At this point, we know that antidepressant use is skyrocketing, there are negative health effects of antidepressant use on fetal development, and we understand some of the mechanisms for how this might happen. But how should we move forward from a scientific and medical standpoint?
Source: XKCD
Science!
From a scientific standpoint, future directions are straight-forward: let’s gather more relevant data! A clear gap in the literature is a lack of longitudinal data; studies that follow people for a long period of time and measure health outcomes at different time points. We need to actually collect data about both mental health outcomes and epigenetic modifications in people whose mothers took antidepressants before or during pregnancy and breastfeeding.
The data collection for this type of study necessarily takes a long time. Some of the epigenetic effects may not be visible until future generations, which makes for a ridiculously lengthy scientific study. However, there are some shorter term work-arounds. We could survey mothers who took antidepressants during pregnancy and compare the incidence of mental illness (or other health outcomes)in their children compared to mothers who did not.
We could also examine multigenerational effects of antidepressants use in a suitable species of animal (one whose brain chemistry mimics that of humans well enough to be able to draw relevant conclusions). Animal models can also identify important proteins and genes that are epigenetically regulated by antidepressant use, and then be used as a basis for research in humans.
This sort of work can also be reinforced by regulatory agencies, which currently do not require drugs to be tested for transgenerational effects, even though relevant animal studies can be done in the time scale of drug development.
That classic American bugaboo: The medical system
Clinically, it is a more challenging question, but some concrete steps are clear. It makes sense for people taking antidepressants to have annual follow up appointments with their mental health professionals (like they would with their primary care physician). This is a systemic problem in medical practice; people need better opportunities for follow up. Getting to a doctor is both challenging and expensive, and may seem unnecessary if everything appears to be working well.
Further, while antidepressants are definitely a useful tool, combining them with other meaningful therapies (e.g. cognitive behavioral therapy) and lifestyle changes (e.g. diet and exercise) could also improve mental health outcomes – likely with much lower risk of transgenerational and developmental effects. Treating this goes far beyond the scope of antidepressants, however, as this is more of a cultural issue in America. Patients like problems that can be solved by taking a pill, doctors like solutions that are similarly easy, and doing things differently is not always well supported by the current health care system.
Drugs for you, drugs for me. Drugs for sleeping, drugs for eating. Drugs for pain, drugs for stress. Drugs for everything, they’re the best! Source: Wikimedia commons
As always, open and consistent communication with a doctor and/or a mental health professional seems to be the best option. Antidepressants can be a great tool, and should not be discarded lightly by those suffering from depression. However, a 400% increase in usage over the past 25 years demands a closer look, so we should be cautious moving forward. Only time will tell, but what we are doing now is a huge, messy and potentially harmful experiment.
References
Leslie, Frances M. “Multigenerational epigenetic effects of nicotine on lung function.” BMC medicine 11.1 (2013): 27. DOI
Hidaka, Brandon H. “Depression as a disease of modernity: explanations for increasing prevalence.” Journal of affective disorders 140.3 (2012): 205-214. DOI