Before giving birth to her second child, Heidi DiLorenzo was anxious. She worried about her blood pressure, and the preeclampsia that prompted her to be hospitalized twice during the pregnancy. She worried that some terrible, unnamed harm would come to her 3-year-old daughter. She worried about her ability to love another baby as much as she loved her first.
But DiLorenzo, an attorney in Birmingham, Alabama, did not worry about taking Zoloft. She had used the medication to treat anxiety before she had her first child, and she continued it throughout that pregnancy and this latest one.
And since having her second daughter, in September, she credits an increased dosage with pulling her out of the “dark hole” of sadness she felt postpartum. “I wouldn’t be as good of a mom to my girls if I didn’t take it,” DiLorenzo said. “I wouldn’t have the energy.”
She is among the estimated 20% of women in the U.S. who have depression or anxiety during or after pregnancy. Yet only half of those mothers receive adequate treatment, according to Kay Roussos-Ross, who runs the perinatal mood disorders program at the University of Florida. And just 5% take 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 convened by the Food and Drug Administration could lead to more cases of untreated depression. Many of the 10 members of the panel expressed concern about the use of SSRIs, such as Zoloft, during pregnancy. They included Josef Witt-Doerring, a psychiatrist who owns clinics aimed at helping people wean themselves off antidepressants, and Adam Urato, an OB-GYN who recently petitioned the FDA to put stronger warnings on SSRIs.
While the discussion did not represent any official FDA guidance, the panelists — in claims the American College of Obstetricians and Gynecologists called “outlandish and unfounded” — linked the drugs to increased risks of miscarriage, birth defects, and autism in children exposed to them in utero. The Society for Maternal-Fetal Medicine said its members were “alarmed by the unsubstantiated and inaccurate claims made by FDA panelists.”
Antidepressants are a safe, “lifesaving” tool, given that mental health issues such as suicide and overdoses are the leading cause of maternal death in the country, ACOG President Steven Fleischman said in a statement on the group’s website.
Christena Raines, a nurse practitioner who in 2011 helped found the nation’s first inpatient perinatal psychiatric unit, in North Carolina, said SSRIs are “probably the most well-studied medicine in pregnancy.” In long-term studies of children exposed to the drugs in utero, she said, researchers haven’t seen problems.
It’s too soon to know whether the panel discussion has affected prescribing rates — or whether those who are pregnant are avoiding the drugs more. But Raines, who teaches at the University of North Carolina-Chapel Hill School of Medicine, said she’s already fielding questions from patients. She said the misinformation the panelists spread — along with President Donald Trump’s distorted claims about taking Tylenol during pregnancy — is making her job harder.
Dorothy DeGuzman is a family medicine physician who treats high-risk pregnancies in California. “There’s already so much stigma around taking antidepressants in pregnancy,” she said. “This will just add to the fear.”
This is an excerpt from my recent article for KFF Health News. Read the full story here.
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