A significant number of pregnant women and new mothers, nearly one in five, experience anxiety and depression. Among those, approximately 6-8% are prescribed Selective Serotonin Reuptake Inhibitors (SSRIs), a common group of antidepressants. However, recent statements from an expert panel organized by the U.S. Food and Drug Administration (FDA) have raised concerns about the safety of these medications, igniting a storm of criticism from several esteemed medical organizations.
The Society for Maternal-Fetal Medicine issued a statement late last month highlighting the risks of untreated or inadequately treated depression during pregnancy, such as suicide, preterm birth, preeclampsia, and low birth weight. They emphasized that misinformation surrounding depression and its treatment can create unnecessary barriers for patients seeking care.
Opening the FDA panel discussion, Commissioner Marty Makary referenced studies that have associated SSRIs with various health effects in infants, including pulmonary hypertension and cardiac defects. Several panelists, including psychiatrists and psychologists, cited studies they argued indicate serious risks like miscarriage and autism. This sparked a strong backlash from healthcare organizations like the American College of Obstetricians and Gynecologists (ACOG) and the National Curriculum for Reproductive Psychiatry.
The ACOG and the Society for Maternal-Fetal Medicine expressed concern over the claims made by the panel, describing them as unsubstantiated and inaccurate. ACOG pointed to “robust evidence” supporting the safety of SSRIs during pregnancy, asserting that most SSRIs do not elevate the risk of birth defects.
In response to the backlash, Andrew Nixon, a spokesperson for the Department of Health and Human Services, refuted claims that the FDA’s expert advisory process was politically motivated, labeling such insinuations as disrespectful to the scientists involved.
However, experts have noted flaws in many studies cited by the panel. Dr. Jennifer Payne, a reproductive psychiatrist, pointed out that some studies referenced involve populations not related to pregnant or postpartum women. For example, Dr. Joanna Moncrieff referenced a youth study that linked SSRIs to increased suicidality but failed to address its limited applicability.
Moreover, Dr. Payne argued that several studies mentioned by panelists had been discredited, including those connecting SSRI use during pregnancy to cardiac defects in infants.
Dr. Christopher Zahn of ACOG explained that many studies lack appropriate control groups, pointing out that comparing pregnant patients taking SSRIs to those who do not account for mental health issues related to pregnancy fosters misleading conclusions: “It’s really apples and oranges,” he remarked.
In stark contrast, well-controlled studies—those comparing pregnant women on SSRIs to those with mental health conditions who are not treated—do not support the risks highlighted by the FDA panel.
Dr. Nancy Byatt, a perinatal psychiatrist at UMass Chan School of Medicine, noted the extensive research done on SSRIs, indicating that they are generally deemed safe during pregnancy. According to her, data from numerous studies show that antidepressants are not linked to major birth defects or an increased risk of miscarriage.
One critical aspect largely overlooked during the panel discussion was the detrimental effects of untreated perinatal depression, highlighted by Dr. Byatt and her colleagues. Dr. Kay Roussos-Ross, one of the panelists, emphasized that untreated mental health conditions can result in women being less likely to attend prenatal appointments and more inclined to engage in substance use during pregnancy.
Untreated depression is also linked to increased chances of pre-eclampsia and cesarean deliveries, along with a heightened risk of suicide. Mental health is a leading cause of maternal deaths in the U.S., including those attributed to suicide.
Dr. Payne pointed out the extensive research demonstrating the negative impacts of postpartum depression on children’s IQ, language abilities, and behavioral problems, reinforcing the importance of maternal mental health during pregnancy and postpartum.
Nevertheless, SSRIs are not the sole treatment available for pregnant and postpartum women, as noted by Dr. Byatt and others. For instances of mild depression and anxiety, psychotherapy or talk therapy often serves as the primary treatment method. Dr. Byatt stated, “We have evidence-based psychotherapies that we can, should, and do use in pregnancy and postpartum.”
Alternative psychosocial methods, such as peer support, can also provide significant benefits to expectant and new mothers. Dr. Byatt recommends incorporating practices like exercise, yoga, and meditation into treatment plans.
Despite the challenges many patients face in accessing adequate care due to issues like insurance coverage or scarcity of quality therapy options, the need for effective treatment for perinatal mental health conditions remains urgent.
image source from：npr
