For many years now, researchers have been examining the impact of prenatal exposure to antidepressants on behavior, risk of psychopathology and long-term neurodevelopmental outcomes. The findings have been mixed. One of the most significant challenges in conducting this research has been disentangling the effects of exposure to an antidepressant from the effects of maternal depression (either during pregnancy or later in the child’s development).
Furthermore, our data comes from observational, as opposed to randomized, studies; the women who chose to take antidepressants during pregnancy are distinct in many important ways from women who elect to discontinue antidepressant treatment. Women who take antidepressants during pregnancy are more likely to have more severe or recurrent depression than women who chose to discontinue medications. A growing body of literature indicates that exposure to maternal depression during pregnancy has long-term effects on children’s development and vulnerability to psychiatric illness.
In a recent study, Hutchinson and colleagues examined the associations between maternal depressive symptoms, use of prenatal SSRI antidepressant treatment and children’s behavior up to 12 years of age. For this prospective longitudinal study, mothers were recruited during their second trimester from community (family practice, midwifery) and tertiary referral clinics (reproductive mental health) at the University of British Columbia in Vancouver, Canada in order to examine the developmental effects of prenatal exposure to SSRI antidepressants.
At 3 years and 12 years, the Child Behavior Checklist (CBCL) was completed by the mother and was used to identify maternal reports of internalizing behaviors (depression, anxiety, somatic complaints) and anxiety problems. When their children were 6 years of age, mothers completed the MacArthur Health and Behavior Questionnaire (HBQ), which assesses internalizing, externalizing, over-anxious and inattention behaviors.
Of the original 191 mothers recruited into the study (76 mothers with prenatal SSRI treatment), 147 mothers were evaluated at 3 years (59 mothers with prenatal SSRI treatment), 145 mothers at 6 years (56 mothers with prenatal SSRI treatment) and 112 mothers at 12 years (38 mothers with prenatal SSRI treatment).
Basically there were three categories of participants: women with histories of depression who used SSRIs during pregnancy, women with depression who chose not to use SSRIs, and women who were not depressed. Despite treatment, mothers who used SSRIs during pregnancy had persistently higher levels of depressive symptoms during the second and third trimesters, and at 3 years, 6 years and 12 years, compared to mothers without prenatal SSRI treatment.
Maternal Depression, But Not Prenatal SSRI Use, Predicted Internalizing Behaviors and Anxiety in Children
Maternal depression during the third trimester was associated with increased internalizing behaviors at ages 3, 6, and 12. Neither SSRI exposure alone nor an interaction between SSRI exposure and third trimester maternal mood contributed significantly to risk of internalizing behaviors at any time point.
This was a very carefully done study utilizing standardized measures to assess maternal depression and child behaviors. While previous studies have suggested that antidepressant exposure may impact children’s behaviors later during childhood, this study observes that prenatal maternal depressive symptoms, not prenatal SSRI exposure, were associated with persistently higher levels of internalizing and anxiety behaviors from toddlerhood into pre-adolescence. This study provides reassuring information for women with histories of chronic or current depression who are planning pregnancy.
Ruta Nonacs, MD PhD
Hutchison SM, Brain U, Grunau RE, Kuzeljevic B, Irvine M, Mâsse LC, Oberlander TF. Associations between maternal depressive symptoms and selective serotonin reuptake inhibitor antidepressant treatment on internalising and anxiety behaviours in children: 12-year longitudinal study. BJPsych Open. 2023 Feb 1;9(2):e26.