Pregnancy is a time of physical and emotional vulnerability, which can potentially lead to or exacerbate depression. Sadly, suicide is a leading cause of death in both high- and low-income countries.1,2 Although psychological therapies are effective and may be sufficient treatment for depression in pregnancy, for some women, antidepressant treatment may be required. Research also suggests that when women abruptly cease antidepressants in pregnancy, suicidal ideation may increase.3
Clinicians rely on research to accurately help patients weigh the risks and benefits of treatment options for depression that may save lives. For many women, the potential longer-term impacts on child outcomes are key deciding factors in whether to initiate or continue a specific type of antidepressant treatment.4,5
In a study published in this month’s issue of Pediatrics, Singal et al6 begin by stating that antidepressant exposure during pregnancy may be associated with “sustained cognitive impairment” in the child. However, other studies have not found this to be the case.7–10 The animal studies cited in this report differ from other animal studies that have found protective effects from antidepressant exposure during gestation.11,12 In their report, Singal et al find that antidepressant exposure is associated with “increased risks of deficits in language and/or cognition” on the basis of a screening measure of school readiness in kindergarten.6 How should clinicians interpret this concerning finding?