Antidepressants taken by pregnant women represent a high risk of autism and developmental disorders for their children, especially boys. They also contribute to miscarriages, researchers from several independently working research teams said.
For about 5 years, the number of diagnoses of childhood mental disorders has been increasing. One of the most popular antidepressants – selective SSRI serotonin reuptake inhibitors – has been accused of contributing to their development. They cause an increase in the concentration of a very important neurotransmitter – serotonin – responsible, among others, in for regulating sleep, appetite, blood pressure and also for the mental state. Its decrease increases aggressiveness and at the same time promotes attacks of depression, hence SSRI drugs are used in this disease, generalized drugs and neuroses.
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Two years ago, a team of scientists from the Johns Hopkins Bloomberg School of Public Health decided to verify that these initial diagnoses were indeed true. The researchers examined hospital statistics and found 996 mothers whose children, aged 2 to 5, had mental and developmental disorders. The main diseases identified by the doctors were autism, both mild and moderate, and developmental disorders, e.g. developmental delays, usually mild. These children were included in the Childhood Autism Risks from Genetics and the Environment (CHARGE) research program. Researchers from Johns Hopkins found that they had one thing in common – their mothers took selective serotonin reuptake inhibitors during pregnancy. The children’s diagnoses were confirmed several times by independent medical teams, unfamiliar with the research program, to avoid mistakes. The research took into account such features as family history (e.g. susceptibility to mental disorders, presence of autism in the family), family situation (families full of the possibility of a dysfunctional family) and the health condition of both children and their parents. As it turned out, SSRI drugs were particularly harmful to boys – in the group of children diagnosed with autism, boys constituted 82,5%, and in the group with developmental disorders – 65,6%. Girls were also included in the study, but the effect of SSRIs on boys during their mothers’ pregnancy was clearly stronger. It can be concluded that taking drugs from the group of serotonin reuptake inhibitors by the mother during pregnancy causes that in boys born of this type of pregnancy, autism is three times more frequent than in the control group consisting of children of mothers who did not take such drugs. The first trimester is the period of greatest danger. In turn, in children with developmental disorders, they occur twice as often if the mother took SSRIs during pregnancy than in the control group of children of women who did not take SSRIs. Here, the threat is the third trimester, said Dr. Li-Ching Lee, a psychiatrist and epidemiologist who participated in the study.
According to the researchers, according to surveys in hospitals and treatment facilities, autism is now diagnosed in the US five times more often in boys than in girls. A similar result was obtained by doctors from the Swedish Sahlgrenska Academy who conducted research on autism. In both the USA and the European Union, the number of detected cases of autism is growing. The question is whether this is due to the increasing prevalence of SSRI drugs and their increasing availability, the researchers said.
According to researcher Dr. Irva Hertz-Picciotto, of the UC Davis MIND Institute, the study’s findings are a serious warning to women and psychiatrists. Unfortunately, from now on, it will be necessary to weigh up whether the benefit for the future mother, which is better well-being and mental condition, does not mean a great threat to her child, and in many cases the treatment cannot be interrupted – she added
Worse, the authors of the studies note that maternal depression also poses a great risk to fetuses. Currently, it will be necessary to carry out the same tests only on girls to find out if they are actually more resistant to the negative effects of selective serotonin reuptake inhibitors and what this resistance is all about. It will now be very important to know what doses of SSRIs have the worst effects and which drugs in this class may pose the greatest risk. I still have too little data on this matter, the more so as the dosage of drugs is often not carried out individually, but in accordance with the recommendations of their manufacturers, placed on drug leaflets, which further aggravates the problem, the scientists say.
It is not the only childhood disease of which SSRI medications taken by expectant mothers are accused. A team of scientists from the University of Toronto, led by prof. Amy Cheung found that breathing disorders in newborn babies are associated with these types of drugs. The disorder, known as increased pulmonary pressure, is dangerous for young children as it endangers their respiratory system. In this case, there is no gender division – both newborn girls and boys are at risk of suffering from the disease.
The study was conducted using both hospital statistics and analyzing seven previous studies on the effects of taking antidepressants during pregnancy. Only in the case of drugs from the group of serotonin reuptake inhibitors was a correlation with breathing disorders in newborn children, confirmed also in hospital statistics. The researchers noted that of the 351 women who developed the disorder, 286 were taking SSRIs. The period of greatest risk of developing this disease is the third trimester of pregnancy. As the researchers note, it remains to be seen whether there is a correlation between specific SSRIs and neonatal respiratory disorders. As in the case of autism, researchers and doctors still have too little data on the subject.
The effects of SSRIs, however, can be even more dangerous. A team of scientists from the University of Montreal conducted a case study of 5124 Quebec women who had a pregnancy up to 20 weeks and women who had been pregnant. The causes of miscarriages were varied, the researchers found, the execution was enormous – from the stress of an exam to alcohol abuse after work or even a road accident. However, the researchers found only one regularity – a small group (less than 10%) were women who had miscarried pregnancies, according to the doctors’ preliminary determinations, not at risk. All women in this group were diagnosed with depression or neurosis and were treated with drugs from the group of serotonin reuptake inhibitors. These drugs, such as paroxetine, are administered in higher daily doses than drugs from other classes of antidepressants, according to Dr. Anick Bérard, who leads the study. Worse still, a combination of two drugs in this class, which doctors sometimes recommend, doubles the risk of miscarriage. The greatest risk is in the first trimester of pregnancy, and scientists are now looking to investigate what drugs could replace SSRIs in pregnant women with depression. As Dr. Bérard notes, treating depressed pregnant women can become quite difficult these days.
Text: Marek Mejssner
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