02 May Exposure to SSRI’s During Pregnancy May Raise Risk of Adolescent Depression
MedicalResearch.com Interview with:
Heli Malm, MD, PhD
Specialist in Obstetrics and Gynecology
Teratology Information Service
Helsinki University and Helsinki University Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Malm: Animal studies have demonstrated that exposure to SSRIs during early brain development can result in depression-like behavior in adolescence. Today 6% of pregnant women in the US and 4% in Finland are on selective serotonin reuptake inhibitors (SSRIs) at some stage of pregnancy. SSRIs pass the placenta but no prior studies have followed children beyond childhood to monitor the development of depressive disorders, which typically emerge after puberty onset. Results on autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorders (ADHD) have been conflicting.
The study material is based on national register data from Finland. We investigated offspring psychiatric diagnoses, including depression, anxiety, ASD, and ADHD, of nearly 16,000 mothers who had used SSRIs during pregnancy between 1996 and 2010. Children in this cohort ranged in age from 0 to 15 years old. Because maternal psychiatric illness can affect offspring neurodevelopment in the absence of SSRIs, primary comparisons were made between offspring of the SSRI group and offspring of mothers with a psychiatric disorder diagnosis but no antidepressant use.
Children exposed to SSRIs during gestation were diagnosed with depression at an increasing rate after age 12, reaching a cumulative incidence of 8.2% by age 15, compared to 1.9% in the group of children exposed to maternal psychiatric illness but no antidepressants. Rates of anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) diagnoses did not differ significantly between the two groups.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Malm: The results are strikingly similar with the findings from experimental animal studies and are biologically plausible. However, until confirmed, these findings must be balanced against the adverse consequences of untreated maternal depression. While some women with mild to moderate depression may do well coming off antidepressants during pregnancy, severe depression when left untreated can lead to serious consequences in the mother and can have direct and indirect adverse effects on the pregnancy, the fetus, and the child. Therefore, if the mother clearly benefits from treatment, it should not be discontinued. On the other hand, there should always be a proper indication for using these drugs. Further, until the findings are confirmed or refuted, evidence-based psychotherapies could be better utilized to maximize maternal benefits while minimizing risk to the long-term health of the developing fetus.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Malm: First, the oldest subjects had only just entered the age of risk for depression, which typically emerges after the onset of puberty. Further research is therefore needed to follow these children as they get older to substantiate our findings. Further studies should also determine whether the developing fetus is particularly sensitive to the effects of SSRIs in different trimesters, and whether some medications may be safer than others for the fetus.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Heli Malm, Alan S. Brown, Mika Gissler, David Gyllenberg, Susanna Hinkka-Yli-Salomäki, Ian W. McKeague, Myrna Weissman, Priya Wickramaratne, Miia Artama, Jay A. Gingrich, Andre Sourander.Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study.Journal of the American Academy of Child & Adolescent Psychiatry, 2016; DOI: 10.1016/j.jaac.2016.02.013
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