Variations in Neurodevelopmental Outcomes in Children with Prenatal SSRI Antidepressant Exposure

Abstract

Mood disorders and treatment with selective serotonin reuptake inhibitor (SSRI) antidepressants during pregnancy are common and both pose neurodevelopmental risks. This often makes the decision to treat prenatal depression with pharmacotherapy (i.e., antidepressants) challenging for clinicians and mothers. SSRIs block the reuptake of the neurotransmitter serotonin (5HT) and given its developmental role, it is not inconceivable that early changes in 5HT signaling could have an impact on early brain development. Identifying long-term neurodevelopmental effects of prenatal SSRI exposure is challenging in humans due to difficulties in distinguishing the effect of the drug from mother's mood during pregnancy and everyday environment in which the child lives, all of which contribute to shaping emotional, cognitive, and social development long after birth. In this review, we focus on the long-term neurobehavioral effects in childhood illustrating wide variations in outcomes revealing that some, but not all children appear to be affected by prenatal SSRI exposure. Emerging research reports findings that are beginning to distinguish the impact of genetic factors and the environment from prenatal medication exposure. Future research is needed to identify genetic, maternal, and environmental factors that put some children at developmental risk and others who may even benefit from maternal SSRI treatment. Birth Defects Research 109:909-923, 2017.© 2017 Wiley Periodicals, Inc.

Perinatal selective serotonin reuptake inhibitor exposure and behavioral outcomes: a systematic review and meta-analyses of animal studies

“…The sheer number of animals included in our analyses – hundreds to thousands depending on behavioral category – gives us statistical power that far exceeds the standard in animal studies. Considering the increasing use of SSRIs during pregnancy 1–4 and the uncertainties about their long-term effects on the developing neurobiology of the child 159 , studies of this phenomenon are necessary. We think this review could be valuable to the field, as we were able to concisely summarize the available animal evidence in order to inform design of future preclinical-as well as clinical studies.…”

“…Implications for future clinical study design appear noteworthy as well: there is a clear need for studies on the effects of early SSRI exposure on mental health and behavior extending into adulthood 159 , especially considering that phenotypic differences may emerge only after adolescence 30 . In addition, while examining the risk for developing mental disorders is important, it could be equally or perhaps more informative to focus on their shared symptoms.…”

Effects of maternal depression and prenatal SSRI exposure on executive functions and susceptibility to household chaos in 6-year-old children: prospective cohort study

“…11 However, the developmental impact of prenatal SSRI exposure remains inconsistent and contradictory. 6 Beyond a direct effect related to prenatal exposure to SSRIs or depressed maternal mood, interactions with daily life may shape variations in child development. To further understand the impact of interactions between the environment (i.e.…”

Early developmental exposure to Fluoxetine and Citalopram results in different neurodevelopmental outcomes

“…In a large meta-analysis of environmental risk factors for ASD, SSRI exposure was one of the associations that retained high level of significance (Kim et al, 2019). However, recent comprehensive reviews (Millard et al, 2017;Rotem-Kohavi and Oberlander, 2017), describe the lack of consensus among these clinical studies and meta-analyses. While some report an increased risk of ASD following prenatal SSRI exposure (Boukhris et al, 2016;Croen et al, 2011;Kim et al, 2019), others have countered such conclusions (Malm et al, 2016;Sorensen et al, 2013;Suri et al, 2011).…”