I’m a perinatal psychiatrist. The US is promoting misinformation on SSRIs and pregnancy | Sunny Patel

LAte last month, the FDA advisory panel – on the heels of the decree “Make America Healthy Again” of the president examining psychotropic drugs – raised a debate on the security of selective serotonin reuptake inhibitors (ISRS) during pregnancy. Commonly called antidepressants, these drugs are used to treat a range of disorders, and earlier this year, a consortium of large mental health organizations has rejected the position of the administration.

As a perinatal psychiatrist who sees pregnant and postpartum people struggling with conditions such as depression and anxiety every week, I am deeply worried that this public discussion – chaired by the controversial commissioner of the FDA Marty Makary – has shared bad information on mental illness and treatment modelities (with too simplified statements denouncing “chemicals” pregnancy).

Here in Washington DC, I recently examined a pregnant woman struggling with severe depression and anxiety. As she nervously thought about the treatment options we had discussed, she asked me questions about the start of drugs to deal with her condition: will this affect the development of my child? How long will the drug stay in my child’s blood circulation? How many drugs will go in my breast milk? Do I have to stay there forever?

These questions are part of the daily practice for those who care about people who make decisions concerning the treatment of their mental health challenges during pregnancy. And responding clearly to it is essential for people who already treat with some of the most difficult and vulnerable moments in their lives.

But giving established advice becomes difficult at a time when the authorities themselves are in the disinformation platform under the guise of a scientific investigation.

There is not enough space here to deconstruct all the lies shared by some of the Panelists of the FDA, with often winding anecdotes which have not addressed the main question discussed.

Panelists have overestimated the risks, which can dissuade processing, despite robust data supporting the safety of the use of SSRIs when clinically indicated.

Like the adage attributed to W Edwards Deming says it: “In God, we have confidence; all the others provide data. ” Here are the data: we know that serious maternal mental health challenges occur during pregnancy and the postpartum period. And according to a recent national study, there was a sharp drop in mental health in pregnant women – one in five pregnant women fights conditions such as anxiety and depression during their pregnancy. Three out of four speakers are not treated. It is more than 500,000 people each year who experience significant mental health problems before, during or after their pregnancy.

There are also real damages of untreated perinatal depression and anxiety – such as premature births, liaison difficulties and even maternal death by suicide or overdose. Low and manageable neonatal risks generally support initiation and continuous ISRS when they are clinically necessary. These women need and deserve care based on evidence.

And as for pregnant people who take SSRIs, large journals, called meta-analyzes, find no overall increase in major congenital malformations in ISRS during pregnancy, and small occasional links with heart problems with certain drugs disappear in larger studies. Some newborns exposed at the end of pregnancy may have a problem called neonatal adaptation syndrome – light and short -lived symptoms that include trembling, poor diet and affect the baby’s breathing – but that is almost always cleared up with routine care during the first week.

There is also an inherent problem in the way the FDA panelists have spoken of the problem: the one who minimized the mother’s health and focused only on the baby. I am the first person to say that there is a shortage of science with regard to maternal mental health care. We need more research, and it is unfair that so many people are left to rush for help outside our health system. But we must seriously weigh the risk of not dealing with these conditions because mental illness is real and has significant impacts on the well-being of the pregnant and baby.

The SSRIs are not new drugs – they have been on the market for over 30 years, and if there is a generalized epidemic of misdeeds that the FDA panel has affirmed, it is not supported in data. So do not apply an incoherent standard for SSRIs during pregnancy. Their comments that we need more data is the last slide or almost all scientific discussions – of course, we need more robust data. This should not sow unnecessary doubt and leave patients and their doctors in limbo on the best way to deal with these conditions.

We need the right treatment, for the right patient, at the right time. At this time when confidence in government institutions is at a bottom, the doubt of sowing is the last thing my patients deserve. The American public must know that they get the highest quality advice; In the absence of this, lives are in danger.

As we saw in the case of vaccines, official federal directives have changed quickly and are often without alignment to the best available science. Professional medical societies are currently filling the void where government guidelines are not abbreviated. If this panel on the SSRIs is a warning sign of what will happen, it could become the case for SSRIs during pregnancy. The American Psychiatric Association and the American College of Obstetrics and Gynecology have expert advice on treatment, including psychotropic drugs.

As for my patient, we evaluated the data – doctor and patient – and together, she made an informed decision weighing the risks and advantages to start an SSRI with therapy. Her mood and anxiety have improved and she had a safe delivery. The mother and the baby thrive.

• Dr. Sunny Patel is a psychiatrist at Georgetown’s Thrive Center for Children, families and communications. He was recently senior advisor to the administration of drug and mental health services