­ard said the find­ings do not prove the drugs are among the causes of the neu­rode­vel­op­men­tal dis­or­der in chil­dren - al­though some pre­vi­ous stud­ies also pointed to the drugs as a pos­si­ble cul­prit.

“We don’t know all the causes of autism,” she said. “Cer­tainly there could be a very strong ge­netic pre­dis­po­si­tion and prob­a­bly some­thing en­vi­ron­men­tal, mean­ing med­i­ca­tions and life­style and so forth.”

Some doc­tors ar­gue that leav­ing de­pres­sion un­treated can be more dan­ger­ous for preg­nant women and their un­born ba­bies, and say the ben­e­fits of an­tide­pres­sants may out­weigh their po­ten­tial harms.

But Ber­ard said that, as with the gen­eral pop­u­la­tion, most preg­nant women have mild to mod­er­ate de­pres­sion, which can be al­le­vi­ated by other means. Ex­er­cise, psy­chother­apy and light ther­apy can all have ben­e­fits, she said.

“When it comes to de­pres­sion in preg­nancy, I’m not say­ing don’t treat, but think of other op­tions,” she ad­vised doc­tors. “And ob­vi­ously fol­low them care­fully dur­ing their preg­nancy, as you would for hy­per­ten­sion or di­a­betes.”

The study, pub­lished re­cently in the jour­nal JAMA Pe­di­atrics, an­a­lyzed the health records of al­most 145,500 Que­bec chil­dren, of whom 1,054 were di­ag­nosed with autism spec­trum dis­or­der, be­tween 1998 and 2009.

Among 2,532 in­fants born to moth­ers who took an­tide­pres­sants in the last two trimesters of preg­nancy, 31 chil­dren were di­ag­nosed with ASD; 22 of the ba­bies’ moth­ers had been tak­ing an SSRI.

In ab­so­lute terms, SSRI use ap­pears to be as­so­ci­ated with a dou­bling in the in­ci­dence of ASD, from one per cent of chil­dren to about two per cent, said Ber­ard.

Anick Ber­ard

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