We read with great interest the umbrella review of Dragioti et al1 in this issue of JAMA Psychiatry that evaluated 45 nonoverlapping meta-analyses of observational studies examining potential adverse health effects of antidepressant agents. In this review, the authors report that there is “convincing evidence”1 of 2 associations: (1) selective serotonin reuptake inhibitors (SSRIs) were associated with increased risk of suicide attempt or completion in children and adolescents,2 and (2) SSRI or antidepressant use during pregnancy was associated with autism spectrum disorder (ASD).3,4 Like the authors, we believe that these associations are not causal but rather attributable to confounding and methodologic limitations inherent in observational studies. As the authors write, “The few with convincing evidence of associations did not reflect causality.”1
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Flores JM, Avila-Quintero VJ, Bloch MH. Selective Serotonin Reuptake Inhibitor Use During Pregnancy—Associated With but Not Causative of Autism in Offspring. JAMA Psychiatry. 2019;76(12):1225–1227. doi:10.1001/jamapsychiatry.2019.2193
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