AYESHA RASCOE, HOST:
Should pregnant women and new mothers take antidepressants? A recent Food and Drug Administration panel raised questions about the safety of these drugs. An estimated 6% to 8% of pregnant women take antidepressants known as SSRIs. Doctors and psychiatrists treating these patients say the FDA panel misrepresented evidence and spread misinformation. NPR's Rhitu Chatterjee is here to tell us more. Rhitu, thank you.
RHITU CHATTERJEE, BYLINE: Happy to be here, Ayesha.
RASCOE: So I understand you watched the FDA panel. What exactly did the panelists say?
CHATTERJEE: So the FDA commissioner, Marty Makary, opened the event, framing the whole discussion around these so-called potential harms of a group of anxiety and depression drugs called SSRIs, which are medicines like Zoloft and Lexapro. And then a majority of panelists, including some psychiatrists, psychologists, a social work professor, cited studies they say illustrate health risks to both mom and baby. One panelist - Roger McFillin, a psychologist from Pennsylvania - suggested that women feel coerced into taking these medicines and that depression is overdiagnosed in women.
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ROGER MCFILLIN: Is that because this underlying mental illness that we're trying to control for - one we don't test for when there is no objective testing - it just is more prevalent in women? Or are women just naturally experiencing their emotions more intensely? And those are gifts. They're not symptoms of a disease.
CHATTERJEE: Now, to be clear, psychiatrists use a specific set of criteria to diagnose depression and anxiety. And a person has to have had five or more of those criteria for a depression diagnosis, and just feeling overly emotional isn't enough to be diagnosed.
RASCOE: What are doctors and psychiatrists saying about the panel's claims of harms caused by SSRI use in pregnancy?
CHATTERJEE: So several health care groups and organizations have released statements against those claims and said that they are misleading. Now, responding to that critique, Andrew Nixon, spokesperson for the federal Health Department, told NPR in an email that the claim that the panel was, quote, "one-sided" is, quote, "insulting" to the panelists.
Now, I spoke with Dr. Christopher Zahn, chief of clinical practice with the American College of Obstetricians and Gynecologists - or ACOG - one of the groups pushing back on some of the panel's claims. He explained why the studies cited by most panelists were what he described as poor-quality evidence or nonevidence-based.
CHRISTOPHER ZAHN: So if you're comparing a pregnant patient who has taken an SSRI, the control group should be the pregnant patient with mental health abnormalities who hasn't taken an SSRI. And part of the problem with a number of those studies - they don't use the right control group. And in fact, it's kind of like comparing apples and oranges.
CHATTERJEE: You know, Dr. Zahn told me that well-controlled studies don't find this association of SSRI use with those health risks that the panelists talked about. Now, the one risk that does show up is for newborns of moms who take the drugs in the third trimester. And the babies can have some withdrawal symptoms, but they resolve on their own in a few days. And according to him and most others in the field, the bottom line is these studies that have followed hundreds of thousands of women find that most SSRIs are safe for pregnant and postpartum women.
RASCOE: What about the people who are just trying to decide whether they should take these drugs when they're pregnant or just after giving birth? What are the main things they need to know?
CHATTERJEE: So firstly, Ayesha, is that there are risks of not treating their symptoms at this stage of life. The negative consequences on the health of both mom and baby are very well-documented. Here's Dr. Kay Roussos-Ross. She's an OBGYN at the University of Florida, and she was the only person on the FDA panel to spell those harms out.
KAY ROUSSOS-ROSS: When mental health conditions go untreated, these women are less likely to attend their prenatal care appointments, and they're more likely to use substances during their pregnancy. They are also more likely to face additional risks such as preeclampsia and cesarean delivery.
CHATTERJEE: And mental illness is a leading cause of maternal deaths in this country, including deaths due to suicide. Now, I should add that SSRIs aren't the only option for treating anxiety and depression during and after pregnancy. For those with mild to moderate depression and anxiety, you know, talk therapy is the first and best option. There's also peer support. But for those with moderate to severe depression and those who are having trouble accessing talk therapy, which is a big issue, then antidepressants are an option. Now, it won't be right for everyone, but talk about all of this with your doctor. Weigh it all against the risk of not treating your symptoms.
RASCOE: That's NPR's Rhitu Chatterjee. Thank you so much.
CHATTERJEE: My pleasure. Transcript provided by NPR, Copyright NPR.
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