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Wednesday, July 13, 2011

Can Anti-depressants cause Autism?

Researchers in two recent studies conclude that environmental factors may be responsible for 55% of the cause of Autism. Researches found a twofold increased risk of ASD associated with selective serotonin reuptake inhibitors (SSRIs) when mothers took the drugs in the year before giving birth.

The closer to the pregnancy that a woman took SSRIs, 
the greater the effect. For example, there was a threefold greater 
risk of Autism among women who took SSRIs in their first trimester.

How can an SSRI or other environmental factors contribute to Autism? A good metaphor for understanding how mental illnesses develop is what I call the Tornado Metaphor. A tornado is not caused by one factor, it is caused by many factors all working together, over the course of time, to produce the outcome, a tornado. With a tornado, you have factors such as high speed winds, warm and cold air, the right kind of clouds and barometric pressure, and so on. You also have the right amount or intensity of each factor, and that will lead to a different effect, the difference between and F1 and and F5 tornado, or how long the tornado will last. No one factor causes the tornado.

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So, there's no one factor that causes a mental illness. People are often told that "genes" cause mental illness, but this is not true. Genes play a role and the role they play varies in significance from one person to another. Also, genes are shaped by environment (epigentics). 

Mental illnesses are caused by many factors working together over the course of time. With Autism, environmental factors play a role in its development, and so far, it seems that there may be several environmental factors that contribute to the development of Autism. The absence of these factors would likely either stop Autism from developing, or it would lead to a variation of Autism - a spectrum.

Autism itself seems to be a poorly developed construct because it's based on behavioral observations. In fact, there are probably two or more distinct forms of Autism. For example, early onset versus late onset (age 5 or 12). There may be different causes for the same behavioral symptoms. For example, focal seizures may cause one-type of Autism and have a better prognosis, than another type. This is the fundamental problem with mental health diagnosis: they're syndromes with multiple causal factors, and so, one treatment will not cure everyone and sometimes one treatment will not "cure" anyone but help minimize the intensity, frequency or duration of some or all the symptoms.

To date, there still is not an effective treatment for Autism that will predictably work better than doing nothing but letting the disorder run its natural course. However, that does not mean that people should not try treating Autism spectrum disorders, it means that there is no universally effective treatment.

Researchers and the press have told people to "proceed with caution" about SSRI medications, recommending that people should not stop taking SSRI medications based on the publication of this one study. An article published in the Huffington Post read: "This is always a really hard decision for women... I worry about people saying 'I'm going to eliminate all these risks and stop treatment.' For women with serious depression and higher anxiety disorders, there are many risks associated with not seeking treatment, too. It's about coming to a conclusion with your physician that's best for you."

I find press reports about this study infuriating. Even though this study had a relatively small sample size, the researchers did study identical and fraternal twins which tend to be more reliable than other types of population samples because they're looking at the same genetic history. 

The media and other doctors present people with a False Dilemma,
either take medications or do not take medications, as though medications 
are the only form of treatment for severe anxiety or depression!

Let me introduce these scientists and the journalists to the Precautionary Principle. This principle helps us make decisions when we're trying to weigh the risks and benefits of alternatives. Basically, it says that you shouldn't choose alternatives that have great risks when you are not certain of the probability or the relationship between the alternative and the outcome. In this case, there is an unknown probability of risk for your child developing Autism (a devastating life long disease with no known cure)  if you take SSRI medication some time before or during your pregnancy. The precautionary principle would say: don't take SSRI medications if you plan on getting pregnant. Either put off the pregnancy or seek an alternative form of treatment. There's no way to monitor a pregnancy in such a way as to stop taking SSRIs mid-way through. It's too fast and complicated of a process to take the risk and there's no correcting the outcome.

If you have depression or anxiety and you plan on getting pregnant, what are your alternatives for treatment? Well, you can try many different things, like self help books; support groups, either in your community or online; you can try different types of psychotherapy (did you know that there are over 100 different types of psychotherapy?) Cognitive Behavioral Therapy (CBT) is the Gold Standard for treating Anxiety Disorders. CBT is also just as effective for mood disorders as is medication. You could also try group therapy, family therapy, or marital therapy (and there are different types therapies for those, too). And, psychotherapy comes without some of those common side effects like weight gain, loss of sex drive, or nausea. 

I always recommend a thorough mental health evaluation where the assessor attempts to determine all the factors that have contributed to the mental health problem. I think that you're more likely to get a thorough evaluation from a Social Worker, Counselor, or Psychologist than from a Psychiatrist. I hate to sound like I'm putting down psychiatry, but I do believe that in America, Psychiatrists and pharmaceutical corporations have been over-selling and over-promoting medications. 

If you're taking medications, remember that there is
 no such thing as a chemical imbalance and medications are not a cure, 
they are only one of many types of treatment.

Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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