Babies born to mothers who took
antidepressants early in their
pregnancy are approximately three
times more likely to develop autism.

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Prominent Researchers Link SSRIs to Autism
and Developmental Delays

Researchers at Johns Hopkins, the University of Massachusetts, and the University of California, Davis have found that boys with autism spectrum disorder (ASD) are nearly three times more likely to have been exposed to SSRI antidepressants in the womb compared to boys with typical development (TD). The association was even stronger (3.2 times) with first-trimester exposure.  Among boys with developmental delay (DD), SSRI exposure was nearly three and a half times more likely compared to boys with typical development. Third trimester exposure was five times more likely. The findings, they conclude, mean that "prenatal exposure to SSRIs may increase susceptibility to ASD and DD." 

A total of 966 mother-child pairs were evaluated for the study. 492 cases of autism spectrum disorder and 154 cases of developmental delay were compared to 320 cases with typical development. Nearly 800 of the children were male. Too few girls were exposed to allow for a specific analysis of the impact of SSRIs on girls.

Last year the authors of the current study published a review of the literature on SSRIs and autism in the journal Autism Research. In that review they summarized several lines of evidence that explain how SSRIs could damage the developing fetus.  For this study they again note that "SSRIs interact with the placenta, may raise maternal serotonin to abnormal levels, and act directly on the fetus." The authors point out that one third of children with autism also have abnormally high levels of serotonin. Serotonin, the neurotransmitter most affected by SSRI antidepressants, "plays an integral role in fetal development," the investigators write, "with the first trimester a period of development especially sensitive to alterations in serotonergic functioning."

The link with first trimester exposure is particularly telling. This is the third study (see Croen, Archives of General Psychiatry, 2011; Hviid, New England Journal of Medicine, 2013, table 3) to find an association between autism and SSRI exposure during this critical period of brain development – a time, say the authors, that is  "especially sensitive to alterations in serotonergic functioning." Evidence related to the specific timing of exposure suggests a drug effect, not an effect of depression itself.

Summary Information

Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay

Rebecca A. Harrington, PhD, MPH1; Li-Ching Lee, PhD, ScM1; Rosa M. Crum, MHS2; Andrew W. Zimmerman, MD3; Irva Hertz-Picciotto, PhD,MPH4

  1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  2. Departments of Epidemiology, Psychiatry, and Mental Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
  3. Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts
  4. Department of Public Health Sciences and the MIND Institute, University of California, Davis, Davis, California

Pediatrics, 2014 April 14;133(5):e1241-1248.

This research was supported by US National Institute on Environmental Health Sciences grants P01-ES11269 and R01-ES015359, the MIND Institute, Autism Speaks, and the National Institutes of Health (NIH).

Additional Studies Linking Antidepressants to Autism


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