Is the FDA about to keep pregnant women from taking antidepressants?

Health and Human Services Secretary Robert F. Kennedy Jr. has long railed against antidepressants, and now he has very practical ways to attack them.

As my colleague Kiera Butler has written, Kennedy has claimed, without evidence, that they can cause addiction and school shootings. He even proposed sending people who take them to “wellness farms,” where they can grow their own organic foods, get “re-parented,” and wean themselves off antidepressants and other medications.

But on Monday, the Food and Drug Administration (FDA) appeared to move closer towards realizing RFK’s goal of getting people off the drugs, quietly convening a so-called expert panel to discuss selective serotonin reuptake inhibitors—a type of antidepressant commonly known as SSRIs—and pregnancy. The two-hour panel was livestreamed and is available to watch on the FDA’s YouTube page. It was moderated by a pair of FDA staffers, who gave each panelist five minutes to make an opening presentation and then asked a few questions submitted by the public. While 13 percent of Americans use antidepressants, whose efficacy varies but have been shown to help at least 20 percent of people who take them, a far smaller number of pregnant women—research suggests six to ten percent—are on them.

Many of the panel’s ten participants—a combination of researchers and practicing psychologists, several of whom have publicly spoken out against the use of antidepressants—largely repeated what one women’s health expert called “MAHA talking points” against medications and the biological legitimacy of anxiety and depression. Often, panelists’ arguments were so full of misinformation that Steven Fleischman, the president of the American College of Obstetricians and Gynecologists (ACOG), a professional group for OB-GYNs, promptly put out a statement calling the panel “alarmingly unbalanced” and alleging that the majority “did not adequately acknowledge the harms of untreated perinatal mood disorders in pregnancy.”

There are, indeed, major mental health struggles facing American moms. Research published by the Centers for Disease Control and Prevention (CDC) in 2020 found that approximately one in eight women experience postpartum depression (PPD) after giving birth, which can lead to difficulties bonding, developmental delays for the infant, and other negative health outcomes. The latest CDC data, from 2017 to 2019, shows that mental health conditions, including suicides and overdoses, were the leading underlying causes of pregnancy-related deaths. The picture has only grown more dire recently: Research published in February in the Journal of Health Economics and Outcomes found that the Supreme Court’s decision overruling Roe v. Wade led to an increase in PPD diagnoses in states with abortion bans compared to those without. Another large study, published in the May issue of JAMA Internal Medicine, found that American mothers reported large declines in their mental health from 2016 to 2023, with single and low-income mothers reporting particularly large drops.

But listening to the FDA panel on Monday, you would be forgiven for thinking that perinatal depression—which refers to depression both during and after pregnancy—is not, in fact, real.

In his introductory remarks, FDA Chief Dr. Martin Makary—an abortion opponent and a former surgeon and professor at the Johns Hopkins School of Medicine—called for more study of the “root causes” of perinatal depression. “We have to talk about the role of healthy relationships, of communities, of natural light exposure, of other modalities and co-factors that may be involved,” he said.

Another panelist, Dr. Josef Witt-Doerring, a psychiatrist whose practice focuses on weaning people from their psychiatric medications, similarly claimed that in contrast to physical conditions, it is impossible to point to distinct causes for mental health disorders. Instead, he claimed, personal problems like loneliness and job dissatisfaction tend to trigger depression. “These are not things to be fixed with medical intervention,” added Witt-Doerring, who also runs a YouTube channel that spotlights the stories of people who have faced adverse side effects from taking psychiatric medications.

Roger McFillen, a psychologist and host of a podcast on which he and guests have railed against vaccines and birth control, suggested that women are “naturally experiencing their emotions more intensely, and those are gifts. They’re not symptoms of a disease.” McFillen also suggested, without evidence, that “many women feel coerced” to get on medications to treat perinatal depression.

I reached out to Wendy N. Davis, a psychotherapist and the president and CEO of Postpartum Support International, to get her take on the panelists’ characterization of perinatal depression. “That kind of thinking is not evidence-based,” she said, “and not even anecdotally true.” Indeed, physicians and researchers who treat and study PPD note that a combination of genetics, a history of anxiety and depression, and psychosocial factors can play a role in the development of the disorder. Experts say it can be effectively treated through a combination of therapy, medication, and support groups.

David Healy, a former professor of psychiatry at McMaster University in Canada and Bangor and Cardiff Universities in the UK, agreed with Witt-Doerring, claiming that people with depression and melancholia, a severe type of depression, can often “recover spontaneously,” even within a few months. But the American Academy of Pediatrics recommends that new parents should repeatedly be screened for PPD until the baby is six months old, noting that, if left untreated, it can lead to “long-term adverse health complications.” A 2020 study published in the journal Pediatrics found that 25 percent of nearly 5,000 mothers studied had higher rates of PPD at some point in the three years after giving birth.

Then there was the misinformation about actually treating perinatal depression with medication. Several of the panelists suggested, for example, that the use of SSRIs during pregnancy can lead to an increased risk of autism in infants. But while some studies have found a higher occurrence of autism in these babies, researchers have cautioned against drawing a causal inference, and several large studies have found no association at all between SSRI use in pregnancy and autism.

Another claim repeated by many panelists was that doctors have withheld information about the risks of SSRIs from pregnant patients. In response, Fleischman, from ACOG, explained, “Patients who choose to continue taking SSRIs during pregnancy with the support of their OBGYNs do so following counseling on the risks and benefits that includes discussion of the data and consideration of their own needs, values, and priorities.”

Panelists offered several suggestions for the path forward. They argued the FDA should strengthen its warnings about SSRI use during pregnancy to include more information about the impacts on preterm birth, preeclampsia, and postpartum hemorrhage. “There is now more than enough evidence to support strong warnings from the FDA about how these drugs disrupt fetal development and impact moms,” panelist Adam Urato, chief of maternal-fetal medicine at MetroWest Medical Center in Massachusetts, claimed. But studies show that SSRIs have only small or negligible impacts on the health issues that Urato raised.

A spokesperson for HHS said the agency would not comment on potential future policy decisions, adding, “The claim that the FDA’s expert advisory process is ‘one-sided’ or politically driven is insulting to the independent scientists, clinicians, and researchers who dedicate their expertise to these panels.”

Dr. Kay Roussos-Ross, an OBGYN and the director of the Perinatal Mood Disorders program at the University of Florida College of Medicine, was a rare expert in this group who pointed out that research has shown how untreated depression and anxiety in pregnancy can lead to a host of health problems for the pregnant person and their baby, including preterm delivery, inadequate prenatal care, substance abuse, and developmental delays for the child. Roussos-Ross also pointed to one study that revealed women who stopped taking medications in pregnancy were five times more likely to experience a relapse of symptoms compared to those who remained on them. “Not every single woman will need an antidepressant,” Roussos-Ross said during the panel, “but for those that do, it’s life-changing and life-saving.”

Jen Gunter, an OB-GYN and author of three books on menstruation, menopause, and vaginal health, called most of the panelists “depression deniers” who did not share basic evidence-based information. In a post on Bluesky, she praised Roussos-Ross for “shutting down all the others who were fear-mongering.”

Davis, from Postpartum Support International, said she just hopes struggling mothers understand that there is evidence-based help out there. “A mom can’t call the FDA panel,” she said, “and it’s not going to help her to listen to it.”