In 2011 I stopped taking Prozac because I wanted to conceive, and I wanted my baby to be as healthy as possible. I had experienced two bouts of major depressive disorder at that point, but my symptoms were well controlled by medication. Still, I tapered off the antidepressant, which is in a class of drugs called selective serotonin reuptake inhibitors, under a psychiatrist’s care. I was med-free by January 2012.
My doctor at the time never informed me of the risks of going off antidepressants for someone with my clinical history. Even back then, there was research showing that pregnant women with a history of clinical depression had a high rate of relapse if they went off their meds. Use of S.S.R.I.s by pregnant women has been widely studied; while there are certainly risks associated with the medications (they include a slight increase in absolute risk of postpartum hemorrhage and pre-eclampsia for the mother and a moderately increased risk of preterm birth and low birth weight), there is ample evidence that untreated depression in mothers can have its own set of risks, including low birth weight and preterm birth.
I was pregnant by March, and by April my depression had relapsed. My extreme morning sickness didn’t help matters, but I was a wreck. I wasn’t sleeping, and I was so anxious that I bordered on delusional. I was convinced there would be a sarin gas attack on the subway, and every commute felt like a panic attack. My voice slowed and quieted, which is a typical cognitive sign of depression. I went back on Prozac by the end of my first trimester, and while my morning sickness was still oppressive, my mental health improved radically.
I wasn’t an outlier in terms of going off meds. Studies have shown that almost half of women who are on antidepressants stop taking them while pregnant, and according to a study of nearly 400,000 women published in January, these women “did not appear to substitute with psychotherapy” — in fact, there was “a slight decrease in psychotherapy claims relative to a trend line.”
I tell you this as background for why I was eagerly awaiting the Food and Drug Administration’s “expert” panel last week on S.S.R.I.s and pregnancy. I was hoping for an in-depth, nuanced discussion of the benefits versus the risks of these well-studied drugs. I wanted someone to talk about how mental health care is inaccessible for so many pregnant women, and why those who would benefit from talk therapy alone may not be able to get it. I wanted to hear them discuss how ashamed many pregnant women feel if they are struggling with their mental health, because there is so much pressure to be joyful and glowing.
But that’s not what happened. Most of the panelists were clearly biased against antidepressant use, and some disclosed conflicts of interest in a research paper that went undisclosed during the presentation. Some went as far as arguing that depressed pregnant women weren’t experiencing medical problems at all, even though the Centers for Disease Control and Prevention found that in 2020, mental health conditions were the leading cause of pregnancy-related deaths in the United States.
One panelist, Roger McFillin, a clinical psychologist, wondered aloud if women are “just naturally experiencing their emotions more intensely.” He characterized those emotions as “gifts,” adding, “They’re not symptoms of a disease.”
After the panel he published a truly bizarre newsletter, a failed attempt at humor purporting to be a PowerPoint from Satan, in which the devil himself says: “This isn’t about medicine. This is about souls. Every woman we convince to depend on our chemicals instead of trusting her divine inner guidance is a soul we’ve successfully separated from her creator.” OK, then!
Lizzy Lawrence, who covers the F.D.A. for the health and medicine website STAT, reported:
Nine out of 10 panelists have either been paid witnesses in litigation involving antidepressants, run media platforms rooted in S.S.R.I. skepticism or have published research pointing to the drugs’ potential risks in developing babies. Many share the views of health secretary Robert F. Kennedy Jr., who has called S.S.R.I.s harder to quit than heroin and has falsely linked them to mass shootings.
This is not how F.D.A. expert panels have generally been conducted under previous administrations. Dr. Reshma Ramachandran, a primary care physician and the co-director of the Yale Collaboration for Regulatory Rigor, Integrity and Transparency, said the way this panel was set up and presented is “highly, highly unusual.”
She told me that the F.D.A. typically has its own scientists describe the current state of evidence on a topic and frame these discussions around specific questions the agency wants answered, which did not happen here. In terms of the panelists themselves, Dr. Ramachandran said that conflicts of interest “would have been publicly made known and also probably vetted out, to be frank.”
I asked the F.D.A. about the widespread perception that the panel was biased against S.S.R.I.s. For example, the American College of Obstetricians and Gynecologists said the panel was “alarmingly unbalanced and did not adequately acknowledge the harms of untreated perinatal mood disorders in pregnancy.” An F.D.A. spokesperson responded, “The claim that the F.D.A.’s expert advisory process is ‘one-sided’ or politically driven is insulting to the independent scientists, clinicians and researchers who dedicate their expertise to these panels.”
I talked to the one panelist who expressed the consensus view of the A.C.O.G. and other professional medical organizations, Dr. Kay Roussos-Ross. She’s an obstetrician and the director of the perinatal mood disorders program at the University of Florida. She said that an oft-repeated claim among the other panelists — that women and their doctors are underplaying the risks of S.S.R.I. use — isn’t accurate. It’s more likely that women are cautioned not to take drugs of any kind during pregnancy.
The risks of medications are discussed and sometimes overstated, while the risks of the untreated disease aren’t talked about enough. “We need to increase education of all clinicians, OB-GYNs, family medicine, internal medicine, nurse practitioners, midwives, everybody on the safety profile of medications,” Dr. Roussos-Ross told me.
It’s not clear whether this panel discussion will eventually lead to a limiting of access to antidepressant medication for pregnant women. If the F.D.A. tried to put a warning label on or narrow approval for these medications without solid evidence for doing so, there would likely be a lot of public pushback and litigation, Dr. Ramachandran said. But she worries that even having a panel filled with biased contributors could have a “chilling effect” on pregnant women struggling with mental health, because for many it could color their perceptions of drugs that have a good risk profile when prescribed appropriately.
I worry about how this plays out in a post-Roe America. Some obstetricians are already finding it difficult to treat high-risk pregnancies in states with restrictive abortion laws. I don’t think it’s a stretch to imagine that, at some point, these embattled physicians may be discouraged from prescribing antidepressants to their patients if the F.D.A. exaggerates their downsides.
None of this means that there aren’t open questions on antidepressants, about their use by pregnant women and others. I personally would love to see more research on long-term use of S.S.R.I.s, because there is so much we don’t know. But it shouldn’t be too much to ask that the federal government hold good-faith scientific discussions with unbiased experts.
I can’t go back in time, but I wish I’d been given better information about the benefits and risks of antidepressants during pregnancy, so that I could have made a decision about going off them based on something other than a vague fear of anything that was “unnatural.” But I hope that sharing my story is instructive.
I got through my first pregnancy on Prozac, and my older daughter was born four days after her due date at a robust nine pounds. I stayed on the medication through the birth of my younger daughter, who was a week late and eight pounds, six ounces. I haven’t had another bout of serious depression since my first pregnancy. My children are thriving. The choices I made aren’t the right choices for everyone. For a patient without a history of depression or more moderate symptoms, talk therapy may be a better way to go.
But after that first bad outcome, the decisions I made were in collaboration with experts in maternal mental health who went over my options with care and deep knowledge. And that’s what matters here. I promise that Satan was not involved.
End Notes
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Days of Rage: I will devour any piece of culture that covers 1960s and ’70s unrest; one of my favorite nonfiction books is “The Skies Belong to Us: Love and Terror in the Golden Age of Hijacking,” by Brendan I. Koerner, about how frequently planes were hijacked in that era. I just watched an old episode of “Vanity Fair Confidential” on HBO Max that covers the bombings perpetrated by the Weather Underground, a violent offshoot of the Vietnam protest movement. This show reminded me that I need to rewatch the excellent 2002 documentary about the group.
Feel free to drop me a line about anything here.
Jessica Grose is an Opinion writer for The Times, covering family, religion, education, culture and the way we live now.
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