Kids Brain Health Network, Mental Health Across Generations: the role of antidepressants in maternal and child wellbeing

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Existing evidence on the impact of antidepressant use during pregnancy on child development is often too mixed to offer women concrete answers about the implications for their children.

This difficult, but urgent area of research has been a long-term research interest for Network Investigator Dr. Tim Oberlander, and the focus of a Brain Canada-KBHN postdoctoral fellowship for Dr. Sarah Hutchison, who presented findings on the effects of SSRIs, on children 12 years following prenatal exposure to the common antidepressant at the Pediatric Academic Societies 2018 Meeting in May.

The KBHN-funded study found the children scored higher than controls on a task that measures thinking and attention skills. The work builds on Oberlander and colleagues’ earlier work following 51 children and their mothers since 26 weeks of pregnancy.

“The impact of prenatal antidepressant exposure is not a simple cause and effect,” says Dr. Oberlander. “When it comes to assessing the long-term impact of SSRI exposure before birth, genes and family-life also play a powerful role in influencing how a child grows and develops.

“At the core of this whole story is mother’s mental health,” adds Dr. Oberlander. “We have to talk about what it is about mother’s mental health during pregnancy that influences not only her health, but the health of her fetus and her child.”

While the full picture of antidepressants’ effect during pregnancy is far from complete, “no treatment is not an option,” observes Dr. Hutchison. “It’s important that women who are pregnant and making decisions about whether to take antidepressants or not have a discussion with their physician or midwife. That’s really the key message.”

“I want to emphasize that this is a big public health issue, and the medication part is a subset of the bigger story about pregnancy-related maternal mood disorders,” adds Dr. Oberlander. “Depression during pregnancy and after is a major public health problem that affects mothers and their children.

“The impact of maternal mental health and related medication treatment during pregnancy go on long after birth,” he adds, “and in that sense, represent an influence of mental health across two generations.”

“Further research is needed to examine whether ‘better’ cognitive skills in children with antidepressant exposure reflect a developmental advantage in some ways but also perhaps a risk in other ways, such as perhaps increased anxiety (Hanley et al, 2015),” reflects Dr. Oberlander. “Our findings when the children were 3 and 6 years of age indicated increased levels of anxiety, though the absence of this at 12 years might indicate that as executive functioning improves, children are able to help calm themselves.

“At this point we are fairly cautious in interpreting these results because data collection is ongoing,” agrees Dr. Hutchison. This is just a preliminary sample that we’ve examined so far,” adding that more research is needed before we can confidently comment on the long term consequences or benefits of this prenatal exposure.

In the end, says Dr. Oberlander, the story of this research is not one of the drugs being good or bad, or depression being good or bad. “This is must be a story of how can we support and optimize children’s developmental and mental health, even under adverse circumstances, regardless of what the particular exposure is. That’s the important thing. At a clinical level as a developmental pediatrician, my focus is really on how does this child think, act, and behave, and how can we support their development in the best ways possible, rather than saying ‘this is a population of kids that got exposed to a drug, we have to treat them in this way.’ It doesn’t work like that. It is not one size fits all.

“I hope that my work will provide a much more nuanced story that tell us about a variety of developmental outcomes and that should help us make much more precise and personal interventions for therapy.”

For more information on the SSRI  study, click here for the press release from PAS.

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