Thursday, July 7, 2011

New study linking SSRIs and autism

I read with interest about an article that suggests that there may be a causal relationship between the use of SSRI (selective serotonin reuptake inhibitors) drugs in pregnant women and the likelihood of their giving birth to a child with autism. Apparently, in a group of women, there seemed to be an increase of about 3% in the risk of her having an autistic offspring than someone who either had no depression or other mental condition or a person with the condition who had not used SSRI drugs. Lead author and Kaiser Permanente epidemiologist Lisa Croen has stated that caution should follow interpretation of the results as they are preliminary and more research will have to be done to see if this could be something contributing to the etiology of autism.

I tried to download the primary source and a commentary on it in the same journal. Unfortunately, they were behind a paywall and I could not obtain them for free. As far as I can tell, no reason how the SSRI could have caused the fetus to become autistic was given.

Though I was unable to read the actual article itself, the story about it interested me for two reasons.

First of all, my maternal grandmother suffered from severe depression well before the days of SSRI drugs. She underwent ECT and ultimately committed suicide at age 49 a couple of years before I was born. I suspect that her genetics may have been a factor in my disability, as well as some ADD traits in a couple of my cousins who are also her grandchildren. Though it sounds like Croen and colleagues did make some attempt to control for genetics of the mental illness, I can't help thinking that it was the mother's depression itself that caused a genetic predisposition to the autism, rather than the ingestion of the drugs being toxic to the fetus.

The second reason the story piqued my interest was that some may remember that Lisa Croen's main claim to fame was her faux pas in publishing some interpretations from CDDS data that suggested to her that the reason for the greatly increased prevalence of autism was due to 100% diagnostic substitution of mental retardation for autism, claiming that there was a corresponding decrease in mental retardation diagnoses to the increase for autism diagnoses. The problem, apparently, with her interpretation was that she did not adjust for age of admission into the CDDS which was very different for persons with retardation than for autism. Mark Blaxill, well-known for his beliefs that vaccines caused his daughter and other children to become autistic, showed that she had misinterpreted her data. Croen later, admitted to the mistake. Whether or not this reduces the credibility of Croen's interpretations of the data in her current study I don't know.

As many persons interested in autism now know, recently there was a study suggesting that the environment may play a greater role than thought in autism. Now that the vaccine hypothesis has been refuted in a variety of studies (regardless of whether or not these studies are in fact tobacco science as some die hard proponents of the vaccines-cause-autism camp state), there is apparently a temporal relationship (though not a casual relationship) in terms of a timeline between the advent of SSRI drugs and increases in autism diagnoses. I have shown elsewhere that there is not a temporal relationship between increases in thimerosal and increases in autistic persons admitted to the CDDS. Whether this is true for all vaccines, which don't contain thimerosal such as the MMR, which could factor into the equation, I don't know.

The temporal relationships between introducing autism as a diagnostic category in 1991 under IDEA and then supreme court decisions favorable to those seeking services for their autistic children and increases in diagnoses have been largely ignored by the public interested in developmental disabilities which sees special education and the IDEA law as a quick fix for their kids problems.

Is it possible that SSRI drugs will be the new factor that those who claim there has actually been an increase in autism will claim is responsible? I don't know. Only time will tell.

15 comments:

Fauxtist said...

SSRI's like Prozac work wonders on some children with autism. Its really individual, but the positive effects can be immediate (as in a couple of days).

MJ said...

"Apparently, in a group of women, there seemed to be an increase of about 3% in the risk of her having an autistic offspring"

I think the increase in risk was thought to be 2.2 to 3.8 times more likely depending on the time frame of the exposure.

So if you had a 1% chance of having a kid with autism normally, taking SSRIs during the first trimester would mean a 3.8% of having a kid with autism which would be a 280% increase in risk.

The results are based on a relatively small of mothers taking SSRIs (70 out of 1,805) so there is a large margin for error but the idea is certainly interesting. Especially in light of other findings that about 40% children with autism are born with abnormally high levels of serotonin.

SM69 said...

We should not confuse the depression you mentioned in your post (ECT/ suicide) for the depression experienced more widely; this responds very well to life style changes, diet, nutrition- unlike the more severe type of depression you are referring to for which such alterations might not be sufficient. Generally there is overmedication both in adults and children.

Alteration of serotonin function during brain development through SSRI medication is unlikely to be a smart move.

E.g.

Serotonin and brain development: role in human developmental diseases

Abstract
Serotonin is known to play a role in brain development prior to the time it assumes its role as a neurotransmitter in the mature brain. Serotonin regulates both the development of serotonergic neurons (termed autoregulation of development) and the development of target tissues. In both cases, the astroglial-derived protein, S-100β plays a role. Disruption of serotonergic development can leave permanent alterations in brain function and behavior. This may be the case in such human developmental illnesses as autism and Down Syndrome.


Autism deserves to be understood at its root, and not be treated by cover up drugs that may address at best partly some of the symptoms. The literature here is controversial- parental accounts are not indicating that SSRI is an effective option- and side effects need to be taken into account http://autism.com/pro_adversereactions.asp /

Notorious advocates such as Temple Grandin advises Diet as primary benefit and if at all, extremely low doses of SSRI.

Drugs should only be used if they correct directly an imbalance (which should be identified) and when all other more "holistic" options have been explored- not as general procedure dictated by pharmaceutical industry purely for marketing purpose.

SM69 said...

I want to add to my earlier comment that as I can’t read the article either, and therefore, I cannot be specific in my views regarding the actual data. Generally speaking though, we should indeed observe great caution in interpreting this sort of study, as far as drawing a conclusion on a specific association. The same general criticism than expressed regarding the SBC Holland IT Autism study applies.

In this specific instance, whilst it is easy to see in the literature arguments against using SSRI during pregnancy (because unaltered endogenous serotonin function is required for normal brain development), the study cannot decipher if the association relates to SSRI medication itself, or to factors that lead to the women opting for this type of medication. As I expressed previously, the common depression can effectively be addressed through nutritional, diet and life style changes. So, could it be issues of this nature instead, that relate to a higher autism rate? Or could it be, as you are trying to infer Jonathan, a genetic predisposition common to ASD and depression. Of course, this type of study will not assist in answering these questions.

Fauxtist said...

"Autism deserves to be understood at its root, and not be treated by cover up drugs that may address at best partly some of the symptoms."

This of course would be ideal. But the reality is no one knows what autism is or what causes it. Anyone that says they do is misinformed.

Getting a child to attend to school, even with "drugs that address some of the symptoms" is far better than betting on a causation solution in some distant future. The child can't wait, and neither can the institutions that are in place currently, for a cure all.

There is an arrogance to the position that we throw the kitchen sink at the child because we are seeking some sort of mysterious cause of autism. Children aren't experiments. They have limited time to be a child. Its best to use something that works for that child rather than use the child as some sort of petri dish.

SM69 said...

Who else but parents can seek the answers to what affect their kids? Is being anti-progressist, opting for a non-inquisitive approach, the way to deal with Autism? And at the same time, how could you accept a drug and the information provided by pharmaceutical industries without looking at other alternative options? And why judge an alternative diet as being experimental?-, or considering optimal nutrition, removing the allergens from the environments and assisting the child’s health for all abnormalities detected?


If I had taken your approach my son’s conditions would never have been understood- now I know he has Neuro-Borreliosis stage III- that explains his chronic fatigue, blood flow issues, raised lymph nodes, loss of motor function, low muscle tone, epilepsy, boots of regression and behavioural alteration. If I had listen to your conservative views, we would have guarantied him to be extremely debilitated as an adult, possibly in his case even to die. If I had not follow my instincts and continue my quests for answers, he would never have had the opportunity to begin to recover from his affliction, as all it requires is intensive antibiotic treatment. Now he is happy, getting stronger by the day, epilepsy receding to the point that I should soon be able to discontinue his medication (that was ineffective BTW). He is now constantly seeking novel experiences and communication; a sharp contrast to our pre-diagnosis stage.

His case is far from unique, a child stacked simply because of a label. Many children do improve when their parents push to get the answers they need to progress along. And effective answers are not drugs, because they aren't any.


Is that being arrogant? In my books, it is what loving and caring for a child is about, it is educated parenting. It is determinism, it is passion.

You may have moved a little since your time as a Pro-ND, but you still cannot advocate for proper interventions, understanding and for seeking answers. Again, let me ask you that straight question, if you really want the right answer for your child, the ideal you referred to earlier, who else but you, us as parents, can demand it? No one will, not in our lifetime, we are on our own and better get moving than being passive disciples.

MJ said...

Fauxtist,

I think I have to agree with SM69 here, pushing to improve your children's prognosis isn't arrogance nor is it depriving them of their childhood.

My children have already had their childhood stolen from them to a large extent by their autism. They have had to work almost non-stop since they were two years old to try and gain the skills that come naturally to "typical" children. And to their credit, they have worked their little butts off and have come a very long way in just a few years.

So why shouldn't I be required to work just as hard on their behalf, to try and find things that can help them overcome their autism? And by that I mean the behavioral as well as the biological problems of autism. Autism is as much of a biological problem as it is a behavioral one, or at least it is for my children.

I would agree that my children are not experimental playgrounds where I try whatever the latest fad is for treating autism but I certainly am not going to hold something back if I have a good reason to believe that it will help them. Nor am I going to stop looking for hints of what is really going on with them.

We certainly have had a number of successes (and some failures) with our children by trying non-conventional approaches. For example, we have had extremely good results in two of our children from the GFCF diet and from using certain nutritional supplements. There would be some that would say that we are just experimenting on our children but I would say that we are working with the my children's medical team to come up with an approach that suits their unique needs.

Another example that is perhaps more on point here is that we fought back against attempts to put our one daughter on medication for mood swings and self-injurious behaviors. Instead, we kept trying a variety of behavioral, dietary, sensory, and other approaches until we finally hit on the underlying cause - seasonal depression.

Armed with that knowledge, we were able to come up with treatments that targeted the core problem and we managed to stop both the SIBs and the mood swings. But if we have taken the less arrogant approach and just threw drugs at the problem and let her be a kid, then all we would have done is cover up the problem.

I'm not saying that drugs are always bad and you have to spend years searching for the answer. Nor am I saying that you should try everything under the sun - you have to use some common sense about what is safe to try and has a reasonable chance of working. But I think there is something to be said for continuing to search for the answers and not being afraid to try something out of the ordinary.

Fauxtist said...

Interesting the assumptions that are made and prognosticated over so little information given. Arrogant, yes.

Jake Crosby said...

"Now that the vaccine hypothesis has been refuted in a variety of studies (regardless of whether or not these studies are in fact tobacco science..."

Jonathan,

That's an oxymoron. Tobacco science does not refute anything. The purpose of tobacco science may be to convince people of a refuted link, but tobacco science
does not count as credible evidence against a connection at all.

MJ said...

So tell me Fauxtist, do you write the sayings in fortune cookies for a living or are you attempting to channel yoda?

SM69 said...

Yes, what information do you actually need? Diet benefit to control ADHD- Lancet paper 2011? http://www.loreneamet.net/?p=311. What else? You are just the person you described earlier, stacked in an echo chamber listening to his own voice. After several years of exchange, you have not heard any other voice, certainly not heard my voice and the ones of parents who have positive developments to report. You just came slowly to realise there are LFAs about, but not that they deserve to be treated and looked at, other than considering a hypothetical cure to refute Ari Ne'eman's position, your own personal weapon. How is that cure/treatment going to occur if other adopt your stance?

As for our more recent development in finding an actual accurate Lyme diagnosis instead of a dead end autism label, I am intending to publish this as a case study, perhaps your curiosity will lead you to it, but I rather doubt you can tolerate anything that challenge your views. Spare the attacks, they only sitract you from answering the questions asked and we have all grown very tired of hearing them.

Jake thanks for bring the subject- I did not dare venturing there, but of course I totally agree with you- there is not one single study that demonstrate that vaccination is safe. The limited studies available are shockingly limited in their duration and in the range of parameters being monitored. I can substantiate all of this, but only if people care to hear.

Fauxtist said...

Looks like I struck a nerve of the petri dish crowd. So much dogma on both sides and so little appreciation for nuance.

MJ said...

Fauxtist,

If there is nuance in this discussion, it isn't from you. You seem to enjoy making inflammatory statements and then sitting back and making snide remarks about the responses.

Are you actually going to say something with some substance behind it or are you just out trolling?

Ender said...

The problem with studies like this is that coorelation does not equal causation. Unless they force SSRIs on women, they can never see that the two groups are equal to begin with. Always remember, high ice cream sales leads to high crime rates (true fact, if you ignore the fact that summer leads to both).

Anonymous said...

Appгecіatiοn tο my fathеr who statеd to me regaгding thіs
blog, this blοg іs rеally аmazing.
Check out my webpage HCG Diet