The study – “Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system” – suggests a potential link between women taking antidepressants during pregnancy and an increased risk of ADHD, but not ASDs, in their children. The limitation to this type of study is that factors other than the antidepressants, such as the depression itself, or genetic factors increasing both depression and ADHD risk, might be causing the effect seen.
The researchers used various methods to take this into account, but acknowledge that other factors could still be having an effect. While the link with ADHD remained significant after taking maternal depression into account, it did not remain significant after taking into account measures of how severe the woman’s illness was.
Other limitations to the study include the following:
- It could only assess what prescriptions the mothers received, and not whether they took them.
- It could not directly assess how severe a woman’s illness was; they had to rely on data that was routinely collected on the types of treatment she was receiving and her previous diagnoses. This is unlikely to capture severity as well as a more direct assessment could.
- If children or mothers were diagnosed or treated outside of the healthcare grouping being assessed, this information would not be available to the researchers, and this could affect results.
It is important to know that no one factor is likely to cause ADHD or ASD. These conditions are complex, and we are not yet entirely sure what causes the majority of cases. Both genetic and non-genetic (known as “environmental”) factors are thought to potentially play a part.
Medications are used sparingly in pregnancy to reduce any risk of harm to the developing foetus. However, if a woman’s condition could have serious consequences if untreated, then the woman and their doctor may decide that the benefits outweigh the harms.
NICE has guidance on how to treat depression in women planning pregnancy, during pregnancy and while breastfeeding. In general, it recommends considering alternatives to antidepressant treatment, and considering doctor-supervised withdrawal of antidepressants for women already taking them. However, under certain circumstances it advises considering antidepressant treatment, such as if the women has not responded to non-drug therapies.
Sources and More Information:
- Antidepressant use in pregnancy linked to ADHD, NHS Choices, Mental Health, August 27 2014.
- Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system, Nature, Molecular Psychiatry , doi:10.1038/mp.2014.90, 26 August 2014.
- Pregnant women who take anti-depressants ‘could raise their child’s risk of ADHD‘, DailyMail, health/article-2734926, 26 August 2014.