Developmental Effects of Prenatal Selective Serotonin Reuptake Inhibitor Exposure in Perspective: Are We Comparing Apples to Apples?
(Oberlander TF and Vigod SN, J Am Acad Child Adolesc Psychiatry 2016;55(5):351–352).
Dr. Vigod recently co-authored an editorial in response to a cohort study in Finland that found a 1.8-fold increased incidence of depression, but not autism or ADHD, by early adolescence among offspring exposed to SSRIs in the prenatal period. Here’s her summary of that editorial.
There were two main points that we wanted to get across. Point one is that when we’re looking at outcomes for SSRIs, we want to be comparing apples to apples to isolate the effect of the SSRI. The authors attempted to do this as much as possible, but there were unmeasurable factors that may have been more highly associated with SSRI use. For example, a big issue is that depression is a heritable disorder. Without knowing what the genetic basis is of a given woman who is also taking an SSRI, it is hard to know what her child’s risk of depression is going to be. If a woman is more likely to take an SSRI during pregnancy if she has a bona fide genetic depression, then wouldn’t her child also have an increased risk of having depression compared to a woman who has less severe depression? And then also, when you’re looking at adolescents, you have to consider all the stuff we know about the environment of postnatal depression and anxiety. Someone who is depressed enough in pregnancy to take a medication—and depression is a chronic and recurrent disorder—what does that mean about that child’s early childhood environment putting them at risk for depression?
Point two is around the fact that there are many different possible maternal and child development outcomes, and the idea that we might want to shift away from a research model where SSRIs are either “good” or “bad.” If you look at some of Dr. Oberlander’s work, you can see how SSRIs may be protective for some outcomes in some environmental circumstances but not others (Hanley GE and Oberlander TF, Birth Defects Res A Clin Mol Teratol 2012;94(8):651–659). So the story about SSRIs may be more complex than some have previously considered.
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