Nobody really knows why autism rates or autism spectrum disorders (ASD) have almost doubled over the last 10 years. Many researchers say that the jump in numbers from a greater public awareness of the condition, a neurodevelopmental disorder characterized by altered social interaction, and change the diagnostic criteria that are catching up previously undetected cases. Others are turning to environmental influences, such as exposure to toxins.
eyebrows Now, a new study raises the communities of Psychiatry and Neuroscience. It suggests that women who use antidepressants during pregnancy are almost twice as likely to have children with ASD. Many epidemiologists and psychiatrists say the study, published today in JAMA Pediatrics is wrong and will cause unnecessary panic.
The controversy is not new. Research in animals has suggested that antidepressants such as Prozac and Lexapro, a class of drugs known as inhibitors of serotonin reuptake (SSRIs) may alter certain aspects of the neurological development of the fetus. Some epidemiological studies have even found a small correlation between the use of SSRIs during pregnancy and ASD, but can largely be explained by other factors such as the severity of maternal depression, says Lars Henning Pedersen at Aarhus University in Denmark, which has no affiliation with antidepressant manufacturers. Several other epidemiological studies have shown no association between SSRIs and ASD.
In the new study, perinatal epidemiologist Anick Berard, at the University of Montreal in Canada, and colleagues used data collected over 145.456 children born in Quebec between January 1998 and December 09 to calculate the risk of autism in babies whose mothers had used one or more antidepressants during pregnancy. Among children whose mothers used SSRIs during the second or third quarter, there was an apparent dramatic 87% increase in ASD diagnosis compared to those whose mothers did not receive the drugs. For mothers who had used more than two classes of antidepressants in late pregnancy, the risk of developing ASD their child quadrupled.
The authors say the results suggest women pregnant mild to moderate but not severe depression should avoid antidepressants, if possible. For mild to moderate depression, "exercise and psychotherapy working very well," said Berard, who also serves as a consultant for plaintiffs in litigation involving antidepressants and birth defects.
some say it is a misleading and potentially dangerous conclusion, given two factors: the relatively low incidence of ASD in the general population and the fact that depression can lead to poor sleep patterns mother and food-can lead to greater risks to the health of unborn children. the incidence in the general population is about 1%, for example, for a 87% increase in the risk of ASD because of the use of SSRIs raise absolute risk of a child developing autism in about 2%. This increase, if indeed caused by antidepressants, could be offset by the benefits to the mother, which include reduced use of harmful substances and a reduced risk of suicide .
But the "critical flaw" in the new research is that it does not fully account that women with psychiatric diseases already have a higher risk of having children with ASD, said Roy Perlis, a geneticist in psychiatry at Harvard University who consults for several start-up biotechnology. Although the authors controlled for maternal depression, "they are not really reliable measurements of gravity," he said. As a result, there is no way to know if children are more at risk because their mothers were taking more drugs or because women had more severe depression. Several documents, including two of the Perlis group, examined a large number of women and children and found no increased risk for ASD after adjusting to the severity of maternal depression, he said. "the risk moves with the disease, not treatment," he said.
Indeed, given the lack of evidence whether SSRIs and other antidepressants have a causal effect on fetal neurodevelopment, it is possible that SSRIs may actually help the developing fetus whose mother is depressed, said Jay Gingrich, a psychiatrist at Columbia University, who n has no affiliation with pharmaceutical companies. "Suffice it to say that there is an urgent need for further research in this area."
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