The consequences of prenatal antidepressant use to treat or prevent depression is a relevant question of risk versus benefit. Antidepressant use in pregnancy has been associated with malformations, neonatal problems and septal heart defects. The BMJ published a new study about the association with autism . Although small risks within a population might seem too high from an individual’s perspective.
The message of the study of Man and colleagues  about risk of attention-deficit/hyperactivity disorder confuses physicians and women. I think the nature and severity of maternal mental disorder must be taken into a greater account. There are strong limitations in the study. The role of confounding by underlying maternal psychiatric disease remains unanswered. The groups of serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants are very heterogeneous regarding their affinities for the serotonin transporters. The question of co medication is unclear, especially the use of atypical antipsychotics (for example, quetiapine with high serotonergic effects and the use of mood stabilizers like lithium and valproate, with a high risk of teratogenic effects). In this study, there was an absence of detailed measures to assess trimester specific effects and discrepancies between specific types and severity of depressive disorders.
1) Rai et al. Antidepressants during pregnancy and autism in offspring: population based cohort study BMJ 2017;358:j2811
2) Man KKC, Chan EW, Ip P, et al. Prenatal antidepressant use and risk of attention-deficit/hyperactivity disorder in offspring: population based cohort study. BMJ2017;357:j2350SUB
Competing interests: No competing interests