If you are pregnant or a new mother struggling with depression or anxiety, you can call or text the National Maternal Mental Health Helpline, 24/7: 833-TLC-MAMA (833-852-6262). Postpartum Support International can help connect you with a local mental health provider at 800-944-4773 or psidirectory.com.
Before giving birth to her second child, Heidi DiLorenzo was worried. She was concerned about her blood pressure and pre-eclampsia which prompted her to be hospitalized twice during the pregnancy. She was worried that some terrible, nameless harm would come to her 3-year-old daughter. She worried about her ability to love another baby as much as she loved her first.
But DiLorenzo, an attorney in Birmingham, Alabama, wasn’t worried about taking Zoloft. She had used the drug to treat anxiety before having her first child and continued to use it throughout that pregnancy and her last.
And since having her second daughter in September, she credits an increased dosage with pulling her out of the “dark hole” of postpartum grief. “I wouldn’t be as good a mom to my girls if I didn’t get it,” DiLorenzo said. “I wouldn’t have the energy.”
She is among the estimated 20 percent of women in the US who they are depressed or anxious during or after pregnancy. However, only half of these mothers receive adequate treatment, according to Kay Roussos-Rosswho directs the Perinatal Mood Disorders Program at the University of Florida. And just 5 percent take a selective serotonin reuptake inhibitor, a class of drugs commonly used to treat both conditions.
Now medical experts are concerned that a July panel discussion convened by the Food and Drug Administration could lead to more cases of untreated depression. Many of the ten panel members expressed concern about the use of SSRIs, such as Zoloft, during pregnancy. They included Josef Witt-Doerring, a psychiatrist who runs clinics aimed at helping people wean themselves off antidepressants, and Adam Urato, an OB-GYN who recently asked the FDA to give stronger warnings about SSRIs.
While the discussion did not represent any official FDA guidance, panelists—in claims the American College of Obstetricians and Gynecologists called “strange and unfounded“- linked the drugs to increased risks of miscarriage, birth defects and autism in children exposed to them in the womb. The Society for Maternal-Fetal Medicine said its members were “concerned by baseless and inaccurate claims made by an FDA panel.’
Antidepressants are a safe, “lifesaving” tool, given that mental health issues such as suicide and overdose are the leading cause of maternal death in the country, ACOG President Steven Fleischmann said in a statement on the group’s website.
Christina Rainesa nurse who in 2011 helped found the nation first inpatient perinatal psychiatric unitin North Carolina, said SSRIs are “probably the most well-studied drug in pregnancy.” In long-term studies of children exposed to the drugs in utero, he said, researchers have seen no problems.
It is too early to know whether the panel discussion has affected prescribing rates or whether pregnant women are avoiding the drugs more. But Raines, who teaches at the University of North Carolina-Chapel Hill School of Medicine, said she’s already fielding questions from patients. He said the misinformation spread by the panelists — along with that of President Donald Trump distortmd claims about taking Tylenol during pregnancy – makes her job harder.
Dorothy DeGuzman is a family medicine practitioner who treats high-risk pregnancies in California. “There is already so much stigma around taking antidepressants in pregnancy,” she said. “This will only add to the fear.”
The panel
The July panel discussion was one of four the FDA has convened since May. In the past, the agency vetted advisory board members to avoid conflicts of interest. However, these panels were selected in private and the events were held with little public notice. In a July research report from MedPage Today, researchers and consultants raised questions about morality and legality of events.
Department of Health and Human Services spokeswoman Emily Hilliard did not directly respond when asked about the process for selecting participants. He called the group’s events “roundtable discussions” in which experts review the latest scientific evidence, assess potential health risks and “explore safer alternatives.”
July’s panel appeared to follow one executive order Trump in February issued the recommendation of the Make America Healthy Again Commission and directed it to “assess the prevalence and threat posed by the prescription of selective serotonin reuptake inhibitors” and other drugs.
Health and Human Services Secretary Robert F. Kennedy Jr., who oversees the FDA, is a frequent critic of such drugs. He has claimedwithout evidence that they may contribute to school shootings.
In opening remarks at the July panel discussion, FDA Commissioner Marty Makary also raised concerns about the drugs. “Nationally, the more antidepressants we prescribe, the more depression there is,” he said.
“It’s not a luxury”
The only panel member who was both a board-certified psychiatrist and OB-GYN—University of Florida’s Roussos-Ross—expressed a different concern. “Research shows that women who stop their medication during pregnancy are five times more likely to relapse,” she said.
Mothers with moderate to severe depression and anxiety during pregnancy are more likely to do so they give birth early and have low birth weight infantsshe added. If they don’t get treatment, he said, they have they are more likely to abuse drugs or alcohol and are at risk of suicide. They can have welding problem with their babies, Roussos-Ross said, and those children are at greater risk for problems like attention deficit/hyperactivity disorderdepression or anxiety—due to their mother’s mental health challenges, not the SSRIs.
“I want to emphasize that treating mental illness in pregnancy is not a luxury,” she told the panel. “It’s a necessity.”
Overall, about 19 percent of U.S. women in their 20s and 30s experience depression, according to the latest data from the Centers for Disease Control and Prevention, and about 10 percent take SSRIs. However, studies show that half of women decide to stop taking antidepressants before or during their pregnancy.
One reason so few expectant mothers receive depression treatment, doctors say, is that they are already afraid to take medication during pregnancy. The majority of DeGuzman’s patients rely on Medicaid, the government health coverage for people with low incomes or disabilities. Half are Latina. She often prescribes SSRIs, she said, but her patients rarely take them.
The issue is especially urgent for Black and Latina mothers, who experience higher rates of depression and anxiety from white, non-Latina mothers but 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.
Shanna Williams, a perinatal mental health therapist who treats African-American mothers in Philadelphia, said many of her clients were already more likely to trust their friends and family than their doctors when it comes to whether antidepressants are safe to take during pregnancy or breastfeeding. The FDA panel is “another voice saying you shouldn’t do this,” Williams said. “And that doesn’t help.”
Judith Blancwho studies perinatal mental health in 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 Blanc, an assistant professor of psychiatry at the University of Miami Miller School of Medicine. “We need the village to be upgraded.”
Kellyn Haight experienced debilitating depression after moving to the mountain town of Brevard, North Carolina. The former labor and delivery nurse had no childcare for her then 2-year-old daughter and no family or friends nearby as her husband traveled for work.
Her doctor prescribed Prozac – it didn’t help. She called her husband back home, but her insomnia worsened. One morning, she begged him to end her suffering. He took her to the emergency room and the staff sent her to the psychiatric unit of a local hospital. She said they stripped her of her clothes and put her in a locked room. “I felt like a creature, like an animal,” said Haight, now 37. “One of my biggest fears is that it could happen again.”
After being released from prison, Haight found a psychiatrist and started taking Zoloft. She built a community of friends and began to feel stable.
Now that her daughter is 5, she’s trying for another child—and plans to continue taking Zoloft throughout the pregnancy. “I would rather be safe and present for my child,” she said. “I’m OK with taking the risk, because I know what the alternative looks like, and I’m not going there.”
This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License. KFF Health News is a national newsroom that produces in-depth health journalism and is one of KFF’s core operating programs—an independent source of research, polling and journalism on health policy. Learn more about KFF.
