April 9, 2018

expert reaction to study investigating the association between brain structure in infants and exposure to SSRIs during pregnancy

Researchers publishing in JAMA Pediatrics examine the association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and brain development using structural and diffusion magnetic resonance imaging (MRI).

Prof Andrew Whitelaw, Emeritus Professor of Neonatal Medicine, University of Bristol, said:

“Depression in pregnancy and its treatment are important topics as suicide is a leading cause of maternal mortality and persistent depression after delivery has an adverse effect on child development.  This study used established brain imaging techniques and the differences found look convincing. At the age of 3-4 weeks, infants of mothers treated with SSRI medication had larger right amygdala and right insula compared to infants of depressed mothers not treated with SSRI and healthy control infants.  Advanced MRI techniques showed these two brain regions were more connected in the infants of SSRI treated mothers. These regions of the brain are involved in the regulation of fear and anxiety and other studies have shown that enlargement and activity in these regions are associated with anxiety disorders.

“However, infants in this study were examined at just a few weeks of age and the findings may be transient. We do not know how predictive the imaging findings in newborns are of later depression or anxiety in childhood or adolescence.

“It is disappointing that the mothers treated with SSRI were so very different from those with depression not treated with SSRI. In the former group, 12 out of 16 (75%) were white and had income over 100,000 US dollars and were more educated whereas 13 out of 21 (62%) of the non-drug depressed group had income below 25,000 US dollars and only 3 of 21 (14%) were white.  These differences may have introduced bias at the start and certainly make a comparison of psychological status later in childhood problematic.

“The current findings are original and build on previous research in Finland showing that SSRI-treated mothers have children with an increase in depression in adolescence. Wisely, the authors do not conclude that SSRI treatment should be avoided in pregnancy. Untreated depression in pregnancy has serious risks for mother and baby and psychiatrists have the difficult task of identifying the pregnant women where SSRI treatment is the least risky decision.”

Prof Jean Golding, Emeritus Professor of Paediatric and Perinatal Epidemiology, University of Bristol, said

“Taking medication in pregnancy is always potentially dangerous for the developing fetus, and thus it is very important to balance the risk to the mother of not taking the drug with a possible risk to the development of the child. The harm done by thalidomide was relatively easy to spot as the babies were born with unusual malformations of the limbs. Changes to the brain of the fetus has been much more difficult to detect until recently with the use of brain scans. This study has two advantages – (i) it looks at the structure of the brains of newborn infants, and (ii) it compares infants of women who were depressed and had taken an SSRI, with those who were depressed but did not take this medication, and with a normal group. The infants of women who had taken SSRI had differences in their brain structures. As with all new research findings this needs to be further investigated and replicated in other studies.”

* ‘Associations Between Brain Structure and Connectivity in Infants and Exposure to Selective Serotonin Reuptake Inhibitors During Pregnancy’ by Lugo-Candelas et al. published in JAMA Pediatrics on Monday 9 April.

Declared interests

Prof Jean Golding: No conflicts of interest.

Prof Andrew Whitelaw: “I have some shares in GSK but no other relevant financial attachments.