Almost one in five expectant or new mothers in the U.S. experiences anxiety and depression, with about 6-8% receiving prescriptions for Selective Serotonin Reuptake Inhibitors (SSRIs), a type of antidepressant. This situation, however, has recently been thrown into question by an expert panel organized by the U.S. Food and Drug Administration (FDA), which raised concerns about the safety of these medications during pregnancy—contradicting the general opinion among healthcare professionals that SSRIs are mostly safe.
This panel’s statements triggered substantial backlash from various medical groups. For instance, the Society for Maternal-Fetal Medicine issued a statement highlighting the dangers of untreated depression during pregnancy, such as increased risks of suicide, preterm birth, and low birth weight. They expressed concern that misinformation regarding depression and its treatments could lead to unnecessary obstacles for patients seeking care.
During the FDA meeting on July 21, Commissioner Marty Makary mentioned that SSRIs have been linked to potential adverse effects, including pulmonary hypertension and cardiac defects in infants. Some panelists built upon this, referring to studies that purportedly indicate risks like miscarriage and autism.
Various healthcare organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the National Curriculum for Reproductive Psychiatry, have countered these assertions. They claim the panel misrepresented evidence and spread misinformation about SSRIs.
The Society for Maternal-Fetal Medicine underscored their alarm over the misleading claims made by the panel regarding the relationship between maternal depression and SSRIs, highlighting that robust evidence supports the safety of these medications during pregnancy. They reiterated that SSRIs do not typically increase the risk of birth defects.
In response to the criticism, Andrew Nixon from the Department of Health and Human Services defended the FDA’s advisory process, insisting that it is based on independent scientific research.
Questionable Evidence
Some studies cited by the FDA panel did not focus on pregnant women, as pointed out by reproductive psychiatrist Dr. Jennifer Payne from the University of Virginia. For instance, a study referenced by British psychiatrist Dr. Joanna Moncrieff linked SSRIs to increased suicidality among youth—a demographic not directly related to expectant mothers.
Dr. Payne noted that many studies referenced in the discussion have been disproven, particularly those linking SSRIs to cardiac defects. Some were criticized as poorly controlled, meaning they compared the wrong groups—namely, pregnant women on SSRIs versus those with mental health issues not taking any medications.
Good-quality studies do not find the risks mentioned by the panelists, as clarified by Dr. Christopher Zahn, chief of Clinical Practice at ACOG, who stated that it’s essential to use the correct control groups for comparisons.
Dr. Nancy Byatt, a perinatal psychiatrist, expressed confidence in the safety of SSRIs, asserting that studies consistently show no major risks of birth defects or significant increases in miscarriage rates associated with these medications during pregnancy.
Consequences of Unaddressed Mental Health Problems
According to Dr. Byatt and other experts, the panel did not sufficiently address the serious repercussions of untreated mental health conditions during and after pregnancy. One panelist, Dr. Kay Roussos-Ross, addressed how untreated mental health issues can lead to fewer prenatal appointments and increased substance use. They may also significantly raise suicide risks, highlighting that mental health is a leading cause of maternal mortality in the U.S.
Furthermore, the consequences of postpartum depression could impact children’s development, including their IQ and language skills. Dr. Payne emphasized the importance of ensuring maternal health throughout pregnancy and beyond.
Nonetheless, SSRIs are not the only treatment available. Dr. Byatt advocates for various approaches for pregnant and postpartum women, suggesting that psychotherapy should be the first line of defense for mild depression or anxiety. Evidence-based therapy options are available, alongside peer support systems, exercise, yoga, and meditation, which can help improve symptoms.
Unfortunately, access to therapy can be challenging, sometimes due to insurance issues. For women with moderate to severe symptoms, SSRIs can still provide a valuable treatment route.
