Aria Bendix, breaking health reporter for NBC News Digital, recently covered a contentious panel discussion involving experts on the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. The panel included some of the top experts in the country—psychiatrists, researchers and educators. Their participation ignited a firestorm of controversy over the safety and efficacy of frequently prescribed antidepressants.
The main reason for this meeting of the panel was the widespread use of SSRIs. All of these medications, such as Lexapro, Prozac, and Zoloft, have known risks that can affect pregnant people. The majority of the panelists expressed concern regarding the risks of SSRIs in pregnancy. They drew attention to the dangers, such as associations with autism, miscarriages, and birth anomalies. Yet, there was significant disagreement among the panelists about how to interpret the current evidence and what it means for treatment.
Dr. Adam Urato, one of the panelists, advocated for stronger warnings on SSRI labels, highlighting what he perceives as significant risks. Dr. Kay Roussos-Ross was memorable as the only outspoken proponent of using SSRIs in pregnancy. Commissioner Califf did not mince words when she stated that SSRIs were important for preventing persistent anxiety and severe depression. If they go untreated, the repercussions can be catastrophic.
Dr. Roger McFillin certainly ruffled some feathers with his provocative assertion. He continued to claim that depression is not a disease, but rather an indication of women expressing their feelings more strongly. Almost every environmental, scientific and transportation expert has lambasted this statement. They contend that it trivializes the seriousness of mental health issues.
David Healy, another panelist, dismissed the efficacy of SSRIs outright by stating, “It’s been said that SSRIs help people who are severely depressed. They don’t.” This claim opened up a new line of discussion regarding the evidence of SSRIs’ efficacy.
With developments still unfolding, perinatal psychiatrist Dr. Nancy Byatt was monitoring the conversation along with everyone else. She strongly contends against the conventional wisdom offered by the members of the panel. She emphasized the importance of adequately managing depression during pregnancy: “The best thing a pregnant individual could do for herself and her baby is to get the treatment that they need.”
Our panelists included Dr. Jennifer Payne, director of the Reproductive Psychiatry Research Program. She went on to detail her frustrations that international experts were brought in as opposed to local fellows. “I’m disappointed that the FDA brought people in from outside of the United States when there’s so many experts here who truly know this literature inside and out,” she stated.
While the discussion focused on well established pharmacologic treatments, the difference in opinions and approaches to SSRIs was clear through the conversation. Dr. Joseph Goldberg noted that some panelists raised unsubstantiated safety concerns without adequately balancing them against the risks posed by untreated depression. “They were really rousing concerns about safety that are not evidence-based or established,” he said.
Dr. Lindsay Lebin, an assistant professor of psychiatry, described her fears that this emerging narrative around antidepressants would lead to harmful outcomes. She is not participating in the FDA advisory panel. “I am just very nervous that some of the discourse around the risks of antidepressants could lead to even more barriers for people seeking care,” she stated.
During the panel, observers panned the tribunal’s proceedings. They were disappointed when the panel didn’t do enough to recognize the risks of untreated perinatal mood disorders. As NBC News Digital put it, the panel was alarmingly unbalanced. They rightly criticized the narrowness of the federal government’s approach, where only one expert truly conveyed the importance of SSRIs in safeguarding maternal and fetal health.
The controversy surrounding SSRIs is only worsened by misleading interpretations of research results. Dr. Goldberg highlighted this issue by stating, “All of us can find a study that agrees with exactly what we think,” while advocating for a more objective examination of data surrounding SSRIs and their effects during pregnancy.
In closing, Dr. Kay Roussos-Ross reminded everyone of the need for diverse viewpoints. She called on them to look at the evidence, all of the evidence. “But we need to look at the data very objectively,” she asserted.
Debates over the use of antidepressants in pregnancy are getting quite intense. Even though leaders in the mental health space may have competing agendas, we are at a unique crossroads. The FDA’s role in shaping guidelines and regulations regarding SSRIs remains crucial as stakeholders seek clarity amid conflicting viewpoints.
