Tuesday, April 12, 2016

Experts Caution More Research Is Needed to Understand Link Between Maternal SSRI Use, Depression in Offspring

Prenatal exposure to selective serotonin reuptake inhibitors (SSRIs) was associated with increased rates of depression diagnoses in early adolescence, according to a report online in the Journal of the American Academy of Child and Adolescent Psychiatry. The study is the first to investigate the incidence of psychiatric diagnoses in offspring prenatally exposed to SSRIs as far out as adolescence.

Finnish and American researchers used Finnish national birth registry data to determine the cumulative incidence of depression and other mental illnesses in the offspring of four groups of mother-offspring dyads: those exposed to SSRIs during pregnancy (n=15,729); those exposed to psychiatric disorder but not to antidepressants (n=9,651); mothers who used SSRIs only before pregnancy (n=7,980); and those unexposed to either antidepressants or psychiatric disorders (n=31,394).

They found the cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% by age 14.9 years, compared with 1.9% in the psychiatric disorder/no medication group and to 2.8% in the SSRI-discontinued group.

Authors and reviewers of the study emphasized in interviews with Psychiatric News the importance of treating maternal depression. “…Until either confirmed or refuted, these findings must be balanced against the substantial adverse consequences of untreated maternal depression,” the authors wrote.

The study was based on previous animal studies by Jay Gingrich, M.D., Ph.D., of Columbia, that suggested that SSRIs have an adverse effect on the developing fetal brain. He told Psychiatric News that further research will try to pinpoint antidepressant medications, dosages, titration schedules, and periods during pregnancy when treatment might be more or less safe.

“Ideally, what we will try to do in the next three years is gain enough new information so we can really help clinicians and their patients have some concrete data,” he said. “We know dose and mechanism of action matter, and timing [during pregnancy] matters a lot.”

Past APA President Nada Stotland, M.D. (pictured above), emphasized the stigma surrounding depression, especially for expectant mothers who are concerned about the welfare of their offspring. “Despite repeated attempts to formulate an algorithm, there is no way to get beyond the need to make treatment decisions on a case-by-case basis, taking into account past history of depression and response to treatment, current severity of depression, access to quality psychotherapy, and the patient’s concerns and preferences,” she said. “Somehow we hear far less, if anything, about medications needed during pregnancy to treat non-psychiatric medical conditions. Women depressed during pregnancy are already anxious about causing harm to their babies.”

Lead authors were Heli Malm, M.D., Ph.D., of Helsinki University, and Andre Sourander, M.D., Ph.D., Alan S. Brown, M.D., and Myrna Weissman, Ph.D., of Columbia University and the New York State Psychiatric Institute.

For related information, see the Psychiatric News article “Study Reports Risks, Benefits of SSRIs Taken During Pregnancy.”


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