Antidepressants in Pregnancy: No Autism Risk?

Recent evidence is reassuring that antidepressants are safe during pregnancy, but we've also heard recent warnings associated with the drugs. So what's the deal?

We've seen a lot of conflicting information about the effects of taking antidepressants while pregnant. First we reported that one study found the risk of developing birth defects from antidepressant use to be low; then we shared that another found a link between autism and antidepressant use. And then there's this University of Montreal study that indicates that antidepressant use does up the risk of birth defects.

A more recent study introduces yet another idea: Research from Massachusetts General Hospital suggested there's no increased risk of autism or ADHD with prenatal antidepressants.

"The fact that we now have found, in two large case-control studies, no increase in the risk for autism with antidepressant use itself should be very reassuring," study lead author Roy Perlis, M.D., said in a release. "Some of the studies that have suggested an association did not account for key differences between mothers who take antidepressants and those who don't, in particular that those taking antidepressants are more likely to have more severe illness."

While this study mentioned pre-pregnancy antidepressant use as opposed to antidepressant use during pregnancy, the study's researchers acknowledge that there are conflicting theories. "The prior research on the subject is mixed—some studies suggesting risks, some studies not," Dr. Perlis told Fit Pregnancy. "Unfortunately, the studies that get covered in the media are almost exclusively the ones that say antidepressants are risky. So, people get only half the story. My biggest worry has been that women would be afraid to seek treatment for depression. We're fortunate that there are many treatments for depression, with and without medication."

So why is the idea that antidepressant use might contribute to autism so prevalent? Dr. Perlis shared one theory with us. "At a genetic level, autism is related to other brain diseases, including depression. Our studies suggest that the risk for autism travels with the mom's illness, not the treatment for that illness. In studies that don't have clear measures of mom's illness, it might seem as though the antidepressant is the problem," he said.

It shouldn't come as a surprise considering how many different schools of thought exist when it comes to the dangers of antidepressant use, but there's no clear cut answer as to whether or not they can cause problems. Dr. Perlis shared his best piece of advice for pregnant women who are considering taking antidepressants. "On the basis of our two studies, I would be comfortable that if there is a risk for autism, it is likely to be very modest," he said. "With any treatment, we need to weigh risks and benefits. Taking a medication during pregnancy, any medication, can be a difficult decision. But, depression during and after pregnancy carries risk for the mother and for the baby. There is abundant evidence that depression treatments—medications, but also talk therapies—are effective in treating depression in general. The most important thing is that women not be afraid to talk to their doctors about depression."

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