Five years ago, the Croen et al article in the Figure above appeared suggesting that antidepressant use in pregnancy can cause Autistic Spectrum Disorder (ASD). Pharmaceutical companies rushed to manage the risks – to them.
What you do is you convene your experts and you put them in boxes, a teratology box, an animal studies box, an epidemiology box, a psychology box, a pharmacology box and other boxes and you make sure none of the boxes can communicate with each other. You ask the experts in each box to tell you whether the evidence from their area alone demonstrates conclusively that your drug causes ASD – you make sure they hear the question clearly – it’s your drug not all SSRIs or all antidepressants.
So each group reports back to the person managing the process, who for the sake of objectivity is not an expert in any of these areas, that no there is no conclusive evidence from their little box that our drug causes ASD. Cause here is code for the fact we can fight this in court.
For those not conversant with the data, the epidemiological studies in the figure above show conclusively a link between SSRI use and ASD.
If the person coordinating the process is asked whether she got her hermetically sealed experts to review all studies pointing to Neurodevelopmental Delay of one sort or another, she will almost certainly say no she didn’t, that her brief was to get the groups to review studies that have the words Autistic Spectrum Disorders (ASD) in their title or abstract. If asked the question, do you not think that that ASD is pretty well another word for neurodevelopmental delay, she will say she has no idea, she knows nothing about this. The brief was just to consider articles with ASD in the title or abstract.
Far-fetched? Absolutely not. This is standard company MO when faced with an adverse effect. It’s about being objective. We want to find what is absolutely established without letting personal views get in the way. It would be irresponsible to our shareholders, and any of you who have your pensions invested in our company, to do anything else. Sounds good – no one wants to lose their pension over a media scare story. But the same kind of thinking underpins Holocaust Denialism.
Here is what the Neurodevelopmental Delay studies look like.
For those of you not conversant with Figures like this, the data show SSRIs cause Neurodevelopmental Delay.
So do SSRIs cause Autistic Spectrum Disorder? The first thing to say is that ASD is fuzzy. People contact me who are politicians, or working in the caring professions, wondering if they have ASD. Almost by definition they don’t if they are interacting effectively with people. But we seem to be in a time when the normal variation that exists between all of us is at risk of getting recategorized as a disorder if we do not appear to be exactly the same as some notional average man or woman. Plus we live in a world of horoscope medicine where fuzzy criteria are worded so that it’s easy to figure they apply to you.
That said, what these figures show is that pretty well whatever we dump into the ASD diagnostic basket, SSRIs increase it. The latest study not yet included in the table above shows reduced rates of verbal fluency and disordered communication styles caused it seems by SSRIs. These difficulties are linked to ASD.
Taking SSRIs in pregnancy
For SSRI usage to have played a part in increasing rates of ASD, we would expect there to be evidence that there has likely been an increase in the use of these drugs in women of child-bearing years and a more relaxed medical and public attitude about the use of these drugs during pregnancy.
For antidepressants before the SSRIs, the market was largely in older age groups. For the SSRIs, for whom the marketing mission was to persuade cases of Valium they were really cases of Prozac or Seroxat or Zoloft, it was clear that a large part of the market would be to women of child-bearing years.
In the early 1990s when the SSRIs were marketed first, the prevailing wisdom was that giving psychotropic drugs in pregnancy was to be avoided; regulators supported avoidance [119], professional bodies supported avoidance [120], and leading psychiatrists warned of the teratogenic potential of psychotropic drugs [121-123].
There was not thought to be any increase in the incidence of mood disorder during pregnancy [124]. There was not thought to be any risk from mood disorders to the fetus; the risk from mood disorders lay in the risk posed to the mother such as suicide [125].
In contrast today when Antidepressants are the most commonly used drugs in pregnancy, it is common to hear claims that depression directly or indirectly causes birth defects; to see depressive symptoms regarded as depressive illnesses, so that rates of 15-20% for depressive disorders are cited when this should only apply to depressive symptoms [53]; and it is not widely noted that the majority of states treated with these drugs left untreated clear up spontaneously within weeks.
In 2015, in the absence of any intervening data that depression causes birth defects or that SSRIs are effective in antenatal depression, the exact same authors who advocated caution before the marketing of the SSRIs can be found supporting claims that:
- Depression can cause birth defects [126].
- Antidepressants do not cause birth defects or cognitive problems [127]
- That coming off antidepressants is inadvisable [128]
- Professional bodies endorse the use of antidepressants [129]
If SSRIs work, as claimed by marketing, namely by correcting a serotonergic abnormality it might be thought they would reduce the risk of things going wrong. But there is no such abnormality and treatment with an SSRI on balance will leave serotonin systems more abnormal than they were to begin with [130].
If working means that SSRIs reduce risky behaviors including alcohol and drug intake, the evidence is the opposite; SSRIs increase alcohol and drug use and risky behaviors [131,84].
For anyone who wants to check out the references listed here, they can be found HERE.
Ah, but
Anyone who is concerned about a link between SSRIs and ASD will be faced with the following counter arguments.
First, rates of ASD from these studies, as is the case with rates of birth defects on SSRIs, fall within the background rate of the population at large and on this basis it is claimed that even where the rates in the treated group exceed those in the control group, these rates can be discounted [see 132,128]. This argument is not valid for birth defect studies where the background rate is determined by the study design. The argument is even more misplaced for a condition like ASD or neurodevelopmental spectrum disorders where the background rate appears to be changing by the year.
Second, studies of SSRI use during pregnancy show a consistent rate of problems and that when all studies are meta-analyzed the risks disappear. We have not been able to analyze all studies as some groups, such as the Motherisk group, refuse to share their data. [This was written before the Motherisk group, which had close links with Pharma, imploded, and its director Gideon Koren has vanished.]
Third, it is claimed that depression causes both birth defects and ASD and is endemic in pregnant women at rates of 15-20%. There is no good evidence for these propositions. These claims are from the Donald Trump – Josef Goebbels school of propaganda. [Although it should be noted that the Nazis did good things like try to ban smoking before anyone else and Trump has proposed some useful things too where Clinton has advocated a problematic increase in screening].
Fourth, it is proposed that there are no adequate and well-conducted studies in this area. This statement means that there are no RCTs and assumes the reader will accept the proposition that only RCTs can demonstrate whether an antidepressant causes birth defects or ASD or not. This is just plain wrong. RCTs can get the answer as badly wrong as any other epidemiological study [see 133]. They can easily be gamed to get the wrong answer. To establish what is happening will need judgments that take both epidemiological and biological data into account. It is only when there is a good understanding of what is happening that an appropriate RCT can be designed, and might be useful to confirm (not prove) what is already known.
Finally, it is claimed that the results cited from a majority of studies show no statistically significant difference between women treated and those not treated. For some, if an increase in risk is not significant, they take a view that there is in fact no increase in risk. Other than when it comes to questions about the use of drugs in medicine, there is nowhere else in science that this view has any credibility [134]. The visual plots of the meta-analyses demonstrate the flaws in this argument.
All references to these points can be found in the article above.
Coda
BMJ Open refused to take this article because the review covered everything – both human and animal studies – and BMJ only take human studies. They are a human box only journal.
The Brown et al study showing SSRIs causing Neurodevelopmental delay, also available above, that has just appeared has been difficult to access in JAMA Psychiatry but a critique of it by Lee Cohen – one of those who once advocated caution about the use of antidepressants in pregnancy has been readily available. What does Cohen find wrong with the Brown study? It’s not an RCT etc – see points 1-5 in the coda.
dave says
obvious link
annie says
“an ongoing catastrophe, I really think the FDA needs to review this”
https://www.madinamerica.com/2016/10/antidepressants-pregnancy-risks-potential-harm-fetal-development/
RxISK team members also recently published an article in the International Journal of Risk and Safety in Medicine
https://rxisk.org/wp-content/uploads/2016/10/2016-SSRIs-ASD-IJRSM.pdf?utm_source=October+2016+News&utm_campaign=October+News&utm_medium=email
http://www.nhs.uk/conditions/Autistic-spectrum-disorder/Pages/Introduction.aspx
http://www.nhs.uk/news/2015/12December/Pages/Antidepressant-use-in-pregnancy-linked-to-childhood-autism.aspx
Lawyers and Settlements
https://www.lawyersandsettlements.com/articles/paxil_birth_defects/paxil-autism-00868.html
Robin P Clarke says
Dear David, I have only time for a quick message just now.
The key thing is that there is indeed a correlation of ssri with autism, but it isn’t causal. My research has made clear that the main cause of autism nowadays is mercury vapor from the non-gamma-2 dental amalgams introduced 40 years ago. Mercury is also a (indeed the main) cause of depression. So both the autism and the depression are being caused by the mercury and hence the treatment for depression correlates with the autism.
This is discussed much more fully in a book I have just finished writing, with 36 graphs and 320 scientific references, titled “Experts Lying to You!”. Mercury expert Prof Boyd Haley says “I highly recommend this book”.
A temporary website for the book is at http://www.pseudoexpertise.com where you can register for updates and I hope to get the book available in the next month or so. With best wishes.
pcng says
And the dental profession continues to have one of the highest rates of suicide, despite the fact you might expect the majority of them to be relatively comfortable with their lot…..interesting….
Dr. David Healy says
Robin
Mercury can cause problems. This blog and posts on David Healy.org make it clear mercury causes lots of problems and these have gone unrecognised. It may have been the primary cause for classic autism.
But it is unlikely to be the cause for all depression and certainly not for all nervous problems that lead to scripts for SSRIs, and not for all cases of ASD either. It is clear that SSRIs alone cause birth defects in animals with no exposure to mercury, and behavioral defects in animals with no exposure to mercury and we have to assume in the 25 or so studies referenced in the article linked to this blog post that mercury exposure was distributed across both those on SSRIs and those not if only because these days the problems that lead to SSRI treatment are not ones that women bring to doctors seeking treatment but ones that doctors or services force on women.
This is rather like the opioid epidemic in the davidhealy.org post this week. This hasn’t happened because of mercury. Its down to lethal marketing. In the case of SSRIs you can show exactly the same people switching view from 1990 to 2010 and their views being aggressively marketed.
Are the experts lying? Some do. Most don’t. The experts whose genuinely held views fit a marketing agenda get picked up and promoted while contrary views are silenced.
Having said all this – I’m sure your book will be a good read
David
Robin P Clarke says
Thanks David for your reply which I am just catching up on 3 years late!
In retrospect my comment there could be seen as an exercise in saying that antidepressants don’t have bad effects. Actually my own cynicism about synthetic drugs generally is sufficient that I have steered clear of them since age 15, and they appear to be so frequently toxic that a suspicion that they cause x or y should generally be given credence by default. It is mainly autism that I am a bit sceptical of being a consequence, because autism is not actually something “gone wrong” (per se) anyway!
Having said that, when many drugs have a toxicity effect, they put a strain on general detoxing processes (liver, kidneys, etc) which can then mean that a concurrent mercury burden cannot be detoxed sufficiently so could indeed cause a person to be more autistic.
Re how many experts are lying — I very much agree with you that most aren’t. As author of several theories those theories would not find so much evidential support of conformed predictions if the studies were publishing random falsehoods! I do think however that too many of the wrong people get their voices trumpeted, while the right ones are cowed into silence or invisibility by the adverse career situations (of which I hardly need to lecture yourself!).
The “Experts lying to you” title was a bit of marketing hype from myself, somewhat awesomely justified by a handful of the characters therein (who will not be named here!). But I found I was uncomfortable to associate myself with such a hostile title and so I changed it to Experts Catastrophe. I have since been hopelessly busy with recovering from the mercury poisoning myself, but am planning finally get the book “launched” in the coming month or two. Cheers and merry rXmas!
Kosta says
Do you use the Andrew cutler protocol?
mary says
I trust that your definition OF ASD – going by your remark about what is definitely NOT ASD – would run along the lines of ‘ a difficulty with social interaction’? If so, if it’s that simple, then I suggest that we could all give you a lengthy list of possible cases – mainly doctors, psychiatrists and members of parliament who have grave difficulties when it comes to effective interaction skills!
My remark, obviously, is not a serious one – but the increase in cases of ASD is very much on a serious note. Interestingly, Victoria Derbyshire was, today, discussing new ‘super-parenting’ ideas for parents of autistic children. It was stated that parents working with their children from age 2, encouraging engagement by letting the child lead and the parent being super-aware of gestures etc. and ‘reading’ their child’s unique way of interacting had the potential of improvement in their child (beyond the expected development of an autistic child) for up to six years. The comments, mainly, were to do with lack of diagnosis at that crucial, early stage in a child’s development.
ASD is the ‘in diagnosis’ of the moment but normally not handed out until the child is around seven years of age. It may indeed be a ‘fuzzy’ diagnosis but life-changing as far as many families are concerned. It satisfies the parents (mums mainly) that it is not their parenting skills that are lacking – but rather that their child needs to be nurtured in a ‘different’ way.
We know that autism is so much more than a difficulty in social interaction – that for the ASD label to be handed out there needs to be a ‘triad of impairment’ covering a rigidity of thoughts and reactions that goes way beyond getting along with others. To my mind, the most severe effect is the emotional imbalance caused by their difficulty in coping with everyday life. This difficulty seems to leave them at a loss of dealing with ‘life’ itself. From an early age, some talk of ‘not wanting to be alive’ and dealing with this can be harrowing for parents – especially in this day and age of so many suicides being in the news.
I know very little about the effect of SSRIs pre-birth but find it a plausible possibility. I also hold alcohol accountable for many pre-birth problems. To my mind, Foetal Alcohol Syndrome is being hidden in the ASD labelling. Symptoms of both are quite similar – alcohol leads to foetal ‘poisoning’ so, surely, SSRIs can have the same consequences.
In conclusion, whatever the cause, these problems are with us and probably here to stay therefore we need to learn how to deal with them. Firstly, parents must accept their responsibilities for the development of their children whatever problems may be present. We are in an age where mums are far more attached to their mobile tech gadgets than they are to their children in many cases ( across all social classes)
Robin P Clarke says
Mary wrote:
“I trust that your [not clear whose] definition OF ASD – going by your remark about what is definitely NOT ASD – would run along the lines of ‘ a difficulty with social interaction’?”
Firstly there’s no such thing as ASD as autism isn’t a disorder (as my book will explain, though can certainly be a severe disability).
Secondly autism is basically “the autistic syndrome”. This was dumbed down for the soundbite age to the “triad of impairments”, but a fuller picture can be gained from Table 2 in this document:
https://www.researchgate.net/publication/271507751_A_Theory_of_General_Reduction_of_Gene-Expression_Manifesting_as_Autism_1993_with_2014_revisions_of_presentation?ev=prf_pub
If you can’t log in to that site, then alternatively download link at right of http://www.autism-causes.org .
A further updated presentation of the same will be in the book, now renamed to “A theory of evolution-biased reduction of genome-expression.manifesting as autism”.
mary says
(comment shot off unfinished!)
Parents must not use a ‘label’ given for their child’s condition as an excuse to give up their parenting role of guiding and nurturing. Schools must be aware of all children’s potentials and not simply dwell on their difficulties. Mental health services must support the child, parents and schools for the all- round development of the child in finding its place in society. Lastly, and most importantly, medications should NEVER be an acceptable addition to a life already damaged by elements from without their surroundings at a crucial point before their birth.
Katie B-T says
Thank you so much for posting this. The SSRI link helps explains why the prevalence for ASD’s have skyrocketed off the charts in recent years.
Another awful reason I can’t have children. I’m not willing to subject my baby to withdrawal at birth and risk all kinds of other potentially damaging problems.
I talk about how the SSRI and gabapentin tapers have left me with lasting chronic pain but it’s also ruined the ability to have a sex life, messed w attraction, and caused me not to be able to have children.
Carla says
Dear Mary,
I agree with everything you say especially:
trust that your definition OF ASD – going by your remark about what is definitely NOT ASD – would run along the lines of ‘ a difficulty with social interaction’? If so, if it’s that simple, then I suggest that we could all give you a lengthy list of possible cases – mainly doctors, psychiatrists and members of parliament who have grave difficulties when it comes to effective interaction skills!
I am also worried about the following you have mentioned:
We are in an age where mums are far more attached to their mobile tech gadgets than they are to their children in many cases ( across all social classes)
This is quite sad because we see it happening every day.
From, this article it is interesting to note that it is suggesting that SSRI’s does not cause harm to the developing foetus.
I would tend to disagree with the data because I am quite certain that all the relevant data would be deleted especially, when it comes to looking after the interests of big pharma.
I wonder who does all the assessments of data and statistics and if all the truth is put out there for everyone to see.
Are all these statistics credible????
Statistics do not base their information on objectivity.
I once mentioned for the first time there has been a landmark ruling for a child whose parents claim that his autism was triggered by MMR.
The parents of Valentino Bocca have been awarded compensation from the Italian ministry of health.
The story is a tragic one, Valentino, developing normally, was given the shot at 14 months and started to suffer from diarrhoea, lost interest in food and within a few days lost the ability to use his spoon. Worse was soon to come when he began to be restless at night, screaming in pain for hours. It was later found that he was suffering from a painful bowel condition that is common in autistic children. With an adjusted diet of no wheat or milk, he was able to sleep but the autism symptoms continued, and even at the age of nine, he still does not speak.
In the US over 5000 families are known to the mainstream media as believing that the MMR shot has triggered autism in their children, and the real figure could be much higher.
So why should SSRI’s be an exception to the rule?
We don’t know what they put in SSR’s and we certainly don’t have all the evidence/information or facts to understand/appreciate how these medicines impact the developing foetus.
How much of the negative clinical data trials is swept under the carpet?
This is what worries me because all the information is not put out there.
Then there are all the injections that mothers have whilst pregnant, such as:
– the vitamin D injection
– Vaccinations
– Other injections that we don’t even question whilst pregnant
Imagine, the deleterious effects on the foetus once the injections are administered in conjunction with the SSRI’s the mother is ingesting.
We just don’t have access to the unknown damages it can cause to the developing brain of the foetus? ~ This worries me!
In addition to these toxins, there are also other factors that predisposes a developing foetus to abnormal developmental risks such as: stress, drug intake, Foetal Alcohol Syndrome, pre-eclampsia, severe morning sickness and other pregnancy complications.
If these medicines cause negative adverse reactions to some children and adults, such as: cognitive impairment,suicide, aneurysms, diabetes, encephalitis, severe breakdown of digestive system, cardiovascular problems or other medical problems etc. imagine the overwhelming harm it can do to some developing foetuses.
In my opinion, if we don’t have all the information about the harm these medicines induce to the developing foetus, I believe it is not worth the risk. ~ my opinion.
In summary, I believe strongly that all the toxins we put into our body has a risk of harming the developing foetus.
Anyone, who believes different, in my opinion, does not have all the conclusive evidence to claim that vaccinations, alcohol, drugs and other medicines do not cause any harm to the developing foetus.
If we do not have all the information, we are just giving the unborn no say.
I am sure that all the data is misconstrued and flawed and it would be interesting to note if many developmental disorders are attributed from:
– the injections that mothers have whilst pregnant
– to the antidepressants mothers have whilst pregnant
– the onset of prescripticide begins to take place after baby is born with all the
vaccinations that babies are subjected to.
If we are human boxes, I hate to think how much of the information is flawed.
Robin P Clarke, I also believe that mercury causes problems to the brain.
I wonder if the scientists still put thermisol in vaccinations??
As for the BIS-GMA composites that have replaced mercury restorations, what makes anyone think that they are any better than mercury?
Have they done extensive research to eliminate any risks with the current restorations that dentists are replacing mercury fillings with, today??
It worries me when professionals state:
It is safe.
Don’t worry.
You are just being overly anxious!
Heather says
We became involved with a local group of parents of Aspergers and ASD youngsters when we were invited to go to talk to them about the dangers of RoAccutane/isotretinoin. The charity we set up in our son’s name, to help those suffering with anxiety, has since been funding a little a marvellous club they’ve started, to encourage the youngsters to go out together for a meal and socialising. They understand each other so well and it is proving a great success. They all suffer with anxiety but they share their ways of coping and give each other space.
Next week a friend of ours, who teaches teenage ASD children, is giving a talk about her work to all the parents and we are invited too. I have sent the group the information shown here about SSRIs and ASD and it will be interesting to hear what their take on it is. Listening to their stories, we’ve been struck by their struggles to get a diagnosis, and the stress of having to cope day to day when most of the public don’t understand what ASD is and why children see the world as such a confusing and threatening place.
Heather says
‘Paracetamol in pregnancy linked to hyperactivity. Many women who take paracetamol (acetaminophen) for pain and fever when they’re pregnant, assured that it’s safe – but new research now reveals that it causes a range of behavioural problems, including hyperactivity, in the child.’ JAMAL Pediatr. 2016
This could account for our older son being ADHD. I took paracetamol for a bad case of flu just over 3 months into the pregnancy. Apparently those mums who took it at 18 weeks were more likely to have behavioural or hyperactivity problems, while those who took it at 32 weeks had emotional problems. This has been discovered by researchers at the University of Bristol and Cardiff University School of Medicine.
No one ever said paracetamol could affect the unborn child….
Robin P Clarke says
Paracetamol impairs glutathione functioning, and glutathoine status is one of the prime indicators of health. What an idiotic way to “care” for one’s health by ingesting such rubbish! Furthermore the glutathione is vitally necessary for detoxing mercury, and consequently it is all too obvious why Paratwatamol would be a risk factor for mercury-caused autism.
Robin P Clarke says
(Gosh, a whole busy month has passed in my absence.)
(I’ll see if html tags work here…)
“But [mercury] is unlikely to be the cause for all depression and certainly not for all nervous problems that lead to scripts for SSRIs, and not for all cases of ASD either.”
Indeed, in respect of most psychiatric conditions, as I see it they are at the interface between brain chemistry and outside psycho-social environment. Stressful circumstances clearly play a role in psychoses and neuroses, and also arguably have an impact on how autistics cope or don’t. However….. I made graphs of the history time-series of increase of “insanity”, from the book by E Torrey Fuller. When I get my website properly set up (and or you see the book) you’ll be able to see how “insanity” hardly existed before the introduction of amalgam. Meanwhile it’s complicated because a person can inhale mercury vapour from others (in draughtproofed rooms), a bit like passive smoking. I suspect that “sudden infant death syndrome” is also caused by breathing in parents’ mercury vapor; it fits all the facts.
Oh and I’m certainly not trying to suggest that SSRIs etc are a good thing. Cured my own (transient) depression with vit b6, I’ve since been insanely un-depressed by circumstances that should warrant constant suicide.
“and we have to assume in the 25 or so studies referenced in the article linked to this blog post that mercury exposure was distributed across both those on SSRIs and those not”
I’m sceptical of that assumption myself. I note your reasoning that:
“if only because these days the problems that lead to SSRI treatment are not ones that women bring to doctors seeking treatment but ones that doctors or services force on women.”
The thing is that it could still be a matter of those “services” responding to “diagnoses” of depression which just happened to be caused by mercury in the first place. Another symptom of mercury is getting angry and non-compliant which surely raises the risk of “services” getting both involved and forceful.
“Are the experts lying? Some do. Most don’t. The experts whose genuinely held views fit a marketing agenda get picked up and promoted while contrary views are silenced.”
Well, I think you’ve made the key point there. More fully stated,
(1) there is a minority of “elite” experts who either tell the lies, or at least defend the convenient pseudoscience myths (such as a certain prof at Oxford who STILL defends statins as useful and not causing muscle problems), then
(2) there are the hordes of academics and GPs intimidated into going along with the “guidance” issued by the GMC sheepdogs, and meanwhile
(3) the dissidents get deregistered or dumped as in your own case.
Meanwhile I find reading comprehension a bit difficult, which has the fortunate consequece that I am demanding of the readability of my own writing such as to make it a relatively good read (I like to think!).
Darrell David says
This blog post on the connection between Autistic Spectrum Disorder (ASD) and SSRIs is an interesting read. It sheds light on the potential impact of selective serotonin reuptake inhibitors (SSRIs) on individuals with ASD. The post discusses the different perspectives and research findings surrounding the use of SSRIs in treating ASD symptoms, highlighting the need for careful consideration and personalized approaches in medication decisions. It’s crucial to have a well-rounded understanding of the benefits and potential risks of any medication, and this article raises important questions and considerations in that regard. Thank you for sharing this thought-provoking piece!