Antidepressants taken during pregnancy increase risk of autism | Hacker News Reader

Antidepressants taken during pregnancy increase risk of autism

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Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor / psychiatrist recommends otherwise.

It seems obvious, but after being mostly depression / anxiety free for four years and reading an influx of articles claiming that they do nothing or very little based on new research, I decided to quit. Huge mistake that very nearly ruined my life.

It turned out that despite all the lifestyle changes I made as well as therapy I received to mitigate depression and anxiety, the pills were almost solely responsible for my recovery. Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made.

I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective).

Unfortunately, this is not what these companies are doing, as a rule. And given what we've found out SSRIs -- and the behavior of some of the major players in this industry, in recent years -- no one should be terribly surprised at the findings in the JAMA study (assuming they hold up to scrutiny).

Also:

Restarting the SSRI of course did the trick, but they don't work fast and I lost nearly a year of my life. I currently regard this as the worst decision I have ever made.

With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

[1] Yes, this is a loaded term. But I use it quite intentionally. Having not only studied the tradeoffs associated with one major class of antidepressants, but also having worked for one of the market's leading distributors -- and having made a careful study of their marketing materials -- I'd say "pushing" is not a bad description for the aggressive marketing tactics these companies have used over the years.

It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television.

SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types.

> perhaps the bigger mistake was not going off SSRIs but agreeing to go on them in the first place.

This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.

> It's different in different countries. I'm in Australia and we have laws that limit the influence drug companies have over our doctors here, and we don't have pharma ads on television.

Is there a difference in prescription rates between Australia and countries with less strict rules? i.e. does it actually change anything?

According to this article, the only countries to allow direct marketing to consumers are New Zealand and the United States, and doctors in NZ noticed a dramatic change when direct marketing became prevalent from 2002.

Toop L and Mangin D. The impact of advertising prescription medicines directly to consumers in New Zealand: lessons for Australia (2006) http://www.australianprescriber.com/magazine/29/2/article/78...

SSRIs were recommended to me by a proper doctor and it was a good decision to start them. I was fortunate that the first type I took worked well and I didn't have to change types.

That's great and I'm glad your decision worked out well for you.

This kind of 'common sense' stigma is what kept me away from professional help for years. It's not helpful, it's FUD.

Funny thing is, there's about an equal amount of FUD floating around as to the potential benefits of talk therapy. Which is what kept me off it for decades and decades.

Anyway, what I'm saying about SSRIs isn't FUD. There's a near-consensus view out there that though they may sometimes help, their technical workings are still poorly understood[1]; that they have complex side effects; are hard to get off of, for many people; have been over-proscribed for certain vey broad classes of folks (such as adolescents and children); and have often been disingenuously promoted by their makers -- in at least one very famous case, criminally so.

I'm not giving citations for these points. There's plenty of stuff out there to read about these topics -- most of it not only non-sensationalistic, but quite well-reasoned (to the point of sounding dry and impassioned), and really now, pretty easy to find.

[1] Not in "serotonin re-uptake inhibition" part; but in the, you know, "how do these drugs actually treat chemical depression?" part. (Assuming your depression actually is chemical, which is also quite debatable).

> I look at it the other way: companies "pushing"[1] antidepressants not just on pregnant women, but on all of us, for years on end, should be putting out a very clear message that you should not take these medicines unless absolutely recommended by your doctor, and other, generally more efficacious methods -- such as talk therapy and lifestyle changes -- have been at least explored, and found to be ineffective (or depending on the severity of your case, not immediately effective).

I'm in complete agreement with you here - the majority of people prescribed SSRIs probably should not have been. I don't even recommend them to other people, despite the fact that they worked incredibly well for me.

> With all due respect to your situation -- and not intended in the least to belittle either your suffering, or the thought you put into the decisions you made -- perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

It wasn't a mistake. The mental illnesses I suffered started early in childhood, and nearly all my relatives on one side of my family experience some form of it. I resisted medication for a while because I was brought up by parents who considered psych meds to be against the natural order of things, and prohibited me from so much as asking my doctor about them.

In college, the panic attacks had become so severe I was beginning to lose touch with reality. My psychiatrist convinced me to give SSRIs a shot, so I reluctantly agreed, and they turned my life around. Within 6 months, friends and family (both those who knew I was taking a med and those who didn't) remarked that I seemed to be a completely different (and better) person.

Obviously, they don't work this well for most people. But likely the psychiatrist, in the absence of a mature scientific understanding of these disorders, had learned to recognize patterns that predicted a successful response to SSRIs.

My only point was that the discontinuation of an antidepressant should not be taken lightly when you have already had a successful response to it.

It wasn't a mistake.

Great, I'll take your word for it, then. And I sincerely apologize if my remarks were in any belittling of, or sympathetic towards your experience.

> such as talk therapy and lifestyle changes

The places where anti-depressants are applied vs talk therapy are applied are fairly different. The idea that there is a cohort of mustache-twirling doctors and pill pushers trying to shove pills down the throat of every person who'd be better suited to talk therapy is about as ridiculous as I made it sound.

For many people, talk therapy is simply not effective or possible. And in many situations there are social forces which MUST be taken into consideration because they can cause lead to more anxiety and depression.

> perhaps the bigger mistake was not going off SSRIs (at which point the die may have been more or less cast for you, in the short- to medium-term) -- but agreeing to go on them in the first place.

I get so angry reading this. Hot under the collar even. If you think that SSRIs don't help people then you simply don't understand what a true and chemical despair feels like. The difference they can make, both short term and long, is counted in human lives. Many people like me who used them to bridge a short term gap could barely comprehend days without despair, fear and pain.

To have some smug anti-medicine comment oh-so-politely walk up to someone who says, "Hey I treated my mental illness like a real illness and it worked" and respond with scorn an derision? You simply do not understand what real, clinical, and life-threatening depression is.

If you think you do, if you had a mild case that you talked through? Congratulations! I wish the disease on no one. But that doesn't give you license to skulk about making everyone else with a less treatable form of the illness question everything they've done to secure their right to experience happiness.

> If you think that SSRIs don't help people then you simply don't understand what a true and chemical despair feels like.

Or you read? If SSRIs are so helpful, then why does the majority of the research suggest that this isn't the case?[1] If you think they are helpful, then the burden of proof is on you to show that the science is incorrect.

[1] http://www.amazon.com/Emperors-New-Drugs-Exploding-Antidepre...

http://www.amazon.com/Anatomy-Epidemic-Bullets-Psychiatric-A...

Please for whatever you hold dear do not say please read and then point to books. Books? seriously, most people know that the peer-review is many times laughable but anyone can publish whatever book they want even if they are respected professionals/scientists/philosophers... You are just downgrading the conversation by orders of magnitude...

Issues such as those books address don't generally fall within the scope guidelines of journals. Anyway, his basic point is that there's plenty of information about SSRIs out there, if one is willing do a bit of focused reading.

In any case, the current research consensus is that generally antidepressants and talk therapy are complimentary. So talk therapy is better than nothing and antidepressants are better than nothing and combining both treatments is better than sticking to only one.

For me, it is difficult to disentangle my feelings for talk therapy from my fear and antipathy towards the church councillors of my young life who put me on such a destructive path of self-denial.

I am very sorry that that happened to you and I completely understand how sometimes church counsellors can cause more problems. I was raised Catholic so believe me when I say that I understand your words about being on a destructive path of self denial.

For what it's worth, as an adult, I had to make a conscious decision not to let the assholes of my youth ruin my life.

It's bullshit that people treated you like that. I'm very sorry that that happened.

Thanks. I wish I had been born even 10 years later sometimes, I didn't even know the word for my gender until I was in my 30s. People trying to "correct" my course when I was young left me a lot of scars.

So, I'm not saying my case should shape the world. But I think it's worth considering. People here tend to mix "SSRIs are over-prescribed" with "SSRIs don't work." The data suggests the more focused the study, the stronger the effect, which is usually indicative of practicioners failing to properly use an intervention.

Or so my doctor tells me. He was happy to explain carefully why he uses SSRIs, how long he'll agree to prescribe them for, and what his current reading of the research is. I was surprised, but he says GPs often have to be the first line of defense for people who don't outright end up in the emergency room. I guess that stands to reason.

Sure, but the general pattern is: Get the patient stable. Then, follow with talk therapy since that generally is a more permanent solution.

For many people, talk therapy is simply not effective or possible.

I don't dispute this; not only that, I was basically acknowledging this fact in what I originally said. The crux of the issue would seem to lie with how you quantify "many."

If you think that SSRIs don't help people ...

That is quite definitely not what I said.

...then you simply don't understand what a true and chemical despair feels like.

Inasmuch as others have criticized me for "second-guessing" the original commenter's decision about how to treat his illness, without knowing medical history: you also have no knowledge, whatsoever, of mine. So I'm not sure what value there is in the assertion you're making.

Sorry, but I'm not buying it. You started this by asserting your experience and knowledge gove you a platform to talk down to someone else. Someone who very likely has a difficult story backing them.

You made this a topic of discussion. Now you're upset that people are judging you via what looks like an ableist agenda.

Charitably, lets assume this is all a big misunderstanding. Either you actively are avoiding expressing any empathy or you're not good at empathy.

Whichever it may be, it doesn't matter. You're implicitly picking a fight with this writer and every reader over the efficacy of chemical interventions, and doing it in a crude, inappropriate, backhanded fashion.

Whichever it may be, it doesn't matter.

Agreed. I'd appreciate it, though, if in the future you'd kindly not attribute specific statements to me that I quite simply didn't make.

Your intent is not magic. If your communications are "misinterpreted" then it's your fault for not being specific enough.

Taking me to task for my interpretation (which attributed no SPECIFIC statement but rather an interpretation of your words) is a classic example of trying to use an asymmetric appeal to "civility" as a blind for your mistakes.

So no. If I see you spout stuff I consider to be ableist, and I feel like it, I'm going to hit reply and call your statements ableist and explain why.

That is the nature of this forum, and I'm one of the very few people who actually tries to do these things; so you're not exactly being overwhelmed with recriminations of that sort.

When someone on HN relates their personal experiences with a serious illness, there is no list of mitigating phrases you can apply that makes second-guessing or criticism of their handling of that illness civil. Please don't do that.

HN provides plenty of other venues for airing your feelings about medications; some of them are subthreads of this very story. Here, though, was just about the worst place you could have done that.

Why do you think that "personal experiences with a serious illness" are so special that any second-guessing or criticism is not appropriate?

Simply, that is not how compassionate, caring people respond to such stories in a polite, civilized society.

In this particular instance, a doctor chose to prescribe a drug based upon a person's complete set of symptoms and medical history. And, the person, knowing his or her own set of symptoms and history, chose to follow through and begin taking an anti-depressant. This was the result of a consultation between a victim and a medical professional. Another doctor would not criticize the prescription without doing a full work up. Who are you to criticize without doing the same?

Moreover, this is a mental illness and people who suffer from a mental illness deserve nothing but support. One of the 'joys' of depression is that while you are under the cloud, you are a master at criticizing yourself.

When you add in the stigma still attached to mental illness, simply telling a personal story requires huge amounts of bravery. If you criticize or second guess the story, you provide a strong reason to stay bottled up. This is the exact opposite of what our world needs right now.

In essence, carefully criticize the system not the victim.

With all due respect to your situation, this is the shittiest comment I have read on this site in a very long time.

If you somehow think that belittling another's medical history is okay, you seriously need to grow a bit of compassion.

Seconded. The commenter knows next to nothing about the medical history but feels no compunction about telling him what to do. I wish there were a drug to arrest that malady.

You are neither 'jmhain nor their doctor — nor, as far as I can tell from a quick perusal of your comment history, a medical professional of any kind — and as such it is egregiously irresponsible of you to be offering medical advice, however well-intentioned or well-researched you may think it is.

I have some pretty strongly negative feelings about the way (most) mental illness is treated in modern Western society — not least the radical over-use of SSRIs — but the way to address that does not begin with, or even involve, telling someone who reports unambiguous benefit from the use of antidepressants how wrong they were, how they were a pawn of the Pharma-Industrial Complex, or anything else other than, "I'm glad that's helping."

telling someone who reports unambiguous benefit from the use of antidepressants...

Given that he also said he was unable to go off them without "losing a year of his life", it sounds like the benefit was hardly unambiguous.

... how they were a pawn of the Pharma-Industrial Complex,

I'd address some of the other points you're trying to make, but you know very well that I said no such thing, so why should I bother?

> Articles reporting negatively on antidepressants should come with a huge disclaimer to those taking them that they should continue to do so unless their doctor / psychiatrist recommends otherwise.

Shouldn't choosing "my wellbeing over that of my child" be a personal choice, not a healthcare provider choice?...

You may or may not have had experience with anti depressants. But in the cases referenced in the article (mild to moderate depression), especially during pregnancy, the choice is always with the patient (at least with any good physician). I believe the point being made here is consult with a doctor, since she may have some insight to your specific situation that will help you make an informed decision.

If a physician is forcing or heavily influencing your decision, then its likely that the depression is severe, that you don't have the best physician, or some other unusual circumstance.

You make it sound pretty simple. It's not simple at all. Having untreated depression or anxiety during pregnancy also has bad effects on the child. This is not a decision you make based on one study you read on the internet. You make it based on lots of research, preferably with the help of a perinatal psychiatrist.

It's the choice between telling your doctor you are concerned and would like help to stop the meds vs just flushing them.

As an aside, NEVER flush medicine. Only dispose of them through proper channels which vary depending on where you live.

Of course, but making an informed choice means discussing it with your doctor, and balancing a very small (yes it is, read the abstract) additional chance of ASD against a practical guarantee of biochemical upheaval, for mother and baby both, which will result from discontinuing an SSRI.

That's a pretty simplistic formulation. Doesn't sound like you've encountered the harm that a depressed mother can inflict on a child, born or unborn.

I had similar experiences. Going off the antidepressants didn't have an effect initially, if anything I felt more alert and energetic for the first few weeks. After about 6 months I felt like my terrible old self and had to start taking them again. I've been through this 3 times over the past 20 years.

Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not? That's the most anyone can really say about situations like this one, based on how well these things are currently understood. All I know is that antidepressants saved my freaking life when I first started taking them 20 years ago.

Antidepressants take a while to take effect and take a while to go away. The people talking about dependencies are almost certainly horribly wrong.

That being said, if you feel that decreasing your dose makes you more alert and energetic, take it up with your psychiatrist. You may end up being advised to try a lower dose. (IANA psychiatrist, etc. etc.)

Withdrawal symptoms with SSRIs/SNRIs (often called a "Discontinuation Syndrome" to avoid a semantic argument about what "withdrawal" means) are quite well documented. The symptoms are exacerbated by long term use and especially by sudden discontinuation. Medical professionals will invariably recommend a slow tapering of dosage before attempting to discontinue treatment.

I went through this, too---I felt there were good reasons to get off my antidepressants, so I began tapering off of them at what I thought was a reasonable rate, something like 10% of the original dose per month (I was at 250mg so that was 25mg per month).

Things proceeded smoothly for a long time---getting down to 100mg I felt great. But the closer I got to zero the more sensitive I was to the dose changes, and things started to fall apart for me emotionally. I had terrible withdrawal effects, becoming severely depressed and even developing OCD-like symptoms that I had never experienced before. My anxiety was also through the roof. And so I concluded that I did, indeed, need the antidepressants, and I went back on them at nearly my original doses, and things seemed to go back to normal. (Which wasn't great, but at least wasn't hell either.)

But after learning more about other people's successful attempts at antidepressant withdrawal I decided a few years later to try it again. I'm currently in the midst of that tapering process, taking things much more slowly. The important thing seems to be that as you approach a dose of zero your rate of tapering should also diminish. So going from 200mg down to 100mg I did it in 25mg/month increments. From 100mg to 50mg I did it in 10mg/month increments. And now going from 50mg to 25mg I'm doing it in 5mg/month increments. I'm right at the point where things fell apart last time, but so far things are going great.

The dose->blood serum concentration response curves for this medication are non-linear, suggesting that something other than constant incremental tapering is needed in order to keep the rate of change to brain chemistry constant. The rate of taper must be decreased as the dose comes down.

Of course, in theory you'd have to live infinitely long in order for such an approach to get you to zero. So at some low dose like 12.5mg or 6.25mg I'll just have to cold-turkey it and drop down to zero.

I think people underestimate the degree to which their brain chemistry has adapted to the presence of the drugs. When they fail to do well emotionally when off the drugs, they blame it on their native brain chemistry being broken---it's seen as proof that the original "illness" was real and the drugs were needed. But my belief now is that this is an artifact of the brain being given insufficient time to adapt to the absence of the drugs. Slow, slow tapering is the way to go.

Regarding antidepressants saving lives, I also believed that mine saved mine in my darkest hours. And perhaps they did, but I now consider that to be only due to the placebo effect. The physical symptoms such as dry mouth made it feel like the drugs were really doing something. But ultimately I think their power was only that which I gave them by believing they were a miracle cure.

Its really interesting how the tapering works. I went from like 200mg to 100mg without a problem and then from 100mg to 50mg with no problem then going down to 0 I got terrible headaches. I ended up doing the slow tapering like you're supposed going to 25mg and waiting for a while then 0 but I still got negative side effects. Anyway, things slowly seemed to build up and eventually I was just as bad as before the medication so I had to go back up to 300mg over time.

(Just realized that different SSRIs have different treatment sizes so maybe it doesn't compare)

What sort of time period did you do the taper over? I've been working on this taper for over two years, I think.

This happens because the receptors to which the drug binds are saturated at a concentration lower than that produced by the dose you're taking. So basically everything over 100mg/d is just going straight out via your kidneys, and you can taper down from whatever dosage to there in more or less whatever fashion you please because none of it has a meaningful effect on your brain chemistry in any case.

Interesting possibility. Is there a technical term for this effect so I can find further documentation?

Did you consult with a doctor or psychiatrist? Curious.

I began the taper on my own and only discussed it with my doctor when it came time to drop from a 100mg to 50mg prescription. He wanted me to meet with him monthly to report my status but I thought that was ridiculous. I just meet with him when I need a refill.

This is a general practitioner, not a psychiatrist. I've met with many a psychiatrist before and find they are generally so invested in the biomedical disease model that I don't expect them to be particularly helpful. They're the group of people who got me into the emergency room from over-aggressive onboarding of an off-label drug (geodon for depression? It was insane) and also who advised me to get electro-convulsive therapy when I had "treatment resistent" depression (i.e. the psych meds weren't helping me to feel happy.) Fortunately I declined that frightful procedure.

Did to taper off or stop cold-turkey? I imagine taking several years to decrease dosage could be significantly more manageable than going off them right away.

Everyone's depression is their own, and one experience does not necessarily relate to another's experience. Go ahead and read what you like, but listen to yourself and your doctor.

Counter to the "takes a long time" statements: I was suicidal, and down 24/7. I started taking an SSRI on an afternoon, and that night noticed a difference. It took me awhile to get used to it and get past the side effects, but the depression changed literally overnight.

But that's me, that's my personal depression. I got lucky. Resist changing your routine just because someone has a well told story, no matter how smart they are.

> Some people will no doubt chime in that they are sure that my brain developed a dependency on the drugs and the return of my symptoms was simply that dependency asserting itself. Maybe, but probably not?

Even if it is, does it matter? If the drugs aren't hurting you in other ways then why not stay on them? Especially if you can get off for a while without becoming ill immediately.

That's my feeling as well. No one seems too concerned that diabetics depend on insulin shots.

Some of the anti-depressants have pretty unpleasant side effects.

It makes me a bit sad reading comments like this. I don't doubt that this is what you experienced, but it's pretty much basic science 101 that personal anecdotes aren't evidence. You experienced that you got worse when you stopped taking SSRIs and you got better when you took them again. There are many explanations for this. That SSRIs were the reason is only one of them. Maybe it was a placebo effect, maybe there were other circumstances that made you feel better, maybe it was pure chance.

The only way to find out whether a drug works are properly designed trials. Unfortunately the situation with trials regarding antidepressants is rather murky, with trials results being hidden in the past etc., and from the best I can tell there is no consensus on how well SSRIs work among experts. But the solution to that is not to refer to anecdotes, it is better science.

I made absolutely no claim that my experience provided any sort of scientific evidence for the efficacy of antidepressants. I merely stated that if you're on antidepressants, and are in remission, you probably shouldn't quit because of some FUD you read on the internet as I, quite stupidly, did.

>>from the best I can tell there is no consensus on how well SSRIs work among experts.

No, this is totally wrong.

http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

tl;dr: SSRIs have a substantial and clinically significant positive effect on patients with severe depression. The positive effect only decreases in patients with moderate depression, and becomes indistinguishable in patients with mild depression.

It's also incredibly hard to stop taking antidepressants. A family member was on SSRIs for less than a year, and decided they weren't helping. In the process of trying to wean herself off them she went through long bouts of nausea and vomiting. She said it was like being seasick for 3 months.

Antidepressants can be a lifesaver, but they can also have some terrible side-effects. They should only be used as a last resort.

It depends on the person and I guess on the particular SSRI as well. In my case, I could (and did) go from normal dose to zero immediately, and I wouldn't notice any difference until few weeks later when my average mood and productivity started to visibly deteriorate.

Anyway, SSRIs are relatively safe - that's why they're deployed as entry-level antidepressants. There are many "heavier" options available. Getting on an SSRI is far from last resort.

Withdrawal and dependence varies massively from person to person as you say. I had been taking Tramadol (an opioid) at the maximum allowable daily dose for close to a year, and was told to stop by a new consultant. He told me it will be "hellish" and "worse than quitting heroin"; I stopped taking it immediately (without tapering), and the only effect was the return of the original pain.

Also something to note that SSRI withdrawals are on par with heroin or benzo withdrawals, if you decide to quit you need to tell your doctor and have a tapering plan. If you've been taking SSRIs long term and try to quit cold turkey your life will be a living hell.

> Restarting the SSRI of course did the trick

No, not "of course". It is very possible that stopping and restarting drug treatment will put you in a different place entirely, and you may find that things that worked for years just don't anymore. You say it above, but it really cannot be overstated: if you are on a psychotropic medication regimen that is working, for the love of god don't fuck with it except under the supervision of a trained psychiatrist.

This.

Hey! Mind reaching out to me off line? odonnellryanc@gmail.com

This article is very one-sided. It's simply an interview with the author of the paper. I would very much like to see what other experts in the field are saying, especially because I think the causation claims here are pretty bold for a register-based study.

Also, this: "Our study is not out to scare women" in the same interview as "We have to remember that thalidomide was labeled as 'safe' for use during pregnancy." If you're bringing up thalidomide, you're absolutely out to scare women. It's like Godwin's Law for discussions about drugs in pregnancy.

Thalidomide was never labelled as safe during pregnancy - I don’t think there is a single drug on the market that has ever been tested for safety in pregnancy. The best you will get is category A which just says that studies have failed to demonstrate risk [1].

1. http://www.drugs.com/pregnancy-categories.html

Thalidomide was used to treat morning sickness in pregnancy.

That's as close to calling it safe for pregnancy as you can get.

No it is not. At the time there was no regulatory requirement to test in pregnancy. The only reason it never effected the USA is the FDA were (and are) so slow that the problem was found out before they got around to approving it. If the drug company had launched in the USA first the FDA would have allowed it to be sold.

Interestingly it was tested in pregnant mice, but in mice it doesn't have the same effect as in humans.

Actually, it's a misleading title. There's association, but there's no proven causation. Here's the quote:

>This study is consistent with other studies on the same research question. Each study is observational because randomized controlled trials are not ethically possible during pregnancy. Hence, each study is describing an association. The accumulation of such findings will lead to causation

It's observational study, i.e. a study which can only show association. You can easily think of many reasons why you might get such a result. For example, depression and autism might have overlapping genes, and having such gene, results in depression in mother and higher risk of autism in a child.

Considering that both are characterized by abnormal brain function and that mental illness tends to run in families this seems extremely likely.

> I would always be very cautious about saying that anything is 'safe' during pregnancy. We have to remember that thalidomide was labeled as 'safe' for use during pregnancy.

Holy shit if it isn't manipulative. The most charitable reading, after skimming[0], still says the risk increased from "most likely not going to happen to you" to "still most likely not going to happen to you".

I'd like to see some absolute values please.

[0] - https://en.wikipedia.org/wiki/Epidemiology_of_autism

Effects in the range of 0.5-1.0% of pregnancies (and higher for certain high risk groups) are worth paying attention to.

I don't see how encouraging caution is manipulative. Although we know SSRIs work, we're still figuring out exactly how they work, and we know even less about developing fetuses and the effects of SSRIs on them. The gold standard for care is $reward > $risk; with many medicines we can define $risk pretty darn well. With SSRIs we can't. Saying "we just don't know" or "here are the correlations we've found so far" is a good thing, as is reminding folks -- and ourselves -- of how science has failed us in the past. Women should be empowered to make informed choices, but we need the information to inform them with.

Comparing SSRIs to thalidomide is manipulative at best; I'd call it something else but let's skip it in the interest of civility. SSRIs have been widely deployed for many years. We don't see significant amount of children whose mothers taken SSRIs being born with deformed limbs and dying young.

A better comparison would be between SSRIs and aspirin. In both cases, we know that the drug works and is mostly harmless, but we have clue how exactly it works.

Caution is fine. Fear-mongering isn't, especially if it can lead people to avoid treatment that could significantly improve their quality of life for little-to-no side-effects.

> We don't see significant amount of children whose mothers taken SSRIs being born with deformed limbs and dying young.

This rationalization seems uncompassionate at best, implying that mood/cognitive disorders are less important/disruptive than physical disorders.

> SSRIs and aspirin. In both cases, we know that the drug works and is mostly harmless, but we have [no] clue how exactly it works.

To the contrary, the 1982 Nobel Prize was awarded for the discovery of the mechanism of action for aspirin. In contrast, although we know SSRIs cause elevated mood and have anti-anxiety effects, their method of action is not understood. This is not in dispute within the medical community.

> for little-to-no side-effects

We don't know this, which is the entire point of the article and discussion.

1.5% inherent * 187% from pills = 2.8% risk of autism.

Risk of having started a course of antidepressants for absolutely no reason = ~0%

Articles with headlines like these seem manufactured to lead the statistically ignorant into bad decisions. Clickbait science.

It's important to be aware of the absolute risk even when the relative increase is 87%. In this case the risks are always below 1.5%. I haven't read the paper, but the presence of depression (rather than the SSRIs) could also be a cause for the increase. They might want to look at depressed pregnant women who are treated with alternatives to try to deal with that confounding factor.

Suicide is the leading cause of death of mothers in the perinatal period, so I'm glad they said that talking therapies are important.

They present this increased risk as a percentage. No-one understands what that means. People can't translate that increase in risk into actual numbers of people with autism.

I'm not sure what you mean. If the current risk of autism in a child is 1 in 20, then it means that if the mother takes anti-depressants, the risk then becomes 1.87 in 20.

He probably means that without a reference point, it may as well be a shift from 1 in 20 000 000 to 1.87 in 20 000 000. Or, a shift from 1 in 5 to 4 in 5, which is how an average Joe or Jane will understand such article. Running a headline "Some Common X doubles the risk of Something Very Bad" without giving the baseline risk of Something Very Bad is just fear-mongering.

No one in the general population can do that calculation. Try it, go and talk to people.

Or read Gerd Gigerenzer's book Reckoning with Risk http://www.amazon.com/Reckoning-Risk-Learning-Live-Uncertain...

https://plus.maths.org/content/reckoning-risk

And, as Temporal says, without knowing the base rate (am I raising my risk from 1 in 100,000 or from 1 in 1,000?) it provides very little useful information.

>Suicide is the leading cause of death of mothers in the perinatal period

Do you have a source for that? Looks like homicide remains the leading cause of death of women during the perinatal period, and in general the greatest risk a pregnant woman faces is her partner.

http://www.ncbi.nlm.nih.gov/pubmed/22015873

http://www.webmd.com/baby/news/20010320/number-1-cause-of-de...

Yes, that's true in the US. I keep forgetting that the US is so violent that it needs to be excluded from stuff that's true for the rest of the western world. Also, the US counts pregnancy related deaths differently (notice you're not using CDC as a cite) and the US counts suicide differently.

But even in the US suicide is a leading cause of death of women in the perinatal period.

Here's cites for the UK:

http://bjp.rcpsych.org/content/183/4/279

And the WHO lists suicide as a leading cause of death in the Western world, and in the two most populous countries

> Suicide is a leading cause of maternal death in developed countries. The 1997-1999 Report of the Confidential Enquiries into Maternal Deaths in the UK identified psychiatric disorders, and suicide in particular, as the leading cause of maternal death (6). Suicide is now a leading cause of death in young women in the reproductive age group in the world's two most populous countries, India and China

In the interview, they state that "the rise in autism...".

That's been shown to be fallacious. Autism is only really a very recent diagnosis, and reporting rates were either low or the condition wasn't diagnosed properly.

Then the author hypothesises that the seratonin levels might be what causes the issues with autism. But those taking SSRIs have a problem with seratonin levels already, right? So how do they know it's the anti-depressant?

I read the comments when study was posted to HN previously, but there doesn't seem to be too much questioning of the the study itself. Perhaps I'm being unfair.

This study has been criticised - I think NOR gives a pretty balanced report here:

http://www.npr.org/sections/health-shots/2015/12/14/45966593...

> Autism is only really a very recent diagnosis, and reporting rates were either low or the condition wasn't diagnosed properly.

While you can contribute some of the rise to better screening, we have been seeing increases in the time span of less than a decade. Something else is going on.

https://www.ted.com/talks/juan_enriquez_will_our_kids_be_a_d...

The best guess last year was due to microparticles in the air and general pollution levels. Was it discredited?

There is a good rule of thumb to use when looking at associative studies - if the effect is not 300% or more then it is unlikely to hold up when tested in a double blind study. Anything under 3 fold is mostly noise or bad experimental design.

As a comparison the risk of lung cancer is 1500% higher in smokers than non-smokers.

What are the absolute figures? A relative figure is meaningless (or, at least/highly misleading) if the original chance was miniscule.

I was wondering the same. The original chance wasn't mentioned, only that it increases by 87%.

Relevant section of the abstract:

> Adjusting for potential confounders, use of antidepressants during the second and/or third trimester was associated with the risk of ASD (31 exposed infants; adjusted hazard ratio, 1.87; 95% CI, 1.15-3.04). Use of selective serotonin reuptake inhibitors during the second and/or third trimester was significantly associated with an increased risk of ASD (22 exposed infants; adjusted hazard ratio, 2.17; 95% CI, 1.20-3.93). The risk was persistent even after taking into account maternal history of depression (29 exposed infants; adjusted hazard ratio, 1.75; 95% CI, 1.03-2.97).

It should be noted that relative figures are the standard method of reporting effects in epidemiology, for good reasons and bad. But among them is that the regression models needed for absolute differences under more sophisticated study designs, controlling for confounding variables, etc. may not be available.

http://journals.lww.com/epidem/Fulltext/2010/01000/On_the_Or...

The linked article claims "antidepressants increase risk". Linked JAMA article plainly says "association".

Sure they eliminated a couple of known associations, which is good. But this isn't a slam dunk cause->effect, particularly since some studies have shown no association.

> Randomized controlled trials have also shown that exercise or psychotherapy are valid treatment options

The research on exercise is rather inconclusive (mostly because it's hard to placebo-control exercise, but see e.g. [1] for an interesting attempt), and I don't know of any trials that demonstrate the validity of switching away from a working depression treatment. The chances of success are generally not great when trying a new depression treatment (~30% for the first one, decreasing with each failed treatment [2]), so I'm not convinced that the validity alluded to here actually translates into any actionable advice in the context of this study.

[1] http://www.ncbi.nlm.nih.gov/pubmed/21037212

[2] http://www.edc.gsph.pitt.edu/stard/

Reporting an increase of a percentage of risk is horribly misleading.

I hate to be the one, but I wonder if Jenny McCarthy is looking into this research as a possible alternative explanation for what she went through.

Nobody has mentioned in addition to drugs, talk therapy, food can be a lifesaver wrt depression. Specifically, I and a medical doctor had the same experience that taking fish oil, ie high quality omega 3 DHA/EPA was a lifesaver. Also getting off sugar+ is a huge change to the brain's chemical load.

DHA and EPA are fantastic, but I don't think they should be used completely in lieu of eating fish. Two servings per week will do wonders for health.

Humans are fish eaters. Always have been. Why we don't eat it in America boggles my mind but it's a big problem that doesn't get enough mention.

Could it be because we polluted our rivers and lakes around the time of the industrial revolution a century ago?

Antidepressents are just a vaccine for depression, anti-vaxxers standpoint confirmed /s

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