In the latest edition of Clinical and Practical Psychopharmacology in the Journal of Clinical Psychiatry , Dr Andrade reviews recent studies evaluating neurodevelopmental and cognitive outcomes in children with gestational exposure to antidepressants (FULL TEXT HERE – FREE). This is a great review, summarizing the findings of key studies from the last decade and a more recent study from Christensen and colleagues on mathematical skills in Danish school-aged children.

To summarize, the Christensen study observed that children (9 to 15 years of age) with a history of prenatal exposure to antidepressants performed worse on standardized language and mathematics tests. However, in a fully adjusted analysis, exposure was no longer associated with performance on language tests and was associated with a very small (2 points out of 100) but statistically significantly worse performance on mathematics tests.  This finding was still observed but attenuated in a sibling pair analysis where they compared exposed and unexposed siblings.  

Importantly, Dr. Andrade discusses some of the challenges in interpreting the data from  studies looking at long-term neurodevelopmental outcomes in children with prenatal exposure to antidepressants.  While some studies have demonstrated associations between exposure to antidepressants and cognitive outcomes, he points out that we cannot exclude the impact of maternal depression and behaviors associated with maternal depression.  The magnitude and severity of depressive symptoms and comorbid psychiatric illness are inadequately measured, and these unmeasured variables may influence outcomes and may result in residual confounding.  

 

Ruta Nonacs, MD PhD

 

Andrade C.  Gestational Exposure to Antidepressant Drugs and Neurodevelopment: An Examination of Language, Mathematics, Intelligence, and Other Cognitive Outcomes. J Clin Psychiatry. 2022 Jan 25;83(1):22f14388. 

Christensen J, Trabjerg BB, Sun Y, et al. Association of maternal antidepressant prescription during pregnancy with standardized test scores of Danish school-aged children. JAMA. 2021;326(17):1725–1735.

Nonacs RM, Cohen LS. Challenges in Determining Outcomes of Prenatal Exposure to Antidepressants.  J Clin Psychiatry. 2020 May 12;81(3):20com13269. Free article.

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