Sunday, July 12, 2020

Comments by Adam Urato

Showing 2 of 2 comments.

  • Thank you all for your interest and comments. John, you are correct that physicians should be aware of these risks and should counsel their patients regarding them. Ted, I agree with you that this specific topic (antidepressant use in pregnancy) is only one part of a bigger issue. But focus on this particular point does help to make clear a major problem with chemical (i.e. drug) approaches to mental health. If society is going to take a “drug-first” approach to mental health then we are going to have large numbers of women of childbearing age on psychotropic medications and we will end up with lots of exposure during pregnancy and fetal development—just as we are currently seeing. This is a big problem because it’s highly unlikely that these chemicals (antidepressants, antipsychotics, etc), crossing into the developing baby, are not going to cause problems. Of course they are going to cause some disruption or alteration in fetal development. So an obvious take home point should be that society needs to emphasize non-drug approaches to mental health. Truth in Psychiatry, I share your concern about the statistic that the average pregnant woman takes between 3 to 5 prescription medications during pregnancy. B, I think you are correct that one of the main reasons many women stay on these medications during pregnancy is that they have great difficulty trying to stop. Pregnancy can be hard enough—never mind trying to go through withdrawal from antidepressants. Stephen, I share your concerns about Effexor and thanks for sharing your story. Fiachra, your question is right on the money: “What are ‘anti depressants’ likely to do to the baby’s brain?” This is a very important query and I’m afraid that the research (both animal and human) is not reassuring. Leonie, thank you for your encouragement. Amery, I appreciate your sharing those links about Dr. Koren and for your efforts to bring attention to this issue. (And you are correct that I do try to keep an even keel—even when autocorrect wants to turn me from Dr. Urato into Dr. Irate!)

  • Thank you michellerudy for your interest in my post. I addressed the concerns about case-control studies in the fourth paragraph of this post (my third point on this study.) You are correct that case-control studies have limitations and the website you link to makes some relevant points. The Harrington study (http://pediatrics.aappublications.org/content/early/2014/04/09/peds.2013-3406) is not a randomized-controlled trial, so the authors are clear to point out that it does not prove causation. But it does show a clear association between SSRI use in pregnancy and autism (and developmental delay) in the boys. Could this possibly be due to some other factor in the SSRI-using mothers? Yes, that’s possible. But I don’t think it’s probable because what is deeply concerning is that the animal studies (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3215047/) show that when small mammals (e.g. rats and mice) are exposed to SSRIs during development, these animals develop neurobehavioral changes that resemble autism. Then when we study this question in human populations we are also finding that the children exposed to SSRIs during development have increased rates of autism (even after controlling for underlying depression and other possible confounding factors.) So to blame this effect on the underlying depression strikes me as somewhat farfetched—the results in the human studies echo what we are seeing in the animal studies of SSRI exposure.

    To use another example, in animal studies, pregnancies exposed to SSRIs have increased rates of premature birth (http://www.ncbi.nlm.nih.gov/pubmed/17652957). When we study this association (i.e. between SSRIs and premature birth) in humans we also find increased rates of preterm birth in the SSRI-exposed pregnancies. (Numerous studies have shown this, most recently Huybrechts, et al 2014 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966829/). This association persists even after accounting for underlying depression and other possible confounding factors. So it just doesn’t seem to make sense to blame the preterm birth (or the autism) on other factors in the human studies when we see the same complications in the animal studies with SSRI exposure.