How are SSRIs used to treat depression and anxiety?
Antidepressants such as SSRIs can be lifesaving for people suffering from depression, OCD, anxiety, and other mental health conditions. The process is as follows.
Before giving birth to her second child, Heidi DiLorenzo felt anxious. She was hospitalized twice during her pregnancy because she was worried about her blood pressure and pre-eclampsia. She feared some terrible unnamed harm would befall her 3-year-old daughter. She worried about whether she would be able to love another baby the way she loved her first baby.
But DiLorenzo, a lawyer in Birmingham, Alabama, wasn’t worried about taking Zoloft. She used the drug to treat anxiety before having her first child and continued to use it throughout that pregnancy and this one. And since giving birth to her second daughter in September, she credits upping her dose with pulling her out of the “dark hole” of grief she felt postpartum. “If I hadn’t accepted that, I wouldn’t have been a better mother to my daughters,” DiLorenzo said. “I wouldn’t have had the energy.”
She is one of the estimated 20% of American women who suffer from depression or anxiety during or after pregnancy. But only half of those mothers receive appropriate treatment, said Kay Russos-Ross, who runs the Perinatal Mood Disorders Program at the University of Florida. And only 5% of people take selective serotonin reuptake inhibitors, a type of drug commonly used to treat both conditions.
Now, medical experts are concerned that a panel discussion held by the Food and Drug Administration in July could lead to more cases of untreated depression. Many of the panel’s 10 members expressed concerns about the use of SSRIs such as Zoloft during pregnancy. They include Josef Witt Doering, a psychiatrist who runs a clinic aimed at helping people wean themselves off antidepressants, and Adam Urato, an obstetrician-gynecologist who recently petitioned the FDA to issue stronger warnings against SSRIs.
The discussion did not lead to official FDA guidance, but panelists linked the drug to an increased risk of miscarriage, birth defects and autism in children exposed to the drug in utero, a claim the American College of Obstetricians and Gynecologists called “outlandish and unsubstantiated.” The Society for Maternal-Fetal Medicine said its members were “alarmed by the unsubstantiated and inaccurate claims made by FDA reviewers.”
ACOG President Stephen Fleischman said in a statement on the organization’s website that antidepressants are a safe and “lifesaving” measure, given that mental health issues such as suicide and overdose are the leading cause of maternal death in this country.
Christina Raines, a nurse who helped establish the nation’s first inpatient perinatal psychiatry unit in North Carolina in 2011, said SSRIs are “probably the most well-studied drug for pregnancy.” In long-term studies of children exposed to the drug in utero, researchers have found no problems, she said.
It is too early to know whether the panel discussion had an impact on prescribing rates or whether pregnant people became more likely to avoid the drug. But Raines, who teaches at the University of North Carolina at Chapel Hill School of Medicine, said he is already answering questions from patients. She said the misinformation spread by the panelists, along with President Donald Trump’s distorted claims about taking Tylenol during pregnancy, makes her job difficult.
Dorothy DeGuzman is a family physician who treats high-risk pregnancies in California. “There’s already a lot of stigma about taking antidepressants during pregnancy,” she says. “This only adds to the fear.”
panel
The July panel discussion was one of four the FDA has held since May. The agency had previously vetted advisory committee members to avoid conflicts of interest. However, these panels were selected behind closed doors and the event was held with little publicity. In a July investigation report by MedPage Today, researchers and consultants raised questions about the ethics and legality of the event.
Emily Hilliard, a spokeswoman for the Department of Health and Human Services, did not respond directly when asked about the selection process for panelists. She called the panel event a “roundtable” where experts consider the latest scientific evidence, assess potential health risks and “explore safer alternatives.”
The July commission appears to follow President Trump’s executive order in February, which established the Commission to Bring America Back to Health and direct it to “assess the threat posed by the prevalence and prescription of selective serotonin reuptake inhibitors and other drugs.”
Secretary of Health and Human Services Robert F. Kennedy Jr., who oversees the FDA, has frequently criticized these drugs. He claimed, without evidence, that they may be involved in school shootings.
In his opening remarks at a panel discussion in July, FDA Commissioner Marty McCulley also expressed concerns about the drug. “From a national perspective, the more antidepressants we prescribe, the more depression we see,” he says.
“It’s not a luxury”
Professor Roussos Ross of the University of Florida, the only board-certified psychiatrist and obstetrician-gynecologist on the panel, raised other concerns. “Studies have shown that women who stop taking their medications during pregnancy are five times more likely to have a relapse,” she says.
Mothers with moderate to severe depression or anxiety during pregnancy are more likely to deliver prematurely and have low birth weight babies, she added. Without treatment, she said, people are more likely to abuse drugs and alcohol and be at risk of suicide. Roussos-Ross said that sometimes children do not bond well, and those children are at higher risk for problems such as attention-deficit/hyperactivity disorder, depression and anxiety, due to the mother’s mental health issues rather than the SSRI.
“I want to emphasize that treating mental illness during pregnancy is not a luxury,” she said during the panel discussion. “It’s a necessity.”
Overall, about 19% of American women in their 20s and 30s experience depression, and about 10% take SSRIs, according to the latest data from the Centers for Disease Control and Prevention. However, research shows that half of women decide to stop taking antidepressants before or during pregnancy.
Doctors say one reason so few pregnant women seek treatment for depression is because they are already afraid of taking drugs during pregnancy. The majority of DeGuzman’s patients rely on Medicaid, the government’s health insurance for low-income and disabled people. Half are Latino. Although she often prescribes SSRIs, her patients rarely take them, she said.
This issue is especially urgent for Black and Latino mothers. Although they experience higher rates of depression and anxiety than white non-Latino mothers, they are less likely to receive adequate treatment. Many factors contribute to this disparity, including systemic racism, exposure to violence, misdiagnosis, and lack of access to care.
Shana Williams, a perinatal mental health therapist who treats African American mothers in Philadelphia, said many of her clients are already more likely to trust friends and family than their doctors about whether it’s safe to take antidepressants during pregnancy or breastfeeding. The FDA committee is “another voice saying we shouldn’t do this,” Williams said. “And that doesn’t help.”
Judith Blanc, who studies perinatal mental health among women of color, said universal child care and paid parental leave would help. “My research has shown that the most important thing we can provide is social support,” said Brann, assistant professor of psychiatry at the University of Miami Miller School of Medicine. “The village needs to step up.”
Kellyn Haight experienced debilitating depression after moving to the North Carolina mountain town of Brevard. The former labor and delivery nurse was unable to provide childcare for her 2-year-old daughter at the time because her husband was traveling for work, and she had no family or friends nearby.
Her doctor prescribed Prozac, but it didn’t help. She called her husband to come home, but her insomnia only worsened. One morning she begged him to end her suffering. He took her to the emergency room, and staff sent her to a local hospital’s psychiatric ward. She said she was stripped of her clothes and kept in a locked room. “I felt like a living thing, like an animal. One of my biggest fears is that it would happen again,” said Haight, now 37.
After being released, Haight found a psychiatrist and started taking Zoloft. She built a community of friends and began to feel a sense of stability.
Now that her daughter is 5 years old, she is about to have another child and plans to continue taking Zoloft throughout her pregnancy. “I would rather be safe and present for my child,” she said. “I’m fine with taking risks because I know what the alternatives are. I’m not going there.”
If you’re pregnant or a new mom struggling with depression or anxiety, give us a call or text. National Maternal Mental Health Hotline24 hours a day, 365 days a year 833-TLC-MAMA (833-852-6262). Postpartum Support International It can help you connect with a local mental health provider. 800-944-4773 or psidirectory.com.
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