Autism and SSRI Exposure

Deciding on whether to take a SSRI/antidepressant during pregnancy can be a difficult one. After considering the various aspects, in general, the benefits outweigh the risks in moderate to severe conditions. More recently, there have been several studies looking at a possible correlation between SSRI (Serotonin Reuptake Inhibitor) exposure and autism risk that has hit the news headlines.    Correlation is important, as that does NOT demonstrate causation, though it guides future scientific studies. However, that leaves mothers and medical providers with some degree of uncertainty. Therefore, it is important to take a closer look at contradictions, study limitations, and understanding the degree of risk if it is indeed present.

A large study in 626,875 births in Denmark that was published in 2013 did not find a statistically significant association, though could not rule it out completely. One study found that first trimester exposure seemed to be associated with an increased risk of autism, while the above found a higher rate with exposure BEFORE pregnancy, and yet another from Canada found the greater association was in second and third trimesters. This same study also found that when the diagnosis of autism was counted only if a specialist had made the diagnosis, then the association was no longer significant. If someone is able to discontinue an antidepressant during pregnancy, they generally will, and so we have to keep in mind that women who take medication during pregnancy may have moderate to severe conditions that may be the actual risk factor. 

In fact, a January 2016 study in Translational Psychiatry used data from multiple New England health systems and found that mothers who received medication OR therapy BEFORE pregnancy had a higher risk for ADHD or autism spectrum conditions, though medication use during pregnancy was not associated. This gives additional support to the hypothesis that the condition leading to treatment is the risk factor rather than the treatment itself. Other studies have found no association with autism when adjusting  (making an apple-to-apple comparison) for severity of maternal illness.  

In summary, it is important to continue to assess for safety via the scientific process, though bearing in mind that not every association is a causal factor. The most important controllable factors remain- focusing on mothers’ mental and physical well-being, making informed clinical decisions with the information that we do have, considering family involvement and utilizing available supports and resources, and optimizing attachment and bonding with the baby.