Antidepressant Use In Pregnancy: Autism Risk?

doctor looking at chart(BlackDoctor.org) — Children born to women who take SSRI antidepressants during pregnancy may have a slight increase in risk for developing autism spectrum disorder (ASD), a new study suggests.

Researchers compared the use of antidepressants among mothers of children with and without ASD. They found that those who had taken selective serotonin reuptake inhibitors (SSRIs) were more than twice as likely to have a child with an ASD diagnosis.

Autism spectrum disorder was uncommon in both groups, and the finding does not prove that SSRI use directly contributed to the children’s ASD.

This is the first study that has shown a possible association between SSRI use and autism and the findings should be considered preliminary.

Autism Diagnosis

Typically diagnosed in early childhood, autism spectrum disorder is characterized by problems with social interaction, verbal and nonverbal communication, and repetitive behaviors or interests.

Autism spectrum disorders include autism, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified.

There has been a huge increase in the diagnosis of autism and related disorders in recent decades. While increased understanding and diagnosis of these conditions may explain the increase, there is also concern that as-yet unidentified environmental influences may be causing more children to develop ASD.

Antidepressant use among women in their childbearing years, especially use of SSRIs, has also increased dramatically in recent decades. These records were compared to those of just over 1,500 children without an autism spectrum disorder.

Twenty mothers of children with ASD (6.7%) and 50 mothers of children without ASD (3.35%) had at least one prescription for an antidepressant in the year prior to giving birth.

Seventy-five percent of those mothers of children with ASD took SSRIs, either alone or with other types of antidepressants. When compared with women who did not take antidepressants during pregnancy, those who had been prescribed SSRIs were more than twice as likely to have a child diagnosed with ASD.

The association was not seen with other types of antidepressants, but this may be because so few women took non-SSRI drugs.

Depression During Pregnancy

Between 14% and 23% of women experience depression symptoms during pregnancy, according to the American Congress of Obstetricians and Gynecologists (ACOG).

In a 2009 joint statement, ACOG and the American Psychiatric Association concluded that both antidepressant use and untreated depression pose potential risks for mother and baby.

Women taking antidepressants should never stop taking them without talking to their doctors. This study is intriguing, but it does not establish a direct link between SSRI use and autism. Until the study has been further investigated in detail women should continue treatment unless told to terminate antidepressant use.

The Kaiser Permanente researchers conclude that even if the association is confirmed, SSRI exposure is not likely to be a major risk factor for autism and related disorders.

Tracy Flanagan, MD, who is director of women’s health for Kaiser Permanente Northern California, says maternal depression itself may be an unrecognized risk factor for autism. In the study, the researchers found no link between a history of depression or other mental health disorder and ASD.

She adds that decisions about treatment must be made on a case-by-case basis by the patient, her ob-gyn, and her psychiatrist.

“A woman who has battled depression for many years and has a history of relapsing when she stops drug treatments is very different from a woman who had a single incidence of depression and is doing great,” she says.

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Rodney & Holly Robinson Peete On Their Son’s Autism

Holly Robinson Peete, Rodney Peete and their son posing for a photo(BlackDoctor.org) —  Their success in the sports and entertainment worlds couldn’t prepare them for the awful truth they heard in the doctor’s office nearly a decade ago. But celebrity Apprentice star Holly Robinson Peete and her husband, former NFL quarterback Rodney Peete, somehow found the strength to face their son’s autism diagnosis.

“Afterwe both kind of cried and said, `Why us?’ But Holly very soon after that rolled up her sleeves and said, `Let’s get to work,”‘ Rodney recalls. “I was the opposite. I was angry more than anything else … I didn’t like to hear what the doctor was saying.”

In his recent autobiography, “Not My Boy!”, Rodney tells the intimate story of his family’s struggle with the diagnosis of R.J., (Rodney James), now 12.

At the time, R.J. was 3, a fraternal twin to his sister Ryan, who showed no symptoms of Autism Spectrum Disorder. As a toddler, R.J. was starting to form words, but around 2, he stopped talking and responding to his name or making eye contact. He began flapping his hands and flicking his ears in repetitive motion.

The Peetes took the twins to the best pediatrician they could find after R.J.’s preschool teacher told the couple he was not teachable. He needed physical, occupational and speech therapy, the doctors confirmed.

“My anger and denial left me in a lonely world,” Rodney writes. “I still thought when the (football) season was over and I could spend every day with him, we would fix this in our own way. I’d be his dad and I’d snap him out of this.”

So doing what he knew best, Rodney headed to the nearest sporting goods store to load up on soccer balls, footballs, baseballs, bats and mitts. But when he took R.J. to the park, the boy was only interested in throwing rocks into a nearby creek, over and over. Some days, he would kick the soccer ball. Then it could be days before that would happen again.

Rodney finally realized that learning to venture into his son’s world was a better option than trying to make R.J. a part of his. Once he was committed to “Team R.J.,” he says, he began taking the child to and from appointments – from three hours a day at a special school, to all the therapies the doctors had recommended.

Through it all, Rodney says, he began to learn how to work with his son and got down on the floor to play. This interaction technique, called Floortime therapy, is a way for parents and therapists to deeply engage autistic children in activities and problem solving.

“When I moved past my denial of R.J.’s condition, I was surprised by how I felt,” he explains in the book. “I felt liberated. Sure, at first I’d mourned the vision I’d had of the kind of father I would be to R.J. And I understood that I had to let go of all the images of fatherhood that I’d received from movies and television – from Ward Cleaver to Cliff Huxtable. I wanted to have as loving a relationship with R.J. as I’d enjoyed with my own dad, but I had to come to terms with the fact that it couldn’t be exactly the same.”

Since the diagnosis, the Beverly Hills family has grown with sons Robinson, 7, and Roman, 5. Each member has his or her own role in R.J.’s progress.

While his parents focus on a bigger picture that includes school, his twin sister, Ryan, 12, acts as his protector. The younger boys always want to play, which keeps R.J. engaged and working on his social skills, a challenge faced by those with autism.

R.J. has learned to look his parents in the eyes, tell them he loves them and even has asked for spaghetti for dinner. He’s made friends, plays soccer and basketball and is getting ready for middle school. He even appears on Fox Sports Net’s “Kid Pitch” with a segment of his own, “Stump Rodney.”

“We were nervous about it at first because he has autism and we didn’t want people to make fun of him. We’re protective of him. We were thrilled he wanted to do it,” says the former co-star of “21 Jump Street” and “Hangin’ with Mister Cooper.” “It’s a great opportunity for Rodney to represent the strength and uniqueness of kids who have autism.”

Yet, with any child, as they grow, new challenges arise. For the Peetes, it’s puberty. For young adults on the autism spectrum, this stage of development causes more confusion, aggression and some regression in the progresses made, Holly says.

“It’s very, very hard for him to sort out all of those hormones,” she says. “We are now faced with a new set of challenges.”

Ryan, R.J.’s twin, has joined her parents in reaching out to the community in sharing her experience with autism. She recently collaborated with her mom on a fictional children’s book, “My Brother Charlie,”  based on her childhood experience with R.J.

Holly also has written her own book about autism and is active in the autism community, especially with Walk Now for Autism, which takes place Saturday at the Rose Bowl in Pasadena. She and her husband also have created the HollyRod4Kids Foundation to help children with autism.

Their dreams include eventually opening an autism treatment center in Los Angeles, Holly says. Their vision is of a “one-stop-shop” where families can access treatment, including a restaurant where kids can be themselves. They even want to add a barber shop.

“Take your kid with autism to the barber and it’s a nightmare,” Holly says. “It takes a special type of person who can work with these kids.”

For now, the Peetes are focusing on the future, discussing homeschooling R.J. for middle school and spreading the word about this incurable disorder.

“Once we really started opening up about it and were sharing our story, I felt compelled to really try to help other fathers out there trying to deal with it,” Rodney says of his book. “From a man’s point of view, it’s a difficult situation and it’s not often talked about from a father’s point of view.”