Part II: “Don’t be misled by autism-drug reporting”

A better informed opinion than mine
A better informed opinion than mine

There’s an editorial in today’s Star Tribune, “Don’t be misled by autism-drug reporting” by a woman with a far more informed opinion than mine, Elizabeth M. Larusso, who is a physician practicing in the specialty of perinatal and reproductive psychiatry. On the website
themotherbabycenter.org, Dr. Larusso writes: The term “perinatal and reproductive psychiatrist” really means that I specialize in treating women for conditions that are related to the reproductive cycle.

As I said, a more informed opinion than mine.

Although the study in JAMA Pediatrics seemed to me do be well done well done and reported, Dr. Larusso points out some problems. She says the authors did not

  • account for for risk factors for autism, like family history of autism spectrum disorders, paternal age or a mother’s use of alcohol, tobacco, or illicit drugs;
  • confirm whether the women actually took the antidepressant prescribed; 
  • adequately account for the severity of depression in the mothers studied, so there is no way to tell if the higher rates of autism spectrum disorders were due to use of SSRI’s or to maternal depression.

She also notes that when the authors considered only the children whose diagnosis of autism was made by a neurologist or a psychiatrist, the association between SSRI use and autism spectrum disorders disappeared.

So when our patients call? she concludes. We give them a balanced view of the data. And a recommendation to avoid unnecessary exposure–not to antidepressants, but to oversimplified and misleading media reporting.

As I wrote last week, that’s the most important thing: for the patient to get a balanced view of the data. But I have to wonder about “avoiding unnecessary exposure to oversimplified and misleading media reporting.”

Call me naive, but I don’t imagine JAMA Pediatrics is in the business of oversimplification or misinformation. Here are the exact words from the abstract of Antidepressant Use During Pregnancy and the Risk of Autism Spectrum Disorder in Children, under Conclusions and Relevance:

Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester increases the risk of ASD in children, even after considering maternal depression. Further research is needed to specifically assess the risk of ASD associated with antidepressant types and dosages during pregnancy.

I am not suggesting Dr. Larusso is incorrect in her criticisms of the study. But I think what we do have to acknowledge is there are two patients, here, who deserve a “balanced view of the data.” A perinatal and reproductive psychiatrist is well-equipped to represent the needs of a depressed mother, and has a responsibility to try to prevent the risks of untreated maternal depression, including (from the Star Tribune editorial by Dr. Larusso)

poor prenatal care, adverse obstetric outcomes, use of alcohol and tobacco, suicide, increased risk of cognitive, emotional and behavioral problems in children, and rarely, infanticide.

But a pediatrician may be better able to represent the child in utero.

I am no rabid right-to-lifer and I support a woman’s right to choose. I keep this absolute in my head while at the same time believing that life begins at conception. Best practices for the child inside don’t always correspond easily with best practices for its mother. A pediatrician might better represent the in-utero child’s needs than a physician who is committed to the well-being of the mother.

Nobody’s wrong here. Dr. Larusso says that women who are pregnant or want to become pregnant who use antidepressants are wise to consult with their physicians for a balanced view of the JAMA Pediatrics and other data, as well. But I don’t think it’s fair to a dependent child to suggest that information that challenges the use of even clearly essential maternal medication is put out there simply to mislead.

 

 

 

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