Two antidepressants were associated with an elevated risk of autism and attention deficit hyperactivity disorder (ADHD) in children, researchers said in a new paper.
Researchers with the University of Hong Kong and other institutions carried out a systematic review and meta-analysis, analyzing 37 studies conducted through May 14, 2025, on antidepressant use among mothers before or during pregnancy, and neurodevelopmental disorders, including autism, in the offspring of those parents.
They found that prenatal antidepressant use was associated with a slightly higher risk of neurodevelopmental disorders, as well as autism and ADHD.
Sensitivity and subgroup analyses that accounted for the confounding factors, such as mental disorders among pregnant women and family influences like genetics, largely eliminated the elevated risk or dropped it to levels not considered significant.
One of the few exceptions was for amitriptyline and nortriptyline, which, in subgroup analyses, remained associated with a higher risk of ADHD and autism in children.
“Thus, robust evidence only suggests caution regarding amitriptyline and nortriptyline use during pregnancy, but not for other specific antidepressants,” the researchers said in the paper, which was published by The Lancet Psychiatry on May 14.
Amitriptyline and nortriptyline are tricyclic antidepressants widely available as generics in the United States and other countries.
The two antidepressants are considered by many doctors as backup options and most often used in special cases, which “means that women who receive them may differ systematically from those given first-line agents, so we cannot rule out residual confounding by treatment indication as the reason for the higher observed risk,” Dr. Wing-Chung Chang, chair of the Department of Psychiatry at the University of Hong Kong, one of the authors, told The Epoch Times in an email.
“Decisions about whether to continue antidepressants in pregnancy should involve a careful weighing of the potential small risks of medication against the well-established harms of untreated maternal depression,” Chang added.
Some other studies have found indications that prenatal antidepressant use results in autism and neurodevelopmental problems in children, including a paper based on records from a health care database that was published in April.
Previous meta-analyses and systematic reviews have returned mixed results on the matter.
Chang said that similar papers that identified stronger associations than he and his coauthors did “are likely explained largely by confounding factors, such as maternal depression itself, as well as genetic and familial vulnerabilities, rather than a direct effect of the medications.”
The authors said limitations included a lack of potentially important variables, such as lifestyle factors, in the studies they analyzed, and a general failure to isolate effects based on trimester of pregnancy.
In the conflicts of interest section, multiple authors acknowledged consulting for pharmaceutical companies that make antidepressants. Chang declared no conflicts of interest.
The authors said they received no funding for the research.