Editorials

The safety of antidepressants in pregnancy

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2544 (Published 31 May 2017) Cite this as: BMJ 2017;357:j2544
  1. Lars Henning Pedersen, associate professor
  1. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Institute of Clinical Medicine, Aarhus University, 8200 Aarhus N, Denmark
  1. LHP{at}clin.au.dk

Maternal antidepressants are implicated in ADHD, but so is maternal depression

The safety of antidepressants in pregnancy is controversial, partly because of profound methodological difficulties in separating the fetal effects of antidepressants from those related to maternal depression (confounding by indication). One central concern is the potential impact of these drugs on fetal brain development. Such effects may be subtle and possibly only detectable years after exposure, such as an increased susceptibility to (multifactorial) neurodevelopmental conditions.

Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder linked to prenatal use of antidepressants. The study by Man and colleagues in this issue (doi:10.1136/bmj.j2350) suggests that the association is at least partly explained by shared family factors.1 This is potentially an important finding, but the results should be interpreted within the context of the existing literature.

An effect of antidepressants on the fetal brain is biologically plausible. Monoamines modulate neuronal proliferation and migration and axonal wiring.2 In animals, exposure to antidepressants during brain …

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