The first article linked does not actually say pregnant women should stop taking ADs. Does the full JAMA piece say this?
The research may be questionable ( I have no idea) but the Slate article seems to be misleading as well.
Every article I've seen has encouraged women to *not* stop ADs, or to seriously discuss such a decision with a doctor.
There might be some women who could, indeed, stop medications to lower risks in pregnancy. And they should. But there are many more who absolutely need their meds to handle their for-real medical conditions, and they should not. And that's a decision to be made on a case by case basis with a doctor's input and a real risk-benefit analysis. The "risk" here being pretty small, and difficult to nail down.
Post by juliette21 on Dec 17, 2015 10:17:29 GMT -5
What really pisses me off about sensationalist headlines like this is that they grab people's attention, and get remembered. Like there isn't enough stigma about mental health conditions out there, now we need this. I didn't even take SSRI's during pregnancy and I am pissed off. I really hope this doesn't "take off" like the whole vaccines and autism thing. Because we don't need another reason for people to refuse mental health treatment and/or judge it.
ETA: My issue is not with the study being done, or even how it was done. I am annoyed with how the media spins it.
Post by awkwardpenguin on Dec 17, 2015 10:17:51 GMT -5
Let's be clear - this is not garbage science. It is a huge study (145,456 live births) using sound statistical methodology. It did control for pre-existing maternal depression and that lowered the increased risk from 87% to 75%. It also compared women who stopped taking antidepressants in 1st tri with those who continued taking them in 2nd and 3rd tri (presumably everyone in this group had pre-existing depression) and found the increased risk was only present in those who took them in 2nd and 3rd tri.
I do think the strength of the findings is being overreported by the media, but the basic conclusion being reported is what the study actually found - autism risk is increased 87%. The absolute increase in risk is low (0.7% to 1.2%), but it's a substantial relative risk. The confidence interval is also wide - 15% to 304%.
I totally understand why this feels so personal for many people, but that's not a reason to minimize the findings of the article. I'm on an SSRI and considering a pregnancy, and I want as much information as possible about potential risks so I can make an informed decision.
Edited because my absolute risk numbers were wrong.
yes exactly, if there IS an increased risk in this case, the risk may be genetic to begin with. Depression and anxiety are often things that people suffer from for most of their lives. Therefore in general they have a brain chemistry that is different to that of a person who has never sought out antidepressants or anti anxiety medication, or even someone who went on these medicines temporarily due to say Post Partum depression.
So who is to say that a person who is depressive/overly anxious as their general state would remove that risk by simply not taking their medications? The risk may by there to begin with, in their DNA. passed down to the child either way.
Yes, but causation is really fucking hard to prove, and we have ethics so research on real world problems almost always has to be done in roundabout ways with multiple studies looking at the same issues from different approaches and eventually the evidence all points in the same direction. We can't randomly assign a group of pregnant women to take SSRIs in pregnancy and see what happens. Who wants to sign up for that study?? Not happening.
No, but you can do a longitudinal study of women that are already taking them alongside another group that is not taking SSRIs or other types of ADs.
There are ways to do studies that people wouldn't want to do. My lab did them. And we paid people a lot of money to do it, so it was worth it to them.
That's exactly what this was - a longitudinal study that compared people taking ADs to those not taking ADs. Mean follow up was 6 years 3 months.
Yes, but causation is really fucking hard to prove, and we have ethics so research on real world problems almost always has to be done in roundabout ways with multiple studies looking at the same issues from different approaches and eventually the evidence all points in the same direction. We can't randomly assign a group of pregnant women to take SSRIs in pregnancy and see what happens. Who wants to sign up for that study?? Not happening.
No, but you can do a longitudinal study of women that are already taking them alongside another group that is not taking SSRIs or other types of ADs.
There are ways to do studies that people wouldn't want to do. My lab did them. And we paid people a lot of money to do it, so it was worth it to them.
This study isn't that far off from what you're suggesting. They looked at health records for 150,000 babies born over a 10 year period and then looked at records to find out which mothers were prescribed SSRIs and which kids had been diagnosed with autism. One of the huge strengths of this research is that it is actually prospective, unlike a lot of other research on these issues. Is this study perfect? Of course not. Are there concerns about the bias of one of the lead researchers? Sounds like it. Does that mean women should stop taking SSRIs or doctors should stop prescribing them? Absolutely not. But it's still good research that has gone through a rigorous process of peer review and has been published in a top medical journal.
But no IRB anywhere ever would approve a study that randomized who received SSRIs and who did not. Never. It does not matter how many millions you were willing to pay the women.
It's hard when you've already engaged in the risky behavior now under scrutiny and are basically waiting on the results. The scary thing about autism is that no one really knows what causes it and tons of factors have been considered over the years. Probably a lot of different things can act as an environmental trigger for a genetic component. If you did take ADs during your pregnancy and your child is diagnosed with autism, it will be hard not to blame yourself. I'm not saying we should not discuss it. But I don't think we should pretend that people have no right to be sensitive about it or that people who are sensitive are all "I hate science."
Yes. This is my point. Old lady having boys and taking ADs. As if I don't have enough to blame myself for already?
Hugs. It is hard. The odds are on your side though at least.
- The media coverage of this sucks. If you only read the NBC article, or just the sensationalized headlines, please realize that you know nothing about the actual study itself. - I'm glad that they are studying these things, because I think it should be studied. The authors admitted that this is not the end-all-be-all study, case numbers were low, and risks are very low in both groups. It needs further assessment before drawing the crazy conclusions the media is saying they're drawing. - Hooray, risks are still low - 0.7 to 1.2%, even in this study which (to me) seems to be a worst-case analysis of the increase given how they are actually computing the numbers. - Studies cannot alone discuss all angles of an issue. I do not fault the authors for not going into the great detail about how depression affects pregnant women. It is not their area of expertise! They are simply running statistics on the cases they had available to them. These kinds of conversations that include the WHOLE picture are what needs to happen in doctors offices and preferably also in media coverage of these topics. The Washington Post article that kershnic posted does a much nicer job than the shitty NBC one. - I like bacon and will continue to eat it. Just like I'd continue to take my ADs during pregnancy if I needed to. Just because you choose to accept a risk does not make you a bad parent. It makes you an informed parent. You wouldn't really be living life if you never accepted any risk.
Post by awkwardpenguin on Dec 17, 2015 10:25:18 GMT -5
From the article itself:
"Other studies have explored the association between use of ADs during pregnancy and the risk of ASD. Taken together, these studies are suggestive of an increased risk of ASD associated with use of ADs during pregnancy."
So even the authors of the article are not claiming this is a slam dunk. This study, plus other studies that have found an association, are suggestive of increased risk.
Am I the only one that is shocked that only 31 of the 145,456 babies were exposed to anti-depressants in the last 2 trimesters? I would have thought it would be much higher.
The media ALWAYS leads with the "findings" of a study even if it's a flawed study or has a very small sample size or other compounding factors. I hate that because people take article headlines as facts.
I think in most cases the media deserves more blame than the researchers. How many people actually read the original study before concluding that it's flawed?
No, but you can do a longitudinal study of women that are already taking them alongside another group that is not taking SSRIs or other types of ADs.
There are ways to do studies that people wouldn't want to do. My lab did them. And we paid people a lot of money to do it, so it was worth it to them.
This study isn't that far off from what you're suggesting. They looked at health records for 150,000 babies born over a 10 year period and then looked at records to find out which mothers were prescribed SSRIs and which kids had been diagnosed with autism. One of the huge strengths of this research is that it is actually prospective, unlike a lot of other research on these issues. Is this study perfect? Of course not. Are there concerns about the bias of one of the lead researchers? Sounds like it. Does that mean women should stop taking SSRIs or doctors should stop prescribing them? Absolutely not. But it's still good research that has gone through a rigorous process of peer review and has been published in a top medical journal.
But no IRB anywhere ever would approve a study that randomized who received SSRIs and who did not. Never. It does not matter how many millions you were willing to pay the women.
My fault! I haven't had time to read the second article and I don't remember the blurb on NBC Conn having any more info on the two groups.
You are absolutely right an IRB will not randomize drugs like SSRIs!
Am I the only one that is shocked that only 31 of the 145,456 babies were exposed to anti-depressants in the last 2 trimesters? I would have thought it would be much higher.
No. 2,532 were exposed to anti-depressants in 2 or 3rd trimesters. 31 were diagnosed with Autism.
They seem to focus on SSRI's. What abut other classes of anti-depressants?
They studied several common classes of ADs. From the study:
We defined AD exposure as having at least 1 prescription filled at any time during pregnancy or a prescription filled before pregnancy that overlapped the first day of gestation. Data on prescription filling for AD were validated against medical records and maternal reports,28 with the timing of exposure defined by the date the prescription was filled and duration of therapy. Exposure to ADs was defined according to trimester of use (≥14 weeks’ gestation, first trimester; 15-26 weeks’ gestation, second trimester; and ≥27 weeks’ gestation, third trimester). The exposure time window of interest for ASD was the second and/or third trimester.
The following AD classes were considered: selective serotonin reuptake inhibitors (SSRIs), tricyclic ADs, monoamine oxidase inhibitors, serotonin norepinephrine reuptake inhibitors, and other ADs (eTable in the Supplement). Exposure to a single class was defined as the filling of prescriptions for only 1 AD class in the time window of interest. Use of combined AD classes was defined as the filling of prescriptions for 2 or more different AD classes. The reference category for all analyses was infants who were not exposed in utero to ADs.
ETA: Here's why the reports focus on SSRIs. Again, from the study:
Use of SSRIs during the second and/or third trimester was statistically significantly associated with an increased risk of ASD (22 exposed infants; adjusted HR, 2.17; 95% CI, 1.20-3.93), as was use of more than 1 class of AD during the second and/or third trimester (5 exposed infants; adjusted HR, 4.39; 95% CI, 1.44-13.32) (Table 3). Other classes of ADs were not statistically significantly associated with an increased risk of ASD (Table 3).
I'm waiting for someone to tell me I've overreacted and I want to beat them to the punch and say that I KNOW. lol. It just gets exhausting. I'm tired of reading over and over again that psychotherapy is better than antidepressants - in general, I'm not just talking pregnancy. Psychotherapy is great when it works, and so are drugs. Also I sort of LOL that psychotherapy as we know it has not been around for that long (some could say it's a trend - I'm sure this is a flameful POV), and it seems like people forget that. I really don't get why people are concerned about ADs being overprescribed but don't care how many people see therapists.
It's all about risk. The risks of being in therapy are pretty low (no, not zero) so people aren't up in arms worrying that people are unnecessarily going to therapy.
Almost anyone who is actually trained in some aspect of behavioral health will acknowledge that both medication and therapy are important treatment tools. The idea of trying to say that one is better than the other is nonsensical. It all depends on what the problems are, the individual's circumstances, the expertise of the provider, etc. And yes, mental health treatment is a very young field with a whole lot of questions and uncertainty about what works and why.
This article seriously stresses me out, not that I think we shouldn't post about it BUT - I used ADs during 3rd tri, I'm AMA, and I have 2 boys. I'm pretty much fucked aren't I?
(side question pugz is Zoloft an SSRI, I think it is?)
Flip these statistics around. Great news! New study shows that 98.8% of babies born to women who took SSRIs in their 2nd or 3rd trimester don't have kids with autism!
What if it's the underlying medical health condition of depression/anxiety that is causing the higher risk for autism? I don't know if they evaluated that yet, but I always wonder about the chicken-egg thing. Women who take SSRI's in pregnancy suffer from depression and/or anxiety, and therefore already have altered brain chemistry and/or genes for that.
My theory is that autism is an inherited combination of genetics that are all working together in the "wrong" way.
From the study:
As a secondary analysis, we restricted our sample to children of mothers with a history of depression. Adjusting for the same potential confounders as above, use of ADs during the second and/or third trimester was also associated with an increased risk of ASD compared with those who did not use ADs (29 exposed infants; adjusted HR, 1.75; 95% CI, 1.03-2.97).
I think, like pretty much all studies that manage to get through peer review, it's worth researching further. The sample size is small, an author may have questionable motivations, etc, so that's about as much weight as I would give it - like, hey, there are results here that make this worthy of additional research. I wouldn't make an actual medical decision based on this study, but if this were my area of research, I'd definitely consider using it as a starting point for my next project.
Granted, I've never done clinical research, so I don't know what constitutes a large or small sample size. But this study did involve a total of 145,456 infants, which doesn't seem small to me.
I think, like pretty much all studies that manage to get through peer review, it's worth researching further. The sample size is small, an author may have questionable motivations, etc, so that's about as much weight as I would give it - like, hey, there are results here that make this worthy of additional research. I wouldn't make an actual medical decision based on this study, but if this were my area of research, I'd definitely consider using it as a starting point for my next project.
Granted, I've never done clinical research, so I don't know what constitutes a large or small sample size. But this study did involve a total of 145,456 infants, which doesn't seem small to me.
Ooops, like I said, grading hell and skimming. I thought I saw one of the articles say something about the sample size being small. My mistake.
There was an article on NPR discussing the study, and it said that depression itself was also a possible factor. I will try to find it later.
I read this too. That it wasn't just the AD but being depressed in general may have an impact. I think k it was something to do with seratonin levels and it's role in the developing brain.
Granted, I've never done clinical research, so I don't know what constitutes a large or small sample size. But this study did involve a total of 145,456 infants, which doesn't seem small to me.
Ooops, like I said, grading hell and skimming. I thought I saw one of the articles say something about the sample size being small. My mistake.
Media fail. LOL
Good luck with your grading. I just finished mine yesterday! <)
This is one of the first things you learn as a scientist and I swear it seems like 90% of researchers forget this simple fact.
I don't think researchers forget that fact as much as journalists and fast paced media does. Everything must be spun in to a huge story with a misleading title to get you hooked in to reading the article, which is often poorly written.
What if it's the underlying medical health condition of depression/anxiety that is causing the higher risk for autism? I don't know if they evaluated that yet, but I always wonder about the chicken-egg thing. Women who take SSRI's in pregnancy suffer from depression and/or anxiety, and therefore already have altered brain chemistry and/or genes for that.
My theory is that autism is an inherited combination of genetics that are all working together in the "wrong" way.
From the study:
As a secondary analysis, we restricted our sample to children of mothers with a history of depression. Adjusting for the same potential confounders as above, use of ADs during the second and/or third trimester was also associated with an increased risk of ASD compared with those who did not use ADs (29 exposed infants; adjusted HR, 1.75; 95% CI, 1.03-2.97).
This is really interesting, wow. Thanks for finding it.
Good luck with your grading. I just finished mine yesterday! <)
I lost my mind and did exams with essay questions...that didn't sound so bad when I was considering each of my classes individually, but it wasn't until yesterday that I realized that I have 350 total students. Luckily most of the essay portions of the exams are easy grading, but still. FML.
Jesus Christ, woman. I just graded 47 finals with no essays and thought I was a rock star. LOLOL
I think, like pretty much all studies that manage to get through peer review, it's worth researching further. The sample size is small, an author may have questionable motivations, etc, so that's about as much weight as I would give it - like, hey, there are results here that make this worthy of additional research. I wouldn't make an actual medical decision based on this study, but if this were my area of research, I'd definitely consider using it as a starting point for my next project.
Granted, I've never done clinical research, so I don't know what constitutes a large or small sample size. But this study did involve a total of 145,456 infants, which doesn't seem small to me.