If you are pregnant or a new mother struggling with depression or anxiety, you can call or text the National Maternal Mental Health Hotline 24/7: 833-TLC-MAMA (833-852-6262). Postpartum Support International can help you connect with a local mental health provider at 800-944-4773 or psidirectory.com.
Before Heidi DiLorenzo gave birth to her second child, she was worried. She was concerned about her blood pressure and the preeclampsia that caused her to be hospitalized twice during the pregnancy. She feared terrible, unspecified harm would befall her three-year-old daughter. She worried about her ability to love another baby as much as she loved her before.
But DiLorenzo, an attorney in Birmingham, Alabama, wasn’t concerned about taking Zoloft. She had used the drug to treat anxiety before having her first child, and she continued to use it throughout her pregnancy and this last pregnancy.
And since having her second daughter in September, she credits increased dosing with pulling her out of the “dark hole” of grief she felt after giving birth. “I wouldn’t be as good a mother to my girls if I didn’t accept it,” DiLorenzo said. “I wouldn’t have the energy for it.”
She is among the estimated 20 percent of women in the US who have depression or anxiety during or after pregnancy. Yet only half of these mothers receive adequate treatment Kay Roussos-Rosswho directs the perinatal mood disorders program at the University of Florida. And only 5 percent are taking a selective serotonin reuptake inhibitor, a class of medications commonly used to treat both conditions.
Now medical experts are concerned that a July panel discussion hosted by the Food and Drug Administration could lead to more cases of untreated depression. Many of the panel’s ten members expressed concerns about the use of SSRIs, such as Zoloft, during pregnancy. They included Josef Witt-Doerring, a psychiatrist who owns clinics aimed at helping people get off antidepressants, and Adam Urato, a gynecologist who recently petitioned the FDA to issue stronger warnings on SSRIs.
Although the discussion did not represent official guidance from the FDA, the panelists mentioned – in assertions from the American College of Obstetricians and Gynecologists – “bizarre and unfounded- linked the drugs to an increased risk of miscarriage, birth defects and autism in children exposed to them in the womb. The Society for Maternal-Fetal Medicine said its members were “alarmed by the unsubstantiated and incorrect claims created by FDA panelists.”
Antidepressants are a safe, “lifesaving” drug as mental health problems such as suicide and overdoses are the leading cause of maternal deaths in the country, ACOG President Steven Fleischman said in a statement on the group’s website.
Christena Rainesa nurse who helped found the nation in 2011 first inpatient psychiatric departmentin North Carolina, said SSRIs are “probably the best-studied drug in pregnancy.” In long-term studies of children exposed to the drugs in the womb, researchers have seen no problems, she said.
It is still too early to know whether the panel discussion has affected prescribing rates, or whether pregnant women are more likely to avoid the drugs. But Raines, who teaches at the University of North Carolina-Chapel Hill School of Medicine, said she is already fielding questions from patients. She said the disinformation the panelists spread — along with that of President Donald Trump distorted claims about using Tylenol during pregnancy – makes her job more difficult.
Dorothy DeGuzman is a primary care physician who treats high-risk pregnancies in California. “There is already so much stigma around taking antidepressants during pregnancy,” she said. “This will only increase the fear.”
The panel
The July panel discussion was one of four the FDA has convened since May. In the past, the agency has vetted advisory committee members to avoid conflicts of interest. Yet these panels were chosen privately and the events took place with little public attention. In a July research report from MedPage Today, researchers and consultants say questions asked about it the ethics and legality of the events.
Department of Health and Human Services spokesperson Emily Hilliard did not immediately respond when asked about the panelist selection process. She called the panel events “roundtable discussions” in which experts review the latest scientific evidence, evaluate potential health risks and “explore safer alternatives.”
The July panel seemed like one executive order Trump created the Make America Healthy Again Commission in February and charged it with assessing “the prevalence and threat of prescribing selective serotonin reuptake inhibitors” and other medications.
Secretary of Health and Human Services Robert F. Kennedy Jr., who oversees the FDA, is a frequent critic of such drugs. He has claimedwithout evidence that they may have contributed to school shootings.
In his opening statement during the panel discussion in July, FDA Commissioner Marty Makary also expressed concerns about the drugs. “From a national perspective, the more antidepressants we prescribe, the more depression there is,” he said.
‘No luxury’
The only member of the panel who was both a board-certified psychiatrist and a gynecologist — Roussos-Ross of the University of Florida — raised a different concern. “Research shows that women who stop taking their medications during pregnancy are five times more likely to relapse,” she says.
Mothers with moderate to severe depression and anxiety during pregnancy are more likely to experience this giving birth early and having children with low birth weightshe added. If they don’t get treatment, she said, they will more likely to abuse drugs or alcohol and are at risk of committing suicide. They can have that problems with attachment with their babies, Roussos-Ross said, and those children are at greater risk for problems such as diabetes attention deficit hyperactivity disorderdepression or anxiety – because of their mother’s mental health problems, not because of the SSRIs.
“I want to emphasize that treating mental health conditions during pregnancy is not a luxury,” she told the panel. “It’s a necessity.”
Overall, about 19 percent of American 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. But research shows that half of women decide to stop taking antidepressants before or during pregnancy.
One reason so few expectant mothers get depression treatment, doctors say, is that they already fear taking medications during pregnancy. The majority of DeGuzman’s patients rely on Medicaid, the government’s health care 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 pressing for Black and Latina mothers, who suffer from this higher rates of depression and anxiety than white, non-Latina mothers, but they are less chance of 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 have already trusted friends and family before their doctors when it comes to whether antidepressants are safe to use during pregnancy or while 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 showed 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 step up.”
Kellyn Haight suffered debilitating depression after moving to the mountain town of Brevard, North Carolina. The former labor and delivery nurse had no child care for her then two-year-old daughter and no family or friends nearby because her husband was traveling for work.
Her doctor prescribed Prozac; it didn’t help. She called her husband to return home, but her insomnia only worsened. One morning she begged him to end her suffering. He took her to the emergency room and staffers sent her to the psychiatric ward of a local hospital. She said she was stripped of her clothing and put in a locked room. “I felt like a creature, an animal,” says Haight, now 37. “One of my biggest fears is that this will happen again.”
After she was released, Haight sought out a psychiatrist and began taking Zoloft. She built a community of friends and began to feel stable.
Now that her daughter is five, she is trying for another child and plans to continue taking Zoloft throughout the pregnancy. “I prefer to be safe and present for my child,” she said. “I’m okay 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-NoDerivs 4.0 International License. KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the key operating programs at KFF – an independent source of health policy research, polling and journalism. Learn more about KFF.
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