FAQ - Antidepressants and Autism? | Postpartum Support International (PSI)

Q & A regarding Boukhris et al. et al.’s study ‘Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children’, published in JAMA Pediatrics:

This FAQ was written in response to an article published on the question of rates of autism and a research study’s statement that there might be a relationship to the use of antidepressants. We know that there is so much information on the internet, and we share this FAQ in hopes to reassure women and families. PSI believes that women have the right to information and informed care to aid their decision-making about treatment options during pregnancy and postpartum. Mild to moderate depression can be effectively treated with a variety of evidence-based methods, including psychotherapy and social support. In many cases, the use of medication is warranted, and our goal is to promote resources that provide research-based data on risks and benefit. If you have any questions about your options and risks, please call our support line at 800-944-4773 or write to us. We will help you find resources and information. You are not alone; we know how you feel and are here to help. You’ll find more information on symptoms, local resources, family support, and our FAQs about pregnancy and postpartum mental health on our website.

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Q: Does this study indicate that I should not take antidepressants if I am planning to become pregnant, are pregnant, or am currently breastfeeding?
A: No. This study does not answer the question about whether you should take antidepressants during pregnancy.

The risks of untreated prenatal depression are high:
- 50-62% risk of depression after delivery, postpartum depression.
- Having a baby with low birth weight at delivery, being delivered earlier than predicted, and have a 50% increase risk of having developmental delays at 18 months.
Half of the women who stop antidepressants before or during pregnancy become depressed again during pregnancy or after birth.
These risks must be weighed against the risks of continuing antidepressants during pregnancy.
Further reliable research on the risks of antidepressants vs the risks of untreated depression and anxiety is needed and welcome by the perinatal mental health community.

Q: Does this study show that I have 87% chance of my baby developing autism if I took antidepressants during pregnancy, as mentioned in the media?
A: No. In fact, being exposed to antidepressants during pregnancy may raise the risk of autism from 1% in unexposed children to 1.87%. These numbers could have been obtained by chance, given that there was actually no association between antidepressants and autism when the authors only looked at children diagnosed with autism by a psychiatrist or a neurologist.

Q: Is the study the only one looking at the link between antidepressants during pregnancy and autism?
A: No. In fact, three other large studies (average of 430 000 children) did NOT find an association between exposure to antidepressant medication during pregnancy and autism. In the five studies showing an association between antidepressants and autism (average of 45 000 children), history of depression in the mother seemed to account for most of the increased risk of autism. Taken together, these studies suggest that it is depression during pregnancy (rather than antidepressant treatment) that increases the risk of autism.

Q: I heard that the way the study was conducted has some limitations, and this is why my doctor is not modifying his/her practice or recommendations following these results. What are these limitations?
A: Problems with how this study was done are that other factors known to have associations with autism were not taken into account:

having another family member with autism or other psychiatric disorders
low weight at birth and early delivery
smoking, alcohol and drug use in the mother
mother’s weight
age of the father
this study looked at women who had prescriptions dispensed, it was not based on women who had actually taken medication. Many women have prescriptions, and yet have not actually taken the pills.

Q: The media coverage of that paper mentions that psychotherapy and exercise should be sufficient to treat depression during pregnancy, and that the use of antidepressants is not necessary. Is this true?
A: No. Even though psychotherapy and exercise are effective treatments for depression, a significant proportion of patients do not have access to therapy, cannot exercise because it may endanger the pregnancy, or prefer antidepressants. In addition, some women experience significant depression and anxiety symptoms even after being in psychotherapy. Therefore, antidepressants represent a useful option for the treatment of depression during pregnancy.

Most importantly, we want moms and families to not be frightened. Reach out to us, ask your questions. We will support you and help you find more information and reliable providers.

For support and resources contact 1-800-944-4PPD or postpartum.net
For information about medication during pregnancy and breastfeeding www.mothertobaby.org