Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study
BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2350 (Published 31 May 2017) Cite this as: BMJ 2017;357:j2350
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I very much enjoyed reading the article by Man et al. The article highlighted the need to consider antidepressant treatment and the impact this may subsequently have on risk of ADHD diagnosis in offspring. It was very helpful to learn about the different categories of medication, further sub-categorisation would be helpful to discern specifically which medications to advise pregnant mothers about the risk of ADHD. In further studies it would be helpful to understand how the severity of maternal mental illness relates to the severity of ADHD in offspring.
Competing interests: No competing interests
It is very interesting to read this research study. The study has a simple objective & more or less clear outcomes, finding that the risk of ADHD was higher for the offspring of women with psychiatric disorders irrespective of antidepressant use and of women without psychiatric disorders but with antidepressant use.
Investigators tried their best to study this association, according to an approved study design & protocol (appears to be complicated) in a population based cohort.
ADHD in children is not uncommon in India, and the findings of this study will definitely help in managing the ADHD.
Regards,
Dr. Rajiv Kumar
Competing interests: No competing interests
Prenatal antidepressant use and risks
The consequences of prenatal antidepressant use to treat or prevent depression is a relevant question of risk versus benefit. Antidepressant use in pregnancy has been associated with malformations, neonatal problems and septal heart defects. The BMJ published a new study about the association with autism [1]. Although small risks within a population might seem too high from an individual’s perspective.
The message of the study of Man and colleagues [2] about risk of attention-deficit/hyperactivity disorder confuses physicians and women. I think the nature and severity of maternal mental disorder must be taken into a greater account. There are strong limitations in the study. The role of confounding by underlying maternal psychiatric disease remains unanswered. The groups of serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are very heterogeneous regarding their affinities for the serotonin transporters. The question of co medication is unclear, especially the use of atypical antipsychotics (for example, quetiapine with high serotonergic effects and the use of mood stabilizers like lithium and valproate, with a high risk of teratogenic effects). In this study, there was an absence of detailed measures to assess trimester specific effects and discrepancies between specific types and severity of depressive disorders.
1) Rai et al. Antidepressants during pregnancy and autism in offspring: population based cohort study BMJ 2017;358:j2811
2) Man KKC, Chan EW, Ip P, et al. Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study. BMJ2017;357:j2350SUB
Competing interests: No competing interests