I'm a perinatal psychiatrist. The US is promoting misinformation on SSRIs and pregnancy
As a perinatal psychiatrist who sees pregnant and postpartum people struggling with conditions such as depression and anxiety every week, I'm deeply concerned that this public discussion – chaired by the controversial FDA commissioner Marty Makary – shared significant misinformation about mental illness and the treatment modalities (with overly simplified statements denouncing 'chemicals' during pregnancy).
Here in Washington DC, I recently examined a pregnant woman struggling with severe depression and anxiety. As she was nervously mulling treatment options we had discussed, she asked me questions about starting medication to treat her condition: will this affect my child's development? How long will the medication stay in my child's bloodstream? How much of the medication will go into my breast milk? Do I have to stay on it for ever?
These questions are part of everyday practice for those who care for individuals making decisions about treating their mental health challenges in the course of pregnancy. And answering them clearly is critical for people already dealing with some of the most difficult and vulnerable moments of their lives.
But giving established guidance becomes difficult at a time when the authorities themselves are platforming misinformation under the guise of scientific inquiry.
There isn't enough space here to deconstruct all of the falsehoods shared by some of the FDA panelists, with often meandering anecdotes that did not address the core issue being discussed.
The panelists overstated risks, which may deter treatment, despite robust data supporting the safety of use of SSRIs when clinically indicated.
As the adage attributed to W Edwards Deming goes: 'In God we trust; all others, bring data.' Here's the data: we know that severe maternal mental health challenges occur during pregnancy and the postpartum period. And according to a recent national study, there have been large declines in mental health among pregnant women – one in five pregnant women struggles with conditions such as anxiety and depression during their pregnancy. Three in four pregnant persons are untreated. That's more than 500,000 people every year who experience significant mental health issues before, during or after their pregnancies.
There are also real harms of untreated perinatal depression and anxiety – such as preterm birth, bonding difficulties, and even maternal death by suicide or overdose. The low, manageable neonatal risks generally support initiating and continuing SSRIs when they're clinically needed. These women need and deserve evidence-based care.
And as for pregnant people who do take SSRIs, large reviews, called meta-analyses, find no overall rise in major birth defects from taking SSRIs during pregnancy, and occasional small links to heart problems with certain drugs disappear in larger studies. Some newborns exposed late in pregnancy may have an issue called neonatal adaptation syndrome – mild, brief withdrawal-like symptoms which include jitteriness, poor feeding and affect the baby's breathing – but this almost always clears up quickly with routine care in the first week.
There is also an inherent problem in the way the FDA panelists spoke about the issue: one that minimized the health of the mother and focused solely on the baby. I am the first person to say there is a dearth of science when it comes to maternal mental healthcare. We need more research, and it is unfair that so many are left scrambling for help outside of our health system. But we should be seriously weighing the risk of not treating these conditions because mental illness is real and has significant impacts on the wellbeing of the pregnant person and baby.
SSRIs are not new drugs – they've been on the market for more than 30 years, and if there is a widespread epidemic of the harms that the FDA panel claimed, it is not substantiated in the data. So let's not apply an inconsistent standard towards SSRIs in pregnancy. Their comments that we need more data is the last slide or nearly every scientific discussion – of course, we need more robust data. That shouldn't seed unnecessary doubt and leave patients and their doctors in a limbo on how best to treat these conditions.
We need the right treatment, for the right patient, at the right time. In this moment when trust in government institutions is at a low, sowing further doubt is the last thing my patients deserve. The American public needs to know they are getting the highest quality guidance; in the absence of that, lives are at risk.
As we've seen in the case of vaccines, official federal guidance has been rapidly changing and is often out of alignment with the best science available. Professional medical societies are currently filling the void where government guidance falls short. If this panel on SSRIs is a harbinger of what's to come, this might become the case for SSRIs in pregnancy. The American Psychiatric Association and American College of Obstetrics and Gynecology have expert guidance on treatment, including psychotropic medications.
As for my patient, we evaluated the data – doctor and patient – and together she made an informed decision weighing the risks and benefits to start an SSRI along with therapy. Her mood and anxiety improved, and she had a safe delivery. Both mother and baby are thriving.
Dr Sunny Patel is a psychiatrist at Georgetown's Thrive Center for Children, Families, and Communities. He recently served as senior adviser at the Substance Abuse and Mental Health Services Administration
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
The Independent
43 minutes ago
- The Independent
Nine simple, evidence-based moves to try before calling it quits on fitness
You wouldn't start building a house without laying firm foundations, yet people often focus on fitness minutiae without nailing the basics first. Splashing out on pricey high-tech recovery tools in the absence of a good night's sleep, or spending hours hunting down ' the best exercises ' with time that could be better spent on a simple-yet-effective workout – the former options are shiny and exciting, but the latter deliver the greatest benefits. This is something certified strength and conditioning coach Danny Matranga has repeatedly observed across thousands of sessions, training clients from all walks of life. Worse: when these nuanced interventions don't deliver noticeable results, people's motivation to maintain healthy habits tends to wane. 'An issue that people have is that they don't believe in themselves, and they don't believe they can use food and exercise to reposition themselves for better fitness,' he says. 'I hate when people give up, because there is a bunch of basic stuff you can try first.' Below, he shares the nine things you should try before labelling your fitness a lost cause. Ten-second takeaways: Lift weights two times per week. Aim for seven or more hours of sleep per night. Eat more plants and less processed food. Regulate your stress levels through meditation, mindfulness, nature exposure and managing your behaviours. Drink more water – at least 1.9 litres per day. Spend more time outside, particularly soon after you wake up. Lower your alcohol consumption to within the government guidelines of 14 units per week. If you are looking to build muscle and/or lose weight, aim to consume 1.6-2g of protein per kilogram of body weight each day. If not, aim for a minimum of 0.8g of protein per kilogram of body weight each day. Sit less and walk more, making conscious decisions to increase your opportunities to move. Try to aim for at least 7,000 steps per day or 10 per cent more than your current daily average, according to your phone, fitness tracker or smartwatch – whichever figure is lower. Tip one: Lift weights As a strength coach, this was always likely to be Matranga's top recommendation, but he has good reason to prioritise strength training. Not only is it the type of exercise he finds clients are most likely to stick with long-term, but it also offers immense benefits disproportionate to the amount of time you spend exercising. 'What you get out of weightlifting is improved strength, muscularity and confidence,' Matranga says. It will also strengthen your bones, tendons and ligaments while improving your mobility, leaving you more resilient against injury. Attempting to exercise without these attributes is an uphill struggle. But establishing a baseline level of strength by lifting weights a couple of times per week will increase physical capacity and autonomy, making exercise a more enjoyable proposition. 'If you can hold on to muscle while managing your appetite, you will grow stronger, rather than just getting smaller, and that can be a big driver of sticking with it,' Matranga adds. He also sings the praises of strength training for regulating blood sugar and appetite. This is because glucose – or blood sugar – is pulled into the cells of working muscles during exercise to be used as energy, which can help prevent sharp spikes and drops in blood sugar levels during the day. In a previous article, I spoke to him about the numerous benefits of weightlifting and how to begin strength training for longevity – a valuable resource if you're interested in giving it a try. You can also find a sample full-body dumbbell workout below. Tip two: Sleep more 'Another one that affects our appetite is sleep,' says Matranga. 'If we get less sleep than we need, everything is harder; saying yes to exercise, saying no to a beer. 'So if, like so many of us, your default programming is not aligned with exercising and healthy eating, trying to do those things in a state of chronic sleep deprivation is incredibly hard.' Science supports this. A randomised control trial published in the Annals of Internal Medicine found that 'lack of sufficient sleep [in this case, five-and-a-half hours or less] may compromise the efficacy of typical dietary interventions for weight loss and related metabolic risk reduction'. In short: sleep deprivation made it harder to lose fat, while the study also found that ample sleep – eight-and-a-half hours each night – helped people maintain muscle while losing weight. But how much more sleep do you need? Swerving sleep deprivation by aiming for more than six or seven hours per night is vital, but beyond this, sleep needs can be subjective. 'This is where experimentation comes in,' The Sleep Scientist Dr Sophie Bostock tells me. 'Start with 15-20 minutes of extra sleep in the morning, then if you feel a bit better, consider half an hour.' Tip three: Eat more plants and less processed food 'Fast food and ultra-processed foods are where most Americans get most of their calories,' says California-based Matranga. 'They have lots of calories and very little nutrition. Fruits and vegetables are the opposite. They are very high in micronutrients, which help us function. They are also high in fibre, which is important for feeding our gut microbes, regulating our blood lipids [fats in the blood] and keeping us full.' Fellow trainer, author and fat loss specialist Ben Carpenter says fruit and vegetables can also benefit appetite regulation by replacing other less nutritious foods in our diet. To back this up, he points to research that found that promoting fruit consumption in children and adolescents actually decreased overall calorie consumption and reduced obesity prevalence. Meanwhile, a 2025 study published in Nature found that overweight or obese adults were able to lose significantly more weight on a diet of minimally processed foods than they were on an equivalent diet of ultra-processed foods. Tip four: Manage your stress I recently quizzed longevity specialist Dr Mohammed Enayat on what cost-free behaviours he would recommend for living as healthily as you can for as long as possible. Managing stress – through factors such as meditation, mindfulness and exposure to nature – was one of his four key pillars. 'The human organism is a combination of biological processes and the effects our environment has on us,' he explains. 'If we operate the human body in a toxic environment, we're exposed to bad things and toxins through diet and high stress, and this drives inefficiency and disease within our biology. That's why it's known that stress kills.' Managing stress is one of Matranga's top recommendations, too: 'If you want to live healthily and engage with exercise, you have to ask yourself: 'Is the amount of stress I'm carrying around affecting my diet and exercise compliance?' And if it is, are there things you can do to manage this stress? 'Maybe go for a walk, maybe talk to a counsellor, maybe do some breathwork. Whatever is causing this stress, it is not objectively healthy to carry around. Being chronically stressed is also a great excuse for not exercising, so we want to limit those excuses.' Tip five: Drink more water Like exercising and healthy eating, you probably already know that staying hydrated is good for you. But when a busy day runs away from you, it's not uncommon to find yourself parched come 5pm. Next thing you know, you're reaching for a fizzy drink to quench this thirst. 'Going back to ultra-processed foods, another big issue is that we get a lot of our fluids from calorie-rich drinks,' says Matranga. 'Most people should consume most of their fluids from water, which contains zero calories. It's very hydrating and also satiating, so this is probably the easiest tool on this list to use.' A systematic review of existing research, conducted at the University of California San Francisco, concluded that 'drinking enough water [a minimum of eight cups or roughly 1.9 litres per day, in most cases] can help with weight loss and prevent kidney stones, as well as migraines, urinary tract infections and low blood pressure'. Tip six: Get more sunlight It's widely known that sunlight can top up the body's vitamin D supply, although exposure has to be managed to prevent unwanted adverse effects such as sunburn. But the main benefits of this point lie in the secondary effects of getting outside. Sunlight in the morning can set your circadian rhythm – or your body's internal body clock – on the path to success, improving sleep quality and potentially improving your body's internal functions too. Meanwhile, research has linked nature exposure to improved health. A 2021 narrative review, appearing in the International Journal of Environmental Research and Public Health, 'found evidence for associations between exposure to nature and improved cognitive function, brain activity, blood pressure, mental health, physical activity and sleep'. On a less scientific level, the act of going outside is also going to increase the amount you move, which is rarely a bad thing. 'I have never met a human who thrives sitting in an office all day,' says Matranga. 'We are organisms that evolved to be social and to be outside. For a lot of us, you might not be the type to go to a gym, but if you commit to going on a couple of 30-minute walks outside each day, that's going to be your exercise.' Tip seven: Reduce your alcohol intake You have likely seen articles on the internet or social media videos telling you what not to eat. Alcohol is the major factor missing from much of this content, in Matranga's eyes. 'It is unequivocally the worst thing we consume consistently,' he says. 'It is a known group one carcinogen [categorised by the International Agency for Research on Cancer ]; it increases your risk of disease; it increases your risk of getting bad sleep; and it has calories that make it harder to maintain a healthy weight. 'A lot of people could make tremendous strides with their health if they went from drinking excessively to just drinking in moderation. Alcohol consumption is the one habit I think both the United States and the United Kingdom have a crazy relationship with, compared to a lot of the rest of the world.' A chat with Professor David Nutt, a leading neuropsychopharmacologist and author of Drink? The New Science of Alcohol and Your Health, shed further light on why people struggle to reduce their alcohol intake. 'I think the question you have to ask is why people still drink,' he says. 'The answer is because alcohol is still the best drug or drink we have to relax you.' For this reason, giving it up is not on the table for most people, despite a 2023 release from the World Health Organisation stating that 'no level of alcohol consumption is safe for our health'. If this is the case, Nutt recommends sticking to the government guidelines around alcohol consumption to reduce your risk of related conditions such as cancer, liver cirrhosis and cardiovascular disease. 'The current guidelines are 14 units per week. If you can stick within those, the harms of alcohol are relatively minor. Most people who stick within these limits will not experience significant harm,' he explains. 'If you do drink, always have at least two days a week where you don't drink at all, because that allows your liver, heart and blood vessels to recover – but don't stockpile. If you're going to try and stick to the 14 units, don't take them in one go because that's going to be more deleterious to your brain.' Tip eight: Increase your protein intake 'Like eating more plants, this tip relates to the idea that, 'If I eat more of what's good for me, I'll have less room for what's not so good for me',' Matranga says. 'And just like fruit and vegetables, protein is very filling and often contains many other nutrients. 'It fuels our muscles and it costs a lot of calories to metabolise, so I find that if people add protein and veggies to their diet, and try to drop fast food, that little switch has a massive impact.' He recommends animal proteins such as beef, chicken, fish, eggs and yoghurt, as well as vegan sources like tempeh and tofu. Protein also has plenty of benefits beyond weight management, says FuelHub nutritionist Edward Mather. 'Proteins are essential for a variety of key physiological functions in the human body,' he explains. 'They play a critical role in muscle recovery, so consuming adequate amounts will help repair and rebuild muscle tissue following exercise, as well as facilitate the growth and maintenance of lean muscle mass. 'Proteins also provide structural support to cells and tissues, aid the transport and storage of key molecules, play a role in hormonal regulation and are involved in muscle contraction – along with many other things.' But how much protein do you need to eat per day? As a minimum, aim for 0.8 grams per kilogram of body weight each day. If you are looking to lose weight and build or maintain muscle, this can be bumped up to 1.6-2g of protein per kilogram of body weight. Tip nine: Sit less, walk more Matranga often sees cases where people are walking an average of 3,500 steps per day, then eating 3,500 calories in the same time span. 'People sit so much that for every step they take, they eat one calorie, and that is an untenable mathematical equation,' he says. 'The number one way to fight back against that is to move more, because when you're moving, you're using energy, and you're probably not eating either.' Walking is one of the most accessible ways to do this, providing a low-cost exercise option open to most people. Yet it still offers plenty of benefits. 'Over the last two or three years, there have been a lot of large studies coming out looking at prospective associations between walking and health outcomes like all-cause mortality, which is a fancy way of saying any reason why someone would die,' says Dr Elroy Aguiar, an assistant professor of exercise science at the University of Alabama. 'These studies are showing that walking, not necessarily in huge volumes, is associated with large reductions in risk of all-cause mortality.' If you are looking for a daily step target to hit, recent research from the University of Granada states that 'if we focus on the risk of dying from cardiovascular disease, most of the benefits are seen at around 7,000 steps per day'. However, if this target sounds unattainable, it is worth noting that any increase in your current daily number of steps – ie activity levels – is likely to deliver a net positive effect for your health. To implement this, try taking your current average daily number of steps from your phone, fitness tracker or smartwatch, then aiming to up it by 10 per cent each month until you reach 7,000 or more.
Daily Mail
4 hours ago
- Daily Mail
Doctor's urgent warning about the huge mistake everyone is making with their eyes: 'You need to stop'
An American optometrist has people looking twice after revealing the one bad habit thousands are guilty of, and why it could be putting your vision at risk. Dr Fraser, an eye doctor from Detroit, has racked up more than 2.2million views on TikTok after interviewing his colleagues about the worst thing patients do to their eyes. Their answers were unanimous. 'Eye rubbing,' one optometrist warned in the clip. 'You need to stop. Don't rub your eyes.' However, instead of banning the action altogether she offered a practical, and much safer, alternative. 'Please, for the love of God, if you need to rub your eye, instead of rubbing the eyeball, rub the bone,' she advised. 'It'll scratch the itch, but it will put you at less risk of diseases like keratoconus.' Keratoconus is a progressive eye condition where the cornea (the clear front surface of the eye) thins and bulges into a cone shape. This can distort vision, and in severe cases requires surgery or corneal transplants. Eye rubbing, experts say, is a major risk factor. Another optometrist in Dr Fraser's clinic added that the habit doesn't just damage the eye itself, it can also speed up the ageing process around them. 'It makes your skin loose, don't do it,' she said, warning that the delicate tissue around the eyes is particularly prone to stretching and wrinkling. A third specialist kept it simple and very direct. 'Don't rub your eyes,' she said. Worryingly, eye rubbing isn't the only issue Dr Fraser's team flagged. One colleague pointed out that many don't blink enough, especially when glued to screens. 'Patients will be working on a computer, reading, students will be studying, and they're just too focused on what they're doing and they don't blink,' he said. 'I'm starting to see kids coming in with lid issues and dryness, and I think if you just practice blinking you'll save yourself a lot of hassle.' Experts recommend taking regular breaks from screens, consciously blinking more often, and if your eyes feel itchy, gently pressing on the bony orbital rim rather than the eyeball itself. Dr Fraser's video has struck a chord with viewers, many of whom admitted they were guilty of both bad habits, and others already suffering the negative effects. 'Yep, I have keratoconus,' one wrote. 'I can attest that due to allergies and being uninformed, I rubbed my eyes and now my left eye has it and I have zero clue how to fix or if there is a fix.' 'As soon as the rubbing was mentioned I had an eye itch. It's like it knew,' another added. 'Me blinking a million times after watching the video,' a viewer said in jest. 'I have keratoconus, pleeeease don't rub your eyes.'
Daily Mail
5 hours ago
- Daily Mail
Terrifying details of CDC shooting reveal tragedy could have been much worse as agency slams 'misinformation'
The gunman who opened fire on the Center for Disease Control in Atlanta attempted to enter the headquarters before guards stopped him, authorities revealed on Sunday. Patrick Joseph White, 30, was carrying five guns, including at least one long gun, when he was denied entry and forced to drive across the street to a CVS, where he began his shooting rampage. He wrecked havoc outside the CDC headquarters, striking at least four buildings of the facility's campus and leaving workers and nearby Emory University students terrified for their lives. While responding to the scene as bullets rang and shattered windows, DeKalb County Police Officer David Rose, 33, was shot and killed by the culprit. White was later confirmed dead amid the gunfire. No civilians were injured by his rampage, although workers and 92 children at the campus daycare were locked down until the late night. A union representing CDC workers, the American Federation of Government Employees (AFGE) said the incident was not random and 'compounds months of mistreatment, neglect, and vilification that CDC staff have endured.' It demanded federal officials condemn vaccine misinformation, saying it was putting scientists at risk. This statement comes after it was revealed the shooter was an anti-vaxxer who blamed a recent illness on the COVID-19 vaccine, which was promoted by the CDC. He claimed the vaccine made him feel suicidal and depressed, the Associated Press reported. White's father sounded the alarm to police that his son was the possible shooter. He said White was upset over the death of his dog and had become fixated on the COVID-19 vaccine, according to the law enforcement official. White's neighbor told The Atlanta Journal-Constitution that the shooter told her on several occasions that he distrusted the vaccines. 'He was very unsettled, and he very deeply believed that vaccines hurt him and were hurting other people,' Nancy Hoalst, told the Atlanta outlet. 'He emphatically believed that.' But Hoalst said she never believed White would be violent. White was found on the second floor of a building across the street from the CDC campus and died at the scene, Atlanta Police Chief Darin Schierbaum said. He added that is was unclear if White turned the gun on himself or if an officer had shot him. But due to the complexity of the crime scene, the investigation is expected to take an 'extended period of time,' according to the Georgia Bureau of Investigations. Meanwhile, the AFGE has asserted the CDC and the Department of Health and Human Services (HHS) must provide a 'clear and unequivocal stance in condemning vaccine disinformation.' Fired But Fighting, a group of laid-off CDC employees, has said HHS Secretary Robert F. Kennedy Jr. is directly responsible for the villainization of CDC´s workforce. They claimed he has lied about vaccine safety and fueled a 'climate of hostility and mistrust.' Kennedy reached out to staff on Saturday, saying 'no one should face violence while working to protect the health of others.' The union has argued that until all the windows are repaired and the site is totally secured, staffers should not be mandated to immediately return for work. It also called for 'perimeter security on all campuses until the investigation is over and reviewed by the CDC. Rose, who lost his life during the gut-wrenching attack, had just joined the police force in September. The CVS was also shot at, as the shooter started firing from there after guards denied him entry to the headquarters He leaves behind a pregnant wife and two children. 'This evening, there is a wife without a husband. There are three children, one unborn, without a father,' DeKalb County CEO Lorraine Cochran-Johnson said during a press conference. 'There is a mother and a father, as well as siblings who also share in this traumatic loss. Let's join together to give this family the support it needs.'
