12 ms·

Antidepressants taken during pregnancy increase risk of autism

125 points by kevindeasis 11y ago

jmhain 11y ago
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.
- kafkaesq 11y ago
  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.
  - ryan-allen 11y ago
    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.
    - ars 11y ago
      > 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?
      - sjy 11y ago
        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/787.pdf http://www.australianprescriber.com/magazine/29/2/article/78...
    - kafkaesq 11y ago
      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).
- scott_karana 11y ago
  > 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?...
  - someear 11y ago
    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.
  - ksenzee 11y ago
    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.
  - serge2k 11y ago
    It's the choice between telling your doctor you are concerned and would like help to stop the meds vs just flushing them.
    - Abraln 11y ago
      As an aside, NEVER flush medicine. Only dispose of them through proper channels which vary depending on where you live.
  - aaronem 11y ago
    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.
- mwfunk 11y ago
  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.
  - striking 11y 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.)
    - ajarmst 11y ago
      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.
  - pc2g4d 11y ago
    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.
- hannob 11y ago
  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.
  - jmhain 11y ago
    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.
  - enraged_camel 11y ago
    >>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-you-wanted-to-know/ 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.
- jobu 11y ago
  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.
  - TeMPOraL 11y ago
    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.
    - stordoff 11y ago
      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.
- Igglyboo 11y ago
  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.
- didgeoridoo 11y ago
  > 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.
- aburan28 11y ago
  This.
- odonnellryan 11y ago
  Hey! Mind reaching out to me off line? odonnellryanc@gmail.com
DanBC 11y ago
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.
- steven2012 11y ago
  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.
  - TeMPOraL 11y ago
    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.
  - DanBC 11y ago
    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-Uncertainty/dp/0140297863 http://www.amazon.com/Reckoning-Risk-Learning-Live-Uncertain... https://plus.maths.org/content/reckoning-risk 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.
- parfe 11y ago
  >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.ncbi.nlm.nih.gov/pubmed/22015873 http://www.webmd.com/baby/news/20010320/number-1-cause-of-death-in-pregnant-women-murder http://www.webmd.com/baby/news/20010320/number-1-cause-of-de...
oneeyedpigeon 11y ago
What are the absolute figures? A relative figure is meaningless (or, at least/highly misleading) if the original chance was miniscule.
- pascalo 11y ago
  I was wondering the same. The original chance wasn't mentioned, only that it increases by 87%.
- nharada 11y ago
  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).
- Fomite 11y ago
  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_Origin_of_Risk_Relativism.2.aspx http://journals.lww.com/epidem/Fulltext/2010/01000/On_the_Or...
ksenzee 11y ago
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.
- danieltillett 11y ago
  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 http://www.drugs.com/pregnancy-categories.html
  - DanBC 11y ago
    Thalidomide was used to treat morning sickness in pregnancy. That's as close to calling it safe for pregnancy as you can get.
    - danieltillett 11y ago
      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.
adenadel 11y ago
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.
TeMPOraL 11y ago
> 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 https://en.wikipedia.org/wiki/Epidemiology_of_autism
- gohrt 11y ago
  Effects in the range of 0.5-1.0% of pregnancies (and higher for certain high risk groups) are worth paying attention to.
- Domenic_S 11y ago
  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.
  - TeMPOraL 11y ago
    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.
cjensen 11y ago
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.
dstyrb 11y ago
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.
jesstaa 11y ago
Reporting an increase of a percentage of risk is horribly misleading.
serge2k 11y ago
Antidepressents are just a vaccine for depression, anti-vaxxers standpoint confirmed /s
danielrm26 11y ago
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.
solomatov 11y ago
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.
- Abraln 11y ago
  Considering that both are characterized by abnormal brain function and that mental illness tends to run in families this seems extremely likely.
danieltillett 11y ago
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.
chris_wot 11y ago
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/2015/12/14/459665937/a-new-study-raises-old-questions-about-antidepressants-and-autism http://www.npr.org/sections/health-shots/2015/12/14/45966593...
- maratd 11y ago
  > 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_different_species https://www.ted.com/talks/juan_enriquez_will_our_kids_be_a_d...
  - venomsnake 11y ago
    The best guess last year was due to microparticles in the air and general pollution levels. Was it discredited?
AnneTheAgile 11y ago
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.
- MicroBerto 11y ago
  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.
  - r00fus 11y ago
    Could it be because we polluted our rivers and lakes around the time of the industrial revolution a century ago?
0xcde4c3db 11y ago
> 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 http://www.ncbi.nlm.nih.gov/pubmed/21037212 [2] http://www.edc.gsph.pitt.edu/stard/ http://www.edc.gsph.pitt.edu/stard/

125 points by kevindeasis 11y ago

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.

kafkaesq 11y ago
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.
- ryan-allen 11y ago
  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.
  - ars 11y ago
    > 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?
    - sjy 11y ago
      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/787.pdf http://www.australianprescriber.com/magazine/29/2/article/78...
  - kafkaesq 11y ago
    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).
scott_karana 11y ago
> 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?...
- someear 11y ago
  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.
- ksenzee 11y ago
  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.
- serge2k 11y ago
  It's the choice between telling your doctor you are concerned and would like help to stop the meds vs just flushing them.
  - Abraln 11y ago
    As an aside, NEVER flush medicine. Only dispose of them through proper channels which vary depending on where you live.
- aaronem 11y ago
  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.
mwfunk 11y ago
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.
- striking 11y 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.)
  - ajarmst 11y ago
    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.
- pc2g4d 11y ago
  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.
hannob 11y ago
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.
- jmhain 11y ago
  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.
- enraged_camel 11y ago
  >>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-you-wanted-to-know/ 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.
jobu 11y ago
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.
- TeMPOraL 11y ago
  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.
  - stordoff 11y ago
    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.
Igglyboo 11y ago
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.
didgeoridoo 11y ago
> 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.
aburan28 11y ago
This.
odonnellryan 11y ago
Hey! Mind reaching out to me off line? odonnellryanc@gmail.com

DanBC 11y ago

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.

steven2012 11y ago
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.
- TeMPOraL 11y ago
  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.
- DanBC 11y ago
  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-Uncertainty/dp/0140297863 http://www.amazon.com/Reckoning-Risk-Learning-Live-Uncertain... https://plus.maths.org/content/reckoning-risk 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.
parfe 11y ago
>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.ncbi.nlm.nih.gov/pubmed/22015873 http://www.webmd.com/baby/news/20010320/number-1-cause-of-death-in-pregnant-women-murder http://www.webmd.com/baby/news/20010320/number-1-cause-of-de...

oneeyedpigeon 11y ago

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

pascalo 11y ago
I was wondering the same. The original chance wasn't mentioned, only that it increases by 87%.
nharada 11y ago
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).
Fomite 11y ago
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_Origin_of_Risk_Relativism.2.aspx http://journals.lww.com/epidem/Fulltext/2010/01000/On_the_Or...

ksenzee 11y ago

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.

danieltillett 11y ago
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 http://www.drugs.com/pregnancy-categories.html
- DanBC 11y ago
  Thalidomide was used to treat morning sickness in pregnancy. That's as close to calling it safe for pregnancy as you can get.
  - danieltillett 11y ago
    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.

adenadel 11y ago

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.

TeMPOraL 11y ago

> 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 https://en.wikipedia.org/wiki/Epidemiology_of_autism

gohrt 11y ago
Effects in the range of 0.5-1.0% of pregnancies (and higher for certain high risk groups) are worth paying attention to.
Domenic_S 11y ago
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.
- TeMPOraL 11y ago
  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.

cjensen 11y ago

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.

dstyrb 11y ago

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.

jesstaa 11y ago

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

serge2k 11y ago

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

danielrm26 11y ago

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.

solomatov 11y ago

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.

Abraln 11y ago
Considering that both are characterized by abnormal brain function and that mental illness tends to run in families this seems extremely likely.

danieltillett 11y ago

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.

chris_wot 11y ago

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/2015/12/14/459665937/a-new-study-raises-old-questions-about-antidepressants-and-autism http://www.npr.org/sections/health-shots/2015/12/14/45966593...

maratd 11y ago
> 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_different_species https://www.ted.com/talks/juan_enriquez_will_our_kids_be_a_d...
- venomsnake 11y ago
  The best guess last year was due to microparticles in the air and general pollution levels. Was it discredited?

AnneTheAgile 11y ago

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.

MicroBerto 11y ago
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.
- r00fus 11y ago
  Could it be because we polluted our rivers and lakes around the time of the industrial revolution a century ago?

0xcde4c3db 11y ago

> 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 http://www.ncbi.nlm.nih.gov/pubmed/21037212 [2] http://www.edc.gsph.pitt.edu/stard/ http://www.edc.gsph.pitt.edu/stard/