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Antidepressant use in pregnancy linked to child psychiatric disorders

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

 

Readers' comments (2)

  • My immediate thought was that those mothers with more severe true depression and more clearly needing to continue antidepressants were the ones who did so. However, this was taken into account to some extent.
    From the study: "The risk for psychiatric disorders among offspring in the continuation group was higher than that in the discontinuation group (hazard ratio 1.27, 95% confidence interval 1.17 to 1.38). This was apparent after adjustment for demographic and psychiatric characteristics of the mothers, including inpatient and outpatient psychiatric treatment and comorbid psychotropic drug use (table 2⇓). The population attributable fraction was 0.5%, indicating that continuous antidepressant use during pregnancy explained 0.5% of psychiatric cases in the study population, assuming an unconfounded causal association." (ONLY 0.5% - my comment)
    Study conclusion: "Antidepressant use during pregnancy was associated with increased risk of psychiatric disorders in offspring. The association may be attributable to the severity of underlying maternal disorders in combination with antidepressant exposure in utero. Our findings suggest that focusing solely on a single psychiatric disorder among offspring in studies of in utero antidepressant exposure may be too restrictive."
    Perhaps the headline ought to be "Mothers with depression, especially if severe, more likely to have children with psychiatric disorders." That would however not be so interesting.

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  • Why does the subject of antidepressants wind so many people up??

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