
Antidepressants taken during pregnancy increase risk of autism - kevindeasis
https://www.researchgate.net/blog/post/antidepressants-taken-during-pregnancy-increase-risk-of-autism-by-87-percent
======
jmhain
Articles reporting negatively on antidepressants should come with a huge
disclaimer to those taking them that they should continue to do so unless
their doctor / psychiatrist recommends otherwise.

It seems obvious, but after being mostly depression / anxiety free for four
years and reading an influx of articles claiming that they do nothing or very
little based on new research, I decided to quit. Huge mistake that very nearly
ruined my life.

It turned out that despite all the lifestyle changes I made as well as therapy
I received to mitigate depression and anxiety, the pills were almost solely
responsible for my recovery. Restarting the SSRI of course did the trick, but
they don't work fast and I lost nearly a year of my life. I currently regard
this as the worst decision I have ever made.

~~~
kafkaesq
I look at it the other way: companies "pushing"[1] antidepressants not just on
pregnant women, but on all of us, for years on end, should be putting out a
very clear message that you _should not take these medicines_ unless
absolutely recommended by your doctor, _and_ other, generally more efficacious
methods -- such as talk therapy and lifestyle changes -- have been at least
explored, and found to be ineffective (or depending on the severity of your
case, not immediately effective).

Unfortunately, this is not what these companies are doing, as a rule. And
given what we've found out SSRIs -- and the behavior of some of the major
players in this industry, in recent years -- no one should be terribly
surprised at the findings in the JAMA study (assuming they hold up to
scrutiny).

Also:

 _Restarting the SSRI of course did the trick, but they don 't work fast and I
lost nearly a year of my life. I currently regard this as the worst decision I
have ever made._

With all due respect to your situation -- and not intended in the least to
belittle either your suffering, or the thought you put into the decisions you
made -- perhaps the bigger mistake was not going off SSRIs (at which point the
die may have been more or less cast for you, in the short- to medium-term) --
but agreeing to go on them in the first place.

[1] Yes, this is a loaded term. But I use it quite intentionally. Having not
only studied the tradeoffs associated with one major class of antidepressants,
but also having worked for one of the market's leading distributors -- and
having made a careful study of their marketing materials -- I'd say "pushing"
is not a bad description for the aggressive marketing tactics these companies
have used over the years.

~~~
KirinDave
> such as talk therapy and lifestyle changes

The places where anti-depressants are applied vs talk therapy are applied are
fairly different. The idea that there is a cohort of mustache-twirling doctors
and pill pushers trying to shove pills down the throat of every person who'd
be better suited to talk therapy is about as ridiculous as I made it sound.

For many people, talk therapy is simply not effective or possible. And in many
situations there are social forces which MUST be taken into consideration
because they can cause lead to more anxiety and depression.

> perhaps the bigger mistake was not going off SSRIs (at which point the die
> may have been more or less cast for you, in the short- to medium-term) --
> but agreeing to go on them in the first place.

I get so angry reading this. Hot under the collar even. If you think that
SSRIs don't help people then you simply don't understand what a true and
chemical despair feels like. The difference they can make, both short term and
long, is counted in human lives. Many people like me who used them to bridge a
short term gap could barely comprehend days without despair, fear and pain.

To have some smug anti-medicine comment oh-so-politely walk up to someone who
says, "Hey I treated my mental illness like a real illness and it worked" and
respond with scorn an derision? You simply do not understand what real,
clinical, and life-threatening depression is.

If you think you do, if you had a mild case that you talked through?
Congratulations! I wish the disease on no one. But that doesn't give you
license to skulk about making everyone else with a less treatable form of the
illness question everything they've done to secure their right to experience
happiness.

~~~
ufo
In any case, the current research consensus is that generally antidepressants
and talk therapy are complimentary. So talk therapy is better than nothing and
antidepressants are better than nothing and combining both treatments is
better than sticking to only one.

~~~
KirinDave
For me, it is difficult to disentangle my feelings for talk therapy from my
fear and antipathy towards the church councillors of my young life who put me
on such a destructive path of self-denial.

~~~
hluska
I am very sorry that that happened to you and I completely understand how
sometimes church counsellors can cause more problems. I was raised Catholic so
believe me when I say that I understand your words about being on a
destructive path of self denial.

For what it's worth, as an adult, I had to make a conscious decision not to
let the assholes of my youth ruin my life.

It's bullshit that people treated you like that. I'm very sorry that that
happened.

~~~
KirinDave
Thanks. I wish I had been born even 10 years later sometimes, I didn't even
know the word for my gender until I was in my 30s. People trying to "correct"
my course when I was young left me a lot of scars.

So, I'm not saying my case should shape the world. But I think it's worth
considering. People here tend to mix "SSRIs are over-prescribed" with "SSRIs
don't work." The data suggests the more focused the study, the stronger the
effect, which is usually indicative of practicioners failing to properly use
an intervention.

Or so my doctor tells me. He was happy to explain carefully why he uses SSRIs,
how long he'll agree to prescribe them for, and what his current reading of
the research is. I was surprised, but he says GPs often have to be the first
line of defense for people who don't outright end up in the emergency room. I
guess that stands to reason.

------
ksenzee
This article is very one-sided. It's simply an interview with the author of
the paper. I would very much like to see what other experts in the field are
saying, especially because I think the causation claims here are pretty bold
for a register-based study.

Also, this: "Our study is not out to scare women" in the same interview as "We
have to remember that thalidomide was labeled as 'safe' for use during
pregnancy." If you're bringing up thalidomide, you're absolutely out to scare
women. It's like Godwin's Law for discussions about drugs in pregnancy.

~~~
danieltillett
Thalidomide was never labelled as safe during pregnancy - I don’t think there
is a single drug on the market that has ever been tested for safety in
pregnancy. The best you will get is category A which just says that studies
have failed to demonstrate risk [1].

1\. [http://www.drugs.com/pregnancy-
categories.html](http://www.drugs.com/pregnancy-categories.html)

~~~
DanBC
Thalidomide was used to treat morning sickness in pregnancy.

That's as close to calling it safe for pregnancy as you can get.

~~~
danieltillett
No it is not. At the time there was no regulatory requirement to test in
pregnancy. The only reason it never effected the USA is the FDA were (and are)
so slow that the problem was found out before they got around to approving it.
If the drug company had launched in the USA first the FDA would have allowed
it to be sold.

Interestingly it was tested in pregnant mice, but in mice it doesn't have the
same effect as in humans.

------
solomatov
Actually, it's a misleading title. There's association, but there's no proven
causation. Here's the quote:

>This study is consistent with other studies on the same research question.
Each study is observational because randomized controlled trials are not
ethically possible during pregnancy. Hence, each study is describing an
association. The accumulation of such findings will lead to causation

It's observational study, i.e. a study which can only show association. You
can easily think of many reasons why you might get such a result. For example,
depression and autism might have overlapping genes, and having such gene,
results in depression in mother and higher risk of autism in a child.

~~~
Abraln
Considering that both are characterized by abnormal brain function and that
mental illness tends to run in families this seems extremely likely.

------
TeMPOraL
> _I would always be very cautious about saying that anything is 'safe' during
> pregnancy. We have to remember that thalidomide was labeled as 'safe' for
> use during pregnancy._

Holy shit if it isn't manipulative. The most charitable reading, after
skimming[0], still says the risk increased from "most likely not going to
happen to you" to "still most likely not going to happen to you".

I'd like to see some absolute values please.

[0] -
[https://en.wikipedia.org/wiki/Epidemiology_of_autism](https://en.wikipedia.org/wiki/Epidemiology_of_autism)

~~~
Domenic_S
I don't see how encouraging caution is manipulative. Although we know SSRIs
work, we're still figuring out exactly _how_ they work, and we know even less
about developing fetuses and the effects of SSRIs on them. The gold standard
for care is $reward > $risk; with many medicines we can define $risk pretty
darn well. With SSRIs we can't. Saying "we just don't know" or "here are the
correlations we've found so far" is a good thing, as is reminding folks -- and
ourselves -- of how science has failed us in the past. Women should be
empowered to make _informed_ choices, but we need the information to inform
them with.

~~~
TeMPOraL
Comparing SSRIs to thalidomide is manipulative _at best_ ; I'd call it
something else but let's skip it in the interest of civility. SSRIs have been
widely deployed for many years. We don't see significant amount of children
whose mothers taken SSRIs being born with deformed limbs and dying young.

A better comparison would be between SSRIs and aspirin. In both cases, we know
that the drug works and is mostly harmless, but we have clue how exactly it
works.

Caution is fine. Fear-mongering isn't, especially if it can lead people to
avoid treatment that could significantly improve their quality of life for
little-to-no side-effects.

~~~
Domenic_S
> _We don 't see significant amount of children whose mothers taken SSRIs
> being born with deformed limbs and dying young._

This rationalization seems uncompassionate at best, implying that
mood/cognitive disorders are less important/disruptive than physical
disorders.

> _SSRIs and aspirin. In both cases, we know that the drug works and is mostly
> harmless, but we have [no] clue how exactly it works._

To the contrary, the 1982 Nobel Prize was awarded for the discovery of the
mechanism of action for aspirin. In contrast, although we know SSRIs cause
elevated mood and have anti-anxiety effects, their method of action is not
understood. This is not in dispute within the medical community.

> _for little-to-no side-effects_

We don't know this, which is the entire point of the article and discussion.

------
dstyrb
1.5% inherent * 187% from pills = 2.8% risk of autism.

Risk of having started a course of antidepressants for absolutely no reason =
~0%

Articles with headlines like these seem manufactured to lead the statistically
ignorant into bad decisions. Clickbait science.

------
adenadel
It's important to be aware of the absolute risk even when the relative
increase is 87%. In this case the risks are always below 1.5%. I haven't read
the paper, but the presence of depression (rather than the SSRIs) could also
be a cause for the increase. They might want to look at depressed pregnant
women who are treated with alternatives to try to deal with that confounding
factor.

------
DanBC
Suicide is the leading cause of death of mothers in the perinatal period, so
I'm glad they said that talking therapies are important.

They present this increased risk as a percentage. No-one understands what that
means. People can't translate that increase in risk into actual numbers of
people with autism.

~~~
steven2012
I'm not sure what you mean. If the current risk of autism in a child is 1 in
20, then it means that if the mother takes anti-depressants, the risk then
becomes 1.87 in 20.

~~~
TeMPOraL
He probably means that without a reference point, it may as well be a shift
from 1 in 20 000 000 to 1.87 in 20 000 000. Or, a shift from 1 in 5 to 4 in 5,
which is how an average Joe or Jane will understand such article. Running a
headline "Some Common X doubles the risk of Something Very Bad" without giving
the baseline risk of Something Very Bad is just fear-mongering.

------
chris_wot
In the interview, they state that "the rise in autism...".

That's been shown to be fallacious. Autism is only really a very recent
diagnosis, and reporting rates were either low or the condition wasn't
diagnosed properly.

Then the author hypothesises that the seratonin levels might be what causes
the issues with autism. But those taking SSRIs have a problem with seratonin
levels already, right? So how do they know it's the anti-depressant?

I read the comments when study was posted to HN previously, but there doesn't
seem to be too much questioning of the the study itself. Perhaps I'm being
unfair.

This study has been criticised - I think NOR gives a pretty balanced report
here:

[http://www.npr.org/sections/health-
shots/2015/12/14/45966593...](http://www.npr.org/sections/health-
shots/2015/12/14/459665937/a-new-study-raises-old-questions-about-
antidepressants-and-autism)

~~~
maratd
> Autism is only really a very recent diagnosis, and reporting rates were
> either low or the condition wasn't diagnosed properly.

While you can contribute some of the rise to better screening, we have been
seeing increases in the time span of less than a decade. Something else is
going on.

[https://www.ted.com/talks/juan_enriquez_will_our_kids_be_a_d...](https://www.ted.com/talks/juan_enriquez_will_our_kids_be_a_different_species)

~~~
venomsnake
The best guess last year was due to microparticles in the air and general
pollution levels. Was it discredited?

------
danieltillett
There is a good rule of thumb to use when looking at associative studies - if
the effect is not 300% or more then it is unlikely to hold up when tested in a
double blind study. Anything under 3 fold is mostly noise or bad experimental
design.

As a comparison the risk of lung cancer is 1500% higher in smokers than non-
smokers.

------
oneeyedpigeon
What are the absolute figures? A relative figure is meaningless (or, at
least/highly misleading) if the original chance was miniscule.

~~~
nharada
Relevant section of the abstract:

> Adjusting for potential confounders, use of antidepressants during the
> second and/or third trimester was associated with the risk of ASD (31
> exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of
> selective serotonin reuptake inhibitors during the second and/or third
> trimester was significantly associated with an increased risk of ASD (22
> exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk
> was persistent even after taking into account maternal history of depression
> (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97).

------
cjensen
The linked article claims "antidepressants increase risk". Linked JAMA article
plainly says "association".

Sure they eliminated a couple of known associations, which is good. But this
isn't a slam dunk cause->effect, particularly since some studies have shown no
association.

------
0xcde4c3db
> Randomized controlled trials have also shown that exercise or psychotherapy
> are valid treatment options

The research on exercise is rather inconclusive (mostly because it's hard to
placebo-control exercise, but see e.g. [1] for an interesting attempt), and I
don't know of any trials that demonstrate the validity of switching away from
a _working_ depression treatment. The chances of success are generally not
great when trying a new depression treatment (~30% for the first one,
decreasing with each failed treatment [2]), so I'm not convinced that the
validity alluded to here actually translates into any actionable advice in the
context of this study.

[1]
[http://www.ncbi.nlm.nih.gov/pubmed/21037212](http://www.ncbi.nlm.nih.gov/pubmed/21037212)

[2] [http://www.edc.gsph.pitt.edu/stard/](http://www.edc.gsph.pitt.edu/stard/)

------
jesstaa
Reporting an increase of a percentage of risk is horribly misleading.

------
danielrm26
I hate to be the one, but I wonder if Jenny McCarthy is looking into this
research as a possible alternative explanation for what she went through.

------
AnneTheAgile
Nobody has mentioned in addition to drugs, talk therapy, food can be a
lifesaver wrt depression. Specifically, I and a medical doctor had the same
experience that taking fish oil, ie high quality omega 3 DHA/EPA was a
lifesaver. Also getting off sugar+ is a huge change to the brain's chemical
load.

~~~
MicroBerto
DHA and EPA are fantastic, but I don't think they should be used completely in
lieu of eating fish. Two servings per week will do wonders for health.

Humans are fish eaters. Always have been. Why we don't eat it in America
boggles my mind but it's a big problem that doesn't get enough mention.

~~~
r00fus
Could it be because we polluted our rivers and lakes around the time of the
industrial revolution a century ago?

------
serge2k
Antidepressents are just a vaccine for depression, anti-vaxxers standpoint
confirmed /s

