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ASD, ADHD risk may be influenced by antidepressant-related factors, not antidepressant use

Recent findings suggest risk for autism and attention-deficit/hyperactivity disorder may be influenced by factors associated with prenatal antidepressant use, but not antidepressant use itself.

“The fact that we now have found, in two large case-control studies, no increase in the risk for autism with antidepressant use itself should be very reassuring,” Roy Perlis, MD, MSc, of Massachusetts General Hospital, said in a press release. “Some of the studies that have suggested an association did not account for key differences between mothers who take antidepressants and those who don’t, in particular that those taking antidepressants are more likely to have more severe illness.”

Building on previous research published in Molecular Psychiatry in 2015, Perlis and colleagues analyzed data from multiple New England health systems to assess risk for autism and attention-deficit/hyperactivity disorder (ADHD) following antidepressant exposure during pregnancy. The current cohort included 1,245 children with autism spectrum disorders (ASD) and 1,701 with ADHD, matched 1:3 to children without neurodevelopmental disorders.

Pre-pregnancy antidepressant use was associated with greater risk for ASD and ADHD, even after adjusting for maternal depression. However, risk did not significantly increase during pregnancy overall, or with exposure during particular trimesters, for either disorder.

To compare results with prior research, researchers evaluated high and low/moderate-affinity antidepressants separately in regression models. Neither group was significantly associated with ASD or ADHD risk.

Maternal psychotherapy was associated with significantly increased risk for ASD.

ASD and ADHD risk estimates associated with individual maternal diagnoses significantly varied, suggesting complexity of the familial relationship between childhood neurodevelopmental disorders and maternal psychiatric illness. Despite this, including individual terms in risk models for ASD and ADHD did not significantly change results, according to researchers.

“For both ASD and ADHD, we find no significant increase in risk associated with prenatal antidepressant exposure,” the researchers wrote. “Supporting the possibility that prior reports represent confounding by indication, we do identify risk associated with pre-pregnancy antidepressant exposure, and with prenatal maternal psychotherapy. In other words, the requirement for maternal antidepressant treatment, rather than the medication itself, may be associated with risk for neurodevelopmental disorders in offspring.”

“While taking any medicine during pregnancy can be a difficult decision, we hope the results of our two papers — which now cover more than 2,500 children with autism and almost 4,000 with ADHD — will provide some reassurance to women concerned about getting treatment for depression or anxiety during pregnancy,” Perlis said in the release. “While there are depression treatments that don't involve medication, for some patients they are not effective, available or preferred. We want women and the clinicians working with them to be as informed as possible when making this decision.” – by Amanda Oldt

Disclosure: Castro reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.