Autism and Antidepressants in Pregnancy: Don’t Freak Out

Thank God for Stark. Raving. Mad. Mommy. She pulled this together at the last minute for me and I feel like she just wrote my math exam for me.

Have a read of her level headed perspective on this:

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A handful of studies have come out recently linking autism to the environment, including the environment in the womb.  In particular, one study, which followed fewer than 300 families, found that taking antidepressants during pregnancy may be connected to a higher risk of autism for the baby.

Experts in prenatal mental health point out that this is a very small study, and that it shows a correlative link, not a causative link. In other words, maybe moms who reach out for mental health support for themselves are more likely to reach out for diagnoses for their children. Any medication – prescription or over-the-counter, can pose risks during pregnancy.  However, according to the Mayo Clinic, the risk of birth defect or other problems for babies of mothers taking antidepressants is low.  Some antidepressants have been shown to be safer than others; a list is provided by the Mayo Clinic here.

In 2009, the American Psychiatric Association and the American College of Obstetricians and Gynecologists issued a joint statement outlining their recommendations for treating pregnant women with depression, as well as women planning to become pregnant.  It recommends that for women with mild depression or no symptoms for six months or longer, it may be appropriate to taper off medication before becoming pregnant.  However, for women with a history of severe, recurrent depression (or with bipolar disorder, psychosis, or a history of suicide attempts), medication discontinuation may not be appropriate.

What does this mean?  It means that it’s imperative that women who are pregnant or planning on becoming pregnant work closely with their ob/gyns and their mental health professionals to weigh the risks and benefits of taking antidepressants.  Nontreatment of depression during pregnancy has its own risks, including preterm birth, growth problems, and a potentially much greater risk of postpartum depression.

Also, please heed my warning: reading a two-sentence news bullet point doesn’t actually make random people qualified to ask pregnant women if they’re taking antidepressants.  In fact, unless you’re that woman’s obstetrician, or maybe Oprah, it would be kind of awesome if you would just shut the hell up about it.

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Thank you Stark. Raving. Mad. Mommy., I couldn’t have said it better myself.

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13 Comments

  • I am 31 and have tried to get pregnant for 2 years, with an unknown reason for infertility. 1 failed IVF/ICSI cycle. My RE works alongside a psychologist and together they recommended Zoloft to keep the "wheels from spinning" in my head. I’m not depressed but my mind is just constantly thinking. I got pregnant the month after I started Zoloft with no assisted reproductive therapy. I am currently 6 weeks pregnant and will plan to taper off the Zoloft by the end of my first trimester. After 2 years, $25,000 for IVF, and lots of heartache, I am so thankful that my mind finally calmed down enough to let my body get pregnant.

  • Bravo to the woman with OCD who challenges the scientist who thinks she’s a psychiatrist and the person with a BA. I have bipolar and thanks to the kind of thinking touted by the neurologist, went off my meds, became psychotically depressed, and almost killed myself (and my fetus, incidentally). The personal theory about using cognitive techniques coupled with the rest of the post which encourages women to grin and bear it is veering perilously close to bootstrapping in my view. CBT changed my life for the better, but I still need meds. Many of us do. Why not use your phd to study real causes instead of invoking your credentials in support of your educated guesses?

  • Hello,

    I am sure this comment thread is really old, but as a woman who suffers from OCD, and is planning on becoming pregnant in the near future:

    To the neuroscientist and the BA in Psych commenters: you are full of it. Get off of your high horses, and stop giving unsolicited scare-mongering advice based on a gut feeling to women who are not your patients and therefore didn’t ask for your opinion. Until there is a body of scientific evidence that shows a causal relationship between SSRIs and autism, I will assume that it is indeed better for a woman suffering from a serious mental illness to continue to receive treatment rather than giving up on that treatment due to vague, unproven hypotheses. As well, it is unbelievably insulting to suggest that if only these women would really give therapy the old college try, if only they were stronger and cared more, they wouldn’t need to take drugs at all.

    No one in their right mind would suggest that a woman suffering from an illness such as diabetes should discontinue treatment because she is pregnant and if only she really cared about the future of her baby she would be able to live without drugs. That is ludicrous. It is equally ludicrous to suggest the same for women who suffer from mental illness.

  • Hello – I cannot help but comment on this thread, as i thoroughly agree with the last post . I Graduated college with a BA in Psychology & currently work in Early Intervention for one of the best hospitals. I see children from newborn – 3 everyday and many are on the spectrum for autism, but the biggest thing I have noticed is that typically parents are so wanting the best for their children that it takes a long time for them to accept that their child may be on the autism spectrum. In other words – just because you had a child who is 2 that appears fine to you, that may very well be the case, but you are their parent, you want to see the best for them always. I don't think enough people understand what autism actually is or what to look for, before they go crossing it off for their child. All I can say is, the autistic children I work with appear very bright and developmentally advanced in some areas… but if you know what you are looking for, you can see where the delays are.

    To put it short- It breaks my heart to see this children struggling with a life long diagnosis. And when it comes to taking care of yourself while pregnant or not, I think we often forget that prescriptions are not the only option. There are many different effective types of therapy for people with all sorts of mood disorders and depression. I would HIGHLY advise looking into those options before continuing on using any potentially dangerous medication. It is just not worth the risk to your future child. Just a thought from someone who sees those children AND their families everyday. Imagine the stress you'll be going through if that diagnosis ever comes in. Look it other options FIRST. Psychological medications should always be LAST when another life is at risk.

    • A Bachelor’s in Psychology hardly makes you an expert in medications during pregnancy. You can’t even practice as an LPC without a Master’s, so it’s hardly anything to brag about! Bipolar Disorder, Depression and other mood disorders are potentially fatal diagnoses. Personally, as someone who was diagnosed as Bipolar at 17, I can tell you that with my correct medication you would probably not know I was ever sick. But I was a danger to myself and caused my family a lot of worry when I was not properly medicated. This does not mean I should not have children (and I do) it just means that I need to take medication, like anyone else with a chronic illness. My Maternal Fetal Medicine physician will be the one I consult with about my medication regime, thank you very much.

  • As a neuroscientist, I would just like to say, that Archives of General Psychiatry is an excellent journal, and 300 participants is not a terrible start. Actually, the idea of serotonin dysregulation in autism is not a new concept. Typically, when it comes to mental health, there is no telling how heredity will effect offspring, but you can bet it does. It is not so cut and dried as "take SSRI's and your child will have autism". Everyone has different levels of genetic susceptibility to disorders like this, so taking these drugs may very well just increase the risk, especially if you're already predisposed to have an autistic child. SSRIs cross the placenta. The brain is incredibly malleable and we still don't understand the origins of autism spectrum disorders… this theory is entirely plausible.

    I'm pregnant currently, and have suffered from depression in the past year. I took fluoxetine (Prozac) for a while last year. I started cognitive behavioral therapy, and skipped the drugs, because I felt I could potentially stay on an even keel if I set my mind to it. My research investigates the molecular mechanisms of depression. I am particularly interested in how we perceive stress and how hormones effect these disease states. My theory is that a strong enough cognitive attitude can overcome learned patterns of depression through synaptic plasiticy.

    Sorry to get all technical, but the point is: I think there are better ways to treat depression than just giving everyone an SSRI. Its more complex than that and doesn't work for everyone. If you are pregnant and feel that you have the strength to carry on (for the baby, for yourself… whatever it takes), try – and skip the drugs. We don't know enough about how they work and you very well could be submitting your child to a lifetime of problems by taking them. You can do it!

    • The strength to carry on?? Oh, ok I will just try really hard not to be Bipolar anymore! Thanks, I never thought of that! While I’m at it, maybe I can try really hard to cure my daughter of asthma, since we can cure diseases with mind power now.

  • Thanks for a wonderful post! I've had to give up my anti-anxiety medication and switch to an antidepressant with my pregnancy, and having seen this on the news, I didn't freak out, but I did make a note to talk to my dr about it. I took antidepressants with my now 2-year-old daughter, though, who seems to be just fine, and in fact, ahead of the game in mental and social development!!! I can't see weighing a *possible* risk of autism in an unborn child with a *probable* risk of something happening to the child I already have because I can't properly take care of her while dealing with pregnancy hormones and bi-polar/anxiety issues! I think I'll stay on the meds….

  • I stayed on my anti-depressants (Prozac) during both pregnancies and (gasp!) vaccinated both of my children and they are perfectly fine. For me, the benefit of staying on my medication FAR outweighed the risks to my child and what might happen if I went off of them.
    I am a firm believer that if you do not take care of you first, you will be incapable of taking care of your baby.
    This is horrible study-300 participants????? That is not a plausible study. It just serves to feed to hysteria surrounding medications and autism.

  • Thank you for posting this. I am currently on an anti-depressant for anxiety and also trying to become pregnant. I think I am going to make an appt. with a new ob/gyn because she says that its ok to stay on paxil even though EVERY website says I should not be taking it.

    Thanks Again!

  • I struggled during my first pregnancy, going on and off my meds because I did not feel that they were safe (and because they were contributing to my very severe nausea). My son was premature and has since been diagnosed with autism. I feel like there's no way to assess a situation that is potentially harmful to you AND your baby regardless of how you choose to handle it. I function without medication when I am not pregnant, but of course the hormones were too damn much for me at the time. Now that I am considering baby #2 (this time around at least the father is well-adjusted) I wonder how I will handle it….

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