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Thursday, December 17, 2015

Pushback on the Antidepressant Article

In The Politics of Autism, I discuss various ideas about what causes the condition.  An earlier post discussed a new study that raises a possible link to antidepressants.  The post also includes skeptical commentary, which is mounting.

Importantly, the study defined "autism" as a medical service claim or hospital code for autism or several related diagnoses. When the authors looked only at cases of autism that were confirmed by psychiatrists, link with antidepressants was no longer statistically significant. That means the study found that taking medications for depression is linked with having a child evaluated for autism, but not with actually having autism.
But that's not the fundamental limitation of study. The key problem is that women who take a medication when they are pregnant have a reason for taking it. Blaming the outcome on the medication, without considering the underlying disease, is like saying that umbrellas cause flooding. Taking away the umbrellas -- "not treating the rain" -- does not prevent flooding; it just means that people get soaked.
Furthermore, the authors did not compare women taking antidepressants with women with similarly severe depression who stopped their medication. ... The authors tried to sort this out by comparing women with a history of depression with women who were taking antidepressants. However, these two groups are very different. A woman with a "history of depression" might have been depressed in high school when her grandparent died, and then been fine thereafter. She is completely different from a woman who is continuing to take antidepressants during pregnancy because she has severe major depressive disorder and a history of a suicide attempt.
In  The Politics of Autism, I write: :If the science were not confusing enough, its coverage in the mass media has added another layer of murk. News reports hype tentative findings and weak correlations as `breakthroughs' in the quest for autism answers."

David Auerbach writes at Slate:
Study co-author Bérard, it turns out, has been criticized by a federal judge for cherry-picking results to link antidepressants to birth defects. The press should treat such studies with skepticism rather than leading with their findings. Sober pieces inScience, Wired, and NPR rightly questioned whether the study was significant and whether Bérard’s advocacy for stopping antidepressant usage during pregnancy was justified. In particular, Emily Underwood in Science wisely led off by writing “Many epidemiologists and psychiatrists say the study, published today in JAMA Pediatrics, is flawed and will cause unnecessary panic,” which is the most important point to make about this study. But too many journalists failed to make this point, and with autism research, such credulity is downright dangerous.