Coming off antidepressants may be an option for some women to reduce their child’s risk of developing a mental illness, a study has suggested.
Children were more likely to develop a psychiatric disorder if their mother was using antidepressants before pregnancy and continued to use them during pregnancy, researchers found.
The study, led by researchers in Denmark, followed up just over 905,000 children born between 1998 and 2014 for a maximum of 16.5 years. Children whose mothers continued to take antidepressants during their pregnancy were at a 27% increased risk of developing a psychiatric disorder compared to those whose mothers stopped taking antidepressants during their pregnancy.
The prevalence of psychiatric disorders in children born to mothers who continued using antidepressants during pregnancy was 14%, compared to 8% in children whose mothers had not taken antidepressants before or during pregnancy.
The researchers suggested that coming off antidepressants during pregnancy may be an option for a ‘subgroup’ of women, but caution that the decision to do so must be carefully considered.
They said in the paper: ‘The decision to discontinue or maintain antidepressant treatment during pregnancy is challenging. Discontinuation of antidepressant treatment can lead to psychiatric episodes with subsequent long lasting adverse effects on both the mother and child.
‘Decision making tools and treatment algorithms to identify subgroups of women who can be tapered off antidepressants safely are urgently needed.’
They also cautioned that underlying genetic factors and the severity of the mother’s illness combined with antidepressant exposure are likely to play a role, demonstrated by that fact that children born to women who discontinued antidepressant use during their pregnancy still had an increased risk of developing a psychiatric illness.
Writing in a linked editorial, researchers from the PharmacoEpidemiology and Drug Safety Research Group at the University of Norway said: ‘Observational studies, for all their flaws, are a necessary piece of the puzzle, and healthcare databases such as the one used for this study provide a rich resource.
‘However, database and registry studies have limitations and must be supplemented by genetic and epigenetic studies, pharmacokinetic data, animal studies, and in vitro research, which together can provide a more complete picture of the mechanisms by which drugs may act on the developing foetus.’
BMJ 2017; available 7th August
