Discussion around SSRIs and pregnancy still leans toward treatment

Abstract

Last year a seminal study, “Prenatal antidepressant exposure and offspring brain morphologic trajectory” by Dojukan Koc, M.D., and colleagues was published in JAMA Psychiatry. The cohort study results suggested that there may be an association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and changed brain regions involved in emotional regulation in offspring; however, in some brain regions such as the amygdala, the changes disappeared by age 15. The Koc study included a total of 2,198 mother‐child dyads; compared to nonexposed controls, children prenatally exposed to SSRIs had less cerebral gray matter, and a steeper increase in amygdala volume and gyrus from 7 to 15 years of age. Changes in the amygdala and fusiform gyrus did not persist until early adolescence. Postnatal depression in the mother was associated with a reduced fusiform gyrus in the offspring; prenatal depression was aassociated with a smaller volume of the rostral anterior cingulate gyrus in the child. There was no association of SSRI use before pregnancy with brain outcomes in offspring. The Koc study was notable for its long follow‐up of brain growth, allowing for a focus on trajectory and not just a single image.