Autism and Antidepressants
As you probably know, autism rates have been skyrocketing in recent years, increasing 30 percent in the past two years alone.1 In the 1980's, about one in every 2000 children had autism.2 Today, the rate is one out of every 68. Some experts say that this alarming spike is simply a reflection of changes in diagnostic criteria, and that there really isn't any more autism now than there was a few decades ago. Other experts attribute the rise to various environmental and genetic factors -some saying GMO foods are responsible, others vaccines, others a combination of toxins, and so on. Among the prime candidates for blame, antidepressants loom large.
There have been a number of studies in recent years investigating the link between autism and antidepressants, and the results have been mixed. A few of the studies concluded that antidepressant use definitely increases the risk of autism. Others found no link whatsoever. Now there's yet another study on the table, and this one asserts that yes, if mothers take antidepressants during pregnancy, there's far more likelihood that their kids will be born with autism.3
The new study, just published in JAMA Pediatrics, followed 150,000 babies, about three percent of whom were exposed to antidepressants before birth. Of the approximately 4500 babies exposed to antidepressants in utero, about 89 percent experienced that exposure in the first trimester of pregnancy, and apparently, they weren't affected very much. But for the 2532 babies who were exposed in the second and third trimesters, the news wasn't as good. The researchers found that those babies had an 87 percent increased likelihood of developing autism compared to babies who never were exposed to the drugs. And when the mothers took drugs from a class of antidepressants called SSRIs, or serotonin reuptake inhibitors, the risk shot up by 200 percent. Unfortunately, SSRIs are the most common variety of antidepressant, including such widely prescribed drugs as Paxil, Prozac, Zoloft and Celexa. Even more startling, when mothers took a combination of antidepressants in the second and third trimesters, the risk of autism quadrupled.
Study director Anick Berard expressed surprise at this finding, noting that although the researchers expected to find that antidepressants raised risk, "We were not expecting to find such a huge association between the most used class of antidepressants during pregnancy, which is the SSRI."4
About 4.5 percent of pregnant women take antidepressants, and most experts urge them to continue doing so in spite of the results of this study. They worry that if women drop the antidepressants they might commit suicide or get so depressed that they'll take up smoking and other unhealthy habits (as if antidepressants are the only tool available to fight depression). Plus, many professionals say the study is seriously flawed and point to other research that gives antidepressants the green light. For one thing, this study shows an association between maternal use of antidepressants and autism, but it doesn't prove causality. In other words, it can't be verified based on this evidence that the autism developed because mothers took antidepressants. The naysayers believe there's probably another factor in the depressive biochemistry that triggers autism. This might be particularly true for women who take multiple antidepressants or high doses of the drugs, as the severity of their depression might point to other mental or physical problems that transfer to their offspring. Unfortunately, this study did not track dosage level.
Dr. Bryan King, who directs the Seattle Children's Autism Center, is one of the experts who objects to the study, and in fact, he voiced his concerns in an editorial that accompanied the JAMA article. King says that those with a family history of depression have an increased risk of autism in general, with or without drugs, and that there's a "genetic link" between autism and depression. In other words, it's unclear whether it's the drugs or the depression itself that triggers autism. Dr. King also pointed out that even with the increased risk the study found, the absolute chance that a child of an antidepressant-popping momma will develop autism is only one in every 200 births. Because of this "relatively" low probability, he says, "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."
Again, earlier studies have been all over the map. Research last year out of Johns Hopkins found a worrisome tripling of autism risk in boys who were exposed to SSRIs before birth.5 A Swedish study the previous year found similar results.6 Similarly, a large meta-study published earlier this year in Neuroscience Biobehavioral Review concluded that there is indeed a raised risk and found that at least one of the two prior studies denying the risk did not interpret data correctly.7 Unless you have a vested interest in pharmaceutical profits, you'd be foolish to deny that there might be something to worry about.
Autism risk aside, we've written before about the many problems antidepressant drugs bring, including side effects such as insomnia, nausea, weight gain, tremors and suicidal ideation as well as a possible increased risk of diabetes, brain hemorrhages, infertility, breast cancer, cataracts, bone fractures, and more. The crazy thing is that antidepressants are hardly the only solution, and in fact, as we've written before, studies show that other, non-pharmaceutical approaches such as exercising, going to psychotherapy, meditating, eating better, and even using magnets8 are often more effective. Plus, there are natural supplements that pose far less risk that any depressed person could try-- most particularly pregnant women who need to take extra precautions to protect their developing fetus.
At least some in the medical establishment agree that there are better alternatives. Dr. Adam Urato, a maternal fetal medicine specialist at Tufts Medical Center in Boston says in a Huffington Post interview, "There are, some in the United States, and I think worldwide, who have developed a chemical approach to mental health. This approach is lucrative to the pharmaceutical industry, but it's also simply more convenient and cost-effective to send a woman to have a short visit with a psychiatrist and walk away with a prescription instead of investing in regular psychotherapy, which, as [director of the Canadian study] Bérard points out, is a non-chemical yet highly effective way to treat mild to moderate depression. We should be embracing this information, not running away from it."
Meanwhile, antidepressants continue to be one of the most profitable classes of drugs in the pharmaceutical industry's arsenal, and coincidentally, also one of the most widely prescribed.
- 1. Diament, Michelle. "Autism Rates Spike Again, CDC Says." 27 March 2014. Disability Scoop. 17 December 2015. https://www.disabilityscoop.com/2014/03/27/autism-rates-cdc-says/19237/
- 2. Doheny, Kathleen. "Autism Cases on the Rise; Reason for Increase a Mystery." WebMD. 17 December 2015. https://www.disabilityscoop.com/2014/03/27/autism-rates-cdc-says/19237/
- 3. Takoua Boukhris, Odile Sheehy, Laurent Mottron, Anick Bérard. "Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children." JAMA Pediatr. Published online December 14, 2015. http://archpedi.jamanetwork.com/article.aspx?articleid=2476187
- 4. Almandrala, Anna. "Major Study Links Autism to Antidepressant Use During Pregnancy." 15 December 2015. Huffington Post. 18 December 2015. http://www.huffingtonpost.com/entry/antidepressant-use-during-pregnancy-linked-to-increased-autism-in-kids_56706112e4b0e292150f72e3
- 5. R. A. Harrington, L. C. Lee, R. M. Crum, A. W. Zimmerman, I. Hertz-Picciotto. "Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay." Pediatrics, May 2014, VOLUME 133 / ISSUE 5. http://pediatrics.aappublications.org/content/133/5/e1241
- 6. Clements CC, Castro VM, Blumenthal SR, et al. "Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system." Mol Psychiatry. 2015 Jun;20(6):727-34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4427538/
- 7. Man, K.K. et al. "Exposure to selective serotonin reuptake inhibitors during pregnancy and risk of autism spectrum disorder in children: a systematic review and meta-analysis of observational studies." February 2015. Neuroscience Biobehavioral Review. 18 December 2015. http://www.ncbi.nlm.nih.gov/pubmed/25498856
- 8. Dunner DL, Aaronson ST, Sackeim HA, Demitrack MA, et al. "A multisite, naturalistic, observational study of transcranial magnetic stimulation for patients with pharmacoresistant major depressive disorder: durability of benefit over a 1-year follow-up period." J Clin Psychiatry. 2014 Dec;75(12):1394-401. http://www.psychiatrist.com/jcp/article/Pages/2014/v75n12/v75n1207.aspx