Relatable with Allie Beth Stuckey - Ep 1189 ｜ SSRIs Are Rewiring Babies’ Brains — and Killing Their Moms ｜ Guest： Dr. Adam Urato

00:00:00.560 Dr. Adam Murado is a Harvard-trained, board-certified OBGYN who specializes in maternal-fetal medicine.

00:00:08.540 His focus is on the increase of the prescription of SSRIs, also known as antidepressants, during pregnancy.

00:00:17.140 The effect that that has on women and the effect that that has on babies after they are born and long after they are born.

00:00:24.620 This is an absolutely fascinating conversation.

00:00:28.780 We talk about much more than this subject.

00:00:31.360 We talk about the intervention and pregnancy in general.

00:00:33.940 You are going to learn so much.

00:00:36.060 This episode is brought to you by our friends at Olive.

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00:00:46.780 Before we get into that conversation, let me remind you to sign up for Share the Arrows brought to you by our friends at Every Life.

00:01:04.160 It is going to be amazing, y'all.

00:01:05.960 I am so excited.

00:01:07.440 In case you missed it yesterday, we announced our two new speakers on our Motherhood panel.

00:01:12.840 We've got Abby Halberstadt.

00:01:14.120 She was there last year.

00:01:15.440 That is misformama on Instagram.

00:01:17.720 A lot of you probably know who she is.

00:01:19.320 And then Hillary Morgan Ferrer.

00:01:21.160 She is the author of the extremely popular Mama Bear Apologetics books.

00:01:26.380 She is incredible.

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00:01:40.340 I cannot wait.

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00:01:49.720 Dr. Jurado, thanks so much for taking the time to join me.

00:01:53.420 Could you tell everyone who you are and what you do?

00:01:55.560 Well, first off, thanks for having me down here.

00:01:57.800 I am a maternal fetal medicine specialist, and I work up in my hometown of Framingham, Massachusetts.

00:02:04.980 Maternal fetal medicine is basically a specialization after OB-GYN residency.

00:02:09.660 So I did my OB-GYN residency and then focused specifically on taking care of high-risk pregnancies in maternal fetal medicine.

00:02:17.080 So I take care of patients in the office.

00:02:19.320 Most of what I do is ultrasound and counseling during the day.

00:02:23.360 And then I also do deliveries.

00:02:24.940 I still do deliveries and love doing them.

00:02:29.360 Yeah.

00:02:29.500 What is your favorite part about what you do?

00:02:31.040 Is it the delivery?

00:02:32.120 I think probably.

00:02:32.940 I mean, I love it all.

00:02:33.780 I enjoy what I do.

00:02:34.460 I enjoy the specialty.

00:02:35.580 But there's a lot of excitement and fun and joy and adrenaline on labor and delivery.

00:02:42.460 And so, yeah, it's enjoyable.

00:02:44.400 Yeah.

00:02:44.480 Why did you go into that specialty?

00:02:47.280 It's a great question.

00:02:48.740 When I came through med school, I think I thought maybe I'd be an orthopedic surgeon.

00:02:53.660 I grew up as an athlete and played baseball and basketball up through high school and a little bit into college.

00:02:59.700 And I thought I was going to probably take that route.

00:03:02.280 But then when I did my OB rotation, I got a real charge out of labor and delivery and, in particular, delivering babies.

00:03:08.920 There's a lot of action there.

00:03:10.660 And there's an outcome, which to me felt very much more like athletics than any other area of medicine where we're looking for an outcome.

00:03:21.800 And there's also immediate gratification in it where I come on the shift and I've got maybe three pregnant patients.

00:03:27.560 And by the end of the shift, we've got deliveries.

00:03:30.040 Yeah, you get a prize at the end, which is fun.

00:03:33.760 Yeah, I tell people, I don't know if that makes sense to me, but it's almost like working with a team in a sports season.

00:03:39.560 You're working with the mom.

00:03:40.640 You're working with other people.

00:03:41.740 You're getting through the season.

00:03:43.040 And then the end of the season is like the Super Bowl or the World Series as labor and delivery.

00:03:47.540 And then you get the outcome.

00:03:48.900 And you win most of the time.

00:03:50.640 You get a good outcome most of the time in obstetrics.

00:03:53.540 And how long have you been practicing now?

00:03:55.560 I became an MD in 97.

00:03:58.540 So 28 years now.

00:04:00.240 28 years.

00:04:00.580 28 years doing obstetrics.

00:04:02.320 And what have you seen change in the world of obstetrics in that almost 30-year period, maybe for better and for worse?

00:04:11.160 I feel like we're seeing more intervention now progressively over time just in terms of the medicalization of pregnancy.

00:04:20.640 And pregnancy and childbirth is something, obviously, that's been worked out in mammals for millions and millions of years.

00:04:27.520 And so there's a lot to be said for trying to allow the natural process to proceed without a large number of interventions.

00:04:36.820 And I've seen over time progressively that we're doing more and more, whether it's ultrasound or whether it's medications, which is the area that I focus on now, medication exposure in pregnancy, or C-sections for delivery, et cetera.

00:04:50.660 Sort of over-intervention and sometimes causing more harm than good.

00:04:55.540 Yeah.

00:04:56.100 I'm wondering if you can tell me what is the thinking behind that.

00:04:59.740 So like my first doctor, for example, when I got to 39 weeks, he started saying, OK, we need to just induce.

00:05:07.380 We need to – I didn't have any complications, healthy pregnancy, all of that.

00:05:11.260 My baby wasn't measuring large or anything.

00:05:14.080 But, OK, we need to go ahead and set your induction date.

00:05:17.360 I really don't let my patients go past 40 weeks.

00:05:20.300 So 40 weeks, five days.

00:05:21.820 I was making no progress at all and scheduled the induction.

00:05:25.600 Well, it didn't work.

00:05:26.820 My body was not ready.

00:05:28.060 She was not ready.

00:05:29.400 And so he said, you know what, we're going to go ahead and just do a C-section.

00:05:33.660 You'll have a baby by lunch.

00:05:35.320 And looking back, I didn't want to do that.

00:05:37.660 I had never had surgery before.

00:05:39.060 But my husband and I just didn't know.

00:05:41.280 And when you have a doctor that's telling you this is what you need to do and, you know, the baby's heart rate was fine.

00:05:46.880 There was nothing wrong.

00:05:47.840 It was just like we just probably should do this.

00:05:50.540 What is the thinking behind something like that?

00:05:53.900 Because I've heard from many women that that's pretty common. 1.00

00:05:57.180 Doctors pushing induction and pushing C-section even when it doesn't seem that the situation is calling for that.

00:06:04.100 Yeah, I think it's challenging.

00:06:06.720 End of pregnancy care is challenging for moms and babies and the family and also for the OB providers, doctors, nurses, midwives, et cetera.

00:06:17.720 And I think that they and all parties there, I think, mean well.

00:06:22.240 I take care of a lot of home birth patients now, patients that plan a home birth that want a minimum of intervention or they might have had a bad experience previously.

00:06:29.160 And I'm sympathetic to what they're saying about feeling maybe forced into certain things.

00:06:33.340 But I think my colleagues, my fellow doctors and midwives, et cetera, they want the best for the patients.

00:06:39.580 But it's hard at the end of pregnancy trying to balance things.

00:06:42.920 We tend to, as providers, want to avoid disaster, want to avoid the worst outcomes.

00:06:49.480 So with end of pregnancy care, there's a lot of things that can go wrong at the very end of pregnancy, things like preeclampsia, hypertension, stillbirth is the one everyone worries about.

00:07:01.180 Stillbirth, which can – it's not common, but it's not terribly rare either.

00:07:06.740 And so it can occur.

00:07:07.540 So as we get towards the end of pregnancy, as we get to the due date, that's always kind of weighing on the OB provider's mind.

00:07:14.960 And so there's an argument to be made, and some people are making this argument for delivery – excuse me, for delivery at 39 weeks because that prevents any complications from happening beyond that.

00:07:25.780 The problem with that approach, though, is that while it does avoid disaster by getting the babies out at 39, it really ends up being, in most cases, in the overwhelming majority of cases, over-intervention.

00:07:39.160 Most women don't need to be delivered at 39 weeks, and the labor and birth experience will be much better if we just wait and let the woman go into her own natural labor. 0.99

00:07:49.020 So if you stay – if you just keep your hands off and follow the mom, follow her closely, and, say, let her get to her due date and she goes into labor, she may be able to come into the hospital and have a labor and delivery that lasts on the order of 8, 10 hours or something like that.

00:08:04.320 If you do the induction at 39 weeks, you may be looking at a 1, 2, 3, 4-day induction.

00:08:10.620 And so that's a much more difficult birth experience for the mom. 1.00

00:08:13.620 And so for an OB provider, it's trying to balance those things.

00:08:18.420 In terms of cesarean, the cesarean delivery, our rates are way too high in the United States where it's about 1 in 3 now.

00:08:28.100 It's about 33% cesarean delivery.

00:08:31.100 Part of that problem is also the same dynamic, though, where if you're watching a woman in labor and you're watching the heart rate tracing and there's any question, any concern about it, the fault will always be failure to do a C-section.

00:08:45.540 That's the problem.

00:08:46.520 That's what gets the doctor in trouble.

00:08:48.880 There's almost never or very rarely examples where doing the C-section early leads to litigation, for example.

00:08:57.120 And not that doctors are just focused on litigation, but they're also focused on good care of the patient and avoiding the very bad outcome.

00:09:04.200 And so I think that's probably what's pushing it, both early inductions and the move towards cesarean, is the desire to avoid the catastrophic or the very bad outcome for the patient.

00:09:16.240 Why do you think that has increased, the interventions have increased over the past 28 years, though?

00:09:23.920 Is it just because there's more fear for some reason?

00:09:27.120 Is there a justification behind the higher rates of intervention?

00:09:30.860 Is it because patients are more litigious than they used to be?

00:09:35.120 Like, why do doctors now feel more so than they used to that they've got to do something and induce?

00:09:41.940 Yeah.

00:09:42.280 So as far as the area that I'm interested in particular now, which is medications, I think that the increasing use of medications in pregnancy is just a reflection of the broader society.

00:09:53.100 I heard a statistic the other day, I think this is accurate, that the United States population makes up about 2%, about 4.2% of the world, but we use about 70% of the pharmaceuticals or 50 to 70%.

00:10:05.840 So we're using a large number of medications anyway, background in society, and then that spills over into pregnancy.

00:10:13.300 And so we're seeing more interventions, more medication use.

00:10:16.700 And I think that's just a reflection of the broader society.

00:10:19.260 Okay.

00:10:19.620 In terms of things like induction of labor, we're seeing, I think, less tolerance for watching those pregnancies late.

00:10:29.160 And there's also been studies, a study came out called the ARRIVE trial.

00:10:33.640 ARRIVE is an acronym that made people feel that it was a safer route to take, the 39-week induction, to prevent problems later.

00:10:43.140 The group that got induced in that study had lower rates of hypertension, lower rates of complications, and naturally they're going to have lower rates, if you do it in a widespread population basis, lower rates of stillbirth, etc.

00:10:55.860 Because you can't have a 40 or 41-week stillbirth if you've been delivered at 39.

00:11:00.780 So when that trial came out, it pushed people in that direction towards more intervention.

00:11:05.920 Yeah.

00:11:06.920 It can be difficult for women to find doctors that are striking that balance because I can sympathize with how difficult it is.

00:11:14.840 Obviously, you want to care for the patient.

00:11:16.720 You want to care for the little patient inside her womb. 0.99

00:11:19.500 And the worst case scenario is that someone dies or someone is catastrophically injured.

00:11:25.600 For example, in like a VBAC, you know, vaginal birth after cesarean, for those out there who don't know, there's a risk of uterine rupture, which I guess there's a risk of uterine rupture at, you know, for any pregnancy.

00:11:37.380 But it's increased when you have that scar in your uterus.

00:11:40.140 And I actually had a VBAC after two C-sections.

00:11:43.300 But it was very difficult.

00:11:45.100 Good for you. Way to go.

00:11:46.240 It was difficult to find a doctor who would allow that.

00:11:50.600 And I understand because you're always trying to balance.

00:11:53.680 And actually, the doctor who agreed to take me on and do the VBAC after two C-sections, he was not there for delivery.

00:12:01.840 And the doctor who was on call, she was not pro VBAC.

00:12:07.000 She was very, very worried.

00:12:09.020 But she did let me in the moment because I was very like, no, we're going to try this and I'm going to keep going.

00:12:15.560 And I kept on pushing off having an epidural and I wouldn't get induced or anything.

00:12:20.120 But anyway, it worked.

00:12:21.040 And I went to almost 42 weeks pregnancy, which I guess I just have long pregnancies.

00:12:25.260 But it was fine.

00:12:26.200 I went into labor naturally.

00:12:28.060 You know, it was like probably eight hours and no complications.

00:12:31.500 Praise the Lord.

00:12:32.080 But I just say that to say that it was very difficult to find a team that would balance that, that obviously didn't want anything catastrophic to happen, but also, you know, trusted that childbirth is a natural process and that the risk of uterine rupture is very low.

00:12:50.480 And that it's okay to take that risk.

00:12:52.740 So anyway, there are a lot of just moms out there that have a hard time finding the OBs that will listen to them. 1.00

00:12:58.260 Sure.

00:12:58.440 I give you credit for taking that route and doing it.

00:13:01.460 Congratulations.

00:13:02.260 That's terrific.

00:13:02.600 Thank you.

00:13:02.800 Yeah, I think that with my patients, the main thing for me is to just inform them, inform them accurately, and then support them in the decisions that they make.

00:13:12.800 But the big part of that, of informed consent, is making sure that the patients actually have the accurate information, which in particular in the area that I focus on with medication exposure is a big one.

00:13:24.400 We've been trying to make sure that women have accurate information so that they can make the decision that's right for them and then to try to support them in that process. 1.00

00:13:33.040 It sounds like you got that information.

00:13:34.740 You made the decision that you wanted to and had a successful outcome.

00:13:38.020 Yeah.

00:13:38.280 Which is terrific.

00:13:38.780 Very grateful.

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00:15:09.780 Okay, let's focus on what you focus on, which is medication.

00:15:18.800 You mentioned just a few minutes ago that there has been an increase in prescribing women medication when they are pregnant. 0.96

00:15:27.120 What exactly are you talking about?

00:15:29.120 Yeah, I think what's happened over the years is that we've moved towards less caution with exposures in pregnancy.

00:15:36.160 We've kind of moved away from the precautionary principle of thinking that medications and other exposures could be harmful.

00:15:44.880 Unless they're proven safe.

00:15:46.940 We've kind of turned that on their head and felt like, well, they're probably okay unless we can prove that they're harmful.

00:15:52.200 And so I think we've moved away from that over time.

00:15:54.200 Before I get into that, I just want to say that it's important that I talk about safety of medications in pregnancy all the time.

00:16:31.160 Compassionate care is what you want to provide, compassionate, loving care, but a big part of that compassionate care is giving patients the correct information, telling them the truth about what they're taking.

00:16:42.840 And so that has become, over my career, more and more of a focus for me, especially as I've seen more and more use over time.

00:16:52.420 And these are medications just in general, whether it's for nausea and vomiting early or whether it's for conditions late.

00:17:00.020 The main one I'm focusing on currently is the use of antidepressants during pregnancy because we're seeing so much of that in the general population, but in particular in pregnancy as well.

00:17:10.500 And I think the big thing I feel about it is the patients that I'm seeing just aren't getting the accurate information about what the actual impact of antidepressants, or in particular the SSRI antidepressants are, on the pregnancy, on the developing baby.

00:17:25.480 Okay. I have so many questions about that, but you mentioned all medications, that you're not only talking about SSRIs.

00:17:32.640 So what's the anti-nausea medication?

00:17:35.540 Diclegis or Zofran? 0.90

00:17:37.980 Zofran. That's the one. 0.89

00:17:39.420 Okay. I have taken that, actually not pregnant, when I had like a stomach bug a couple of years ago.

00:17:45.280 It was a miracle.

00:17:46.840 I have never taken a medicine that worked that quickly.

00:17:50.000 Before we get into the SSRIs, because that'll be the longer conversation, like what is your thought about prescribing the anti-nausea medication in the first trimester?

00:17:58.960 Well, I'm glad you got relief from your episode there.

00:18:01.200 I think that it's always, for patients in these scenarios, it's always a balance of risks and benefits and alternatives, and just making sure that the patient's informed.

00:18:12.700 So most nausea and vomiting of pregnancy is well tolerated by the mom. 0.99

00:18:16.620 It may have some physiologic reason for being there in terms of avoiding exposures, avoiding toxins early while the embryo is developing.

00:18:24.820 But some moms will get very severe forms of it, where they'll move into something called severe hyperemesis gravidarum. 1.00

00:18:33.200 That's HG.

00:18:34.200 HG.

00:18:34.960 They'll lose a lot of weight.

00:18:36.300 Their electrolytes will become abnormal.

00:18:38.740 And so it can vary.

00:18:40.180 The rate of that is quite low compared to all background nausea and vomiting of pregnancy.

00:18:45.820 So does it need to be treated?

00:18:47.460 It really depends on the mom and, again, on the counseling.

00:18:51.760 Any medication that a mom takes, virtually any medication that a mom takes, is going to cross over, go into the mom and cross over to the baby. 1.00

00:18:59.760 And I tell my patients that medications are chemicals.

00:19:05.220 They're not naturally occurring substances.

00:19:07.660 They're not like oranges growing on an orange tree.

00:19:10.860 They're like they're synthesized in a chemical manufacturing facility.

00:19:14.740 So if you think about it, if you like look up how chemicals are synthesized, you'll see it's by a lot of steel tubes and workers wearing goggles and they're wearing masks because they're working with chemicals.

00:19:28.380 That's what they're working with.

00:19:29.580 So those come out of the chemical plants and then they get packaged in a little amber bottle and then they get ingested by the women. 1.00

00:19:38.780 So those medications are going to cross over from the mom into the baby. 1.00

00:19:43.120 A drug like Zofran has an impact on the serotonin receptors.

00:19:48.600 Serotonin is a crucial cell signaling molecule.

00:19:53.780 Serotonin is crucial for fetal development.

00:19:56.620 So this discussion now also applies to the SSRIs.

00:19:59.840 Serotonin is absolutely crucial for formation of the baby.

00:20:04.100 And these drugs, Zofran and then in particular the SSRIs, they really impact the serotonin system.

00:20:10.360 So if you just put A and B together, what I just said, the two things I just said, if serotonin is crucial for fetal development, which it is, and there's no scientific controversy about that.

00:20:22.720 And what is serotonin exactly?

00:20:24.620 I know people can take it.

00:20:25.960 It's like a precursor to melatonin that helps people sleep.

00:20:28.740 So sometimes people take serotonin.

00:20:30.920 That's all I know about it.

00:20:32.640 Melatonin.

00:20:33.380 Melatonin is taken for sleep.

00:20:35.380 Serotonin is a naturally occurring neurotransmitter.

00:20:38.260 It's naturally formed by the body.

00:20:40.140 It's in all of us.

00:20:41.200 It's a neurotransmitter and it's a cell signaling molecule that goes way back in evolution.

00:20:47.800 This is a basic chemical compound that helps to, for all of us, regulate our mood, regulate our behavior, regulate our sexual functioning.

00:20:59.440 It plays a significant role for adults, for children, etc.

00:21:02.820 At the fetal level, it plays a crucial role in cell signaling and in actually the formation of the fetus and in particular the fetal brain.

00:21:12.100 I compare it to like a molecule that's acting as a director, an engineer, a supervisor in the building of a building or a town giving directions to the neurons which way to go.

00:21:26.220 The fetal brain has to go basically from zero to like 100 billion neurons with 100 trillion connections.

00:21:35.220 And so what's orchestrating that serotonin and other cell signaling molecules telling the nerves how to grow, where to branch, how to develop.

00:21:45.580 So it's this incredibly intricate, well-developed, well-preserved system that we find through mammals.

00:21:53.260 We find it across the board that's absolutely vital to the formation of a human baby.

00:22:02.660 And so if you've got this delicate system, intricate system that relies on serotonin and other neurotransmitters like norepinephrine, dopamine, that relies on those things.

00:22:11.960 If you have that and you then disrupt it with chemicals like Zofran or like the SSRI antidepressants or other antidepressants, it's going to have an impact.

00:22:23.360 It'll absolutely have an impact.

00:22:24.660 And again, there's not scientific controversy about what I'm saying with that.

00:22:29.200 It's just there's a lack of information in patients understanding that.

00:22:32.860 And so how does Zofran affect serotonin?

00:22:36.560 I guess I just thought it was doing something to your stomach to make you not be nauseous.

00:22:40.720 Is it communicating to your brain to tell your stomach not to be nauseous?

00:22:44.500 Is that why it affects serotonin?

00:22:46.500 Yeah, I believe it's a serotonin receptor antagonist.

00:22:49.280 So it blocks the receptor.

00:22:51.080 And there's a lot of serotonin receptors.

00:22:53.520 I think 90% of serotonin in humans is in the gut.

00:22:57.420 So there's a lot of action there.

00:22:59.260 And so it'll have impact that way in the gut.

00:23:01.460 And then in the brain, there are nausea centers in the brain.

00:23:04.720 And so it'll have impact there.

00:23:07.420 But you're raising a great point,

00:23:09.100 which is that, and I tell patients this,

00:23:11.820 it's that we think of the medications we take

00:23:15.060 as going to the location where we're having a problem.

00:23:19.660 So we think of Zofran.

00:23:21.620 I'm taking that.

00:23:22.480 It's going to make my gut feel better.

00:23:23.960 So I won't be as nauseous.

00:23:25.500 But Zofran is really actually going all throughout the body

00:23:29.560 into all the cells and affecting all of those serotonin receptors.

00:23:33.720 And it's the same thing, for example, with the SSRIs.

00:23:36.780 So patients are thinking that they're taking an SSRI antidepressant

00:23:41.080 like Prozac or Zoloft or Celexa to try to address their depression,

00:23:46.180 their anxiety, what's going on in their head.

00:23:48.120 But in fact, that medication is going all throughout their body.

00:23:52.100 And there's evidence, for example, that patients on antidepressants,

00:23:56.080 on the SSRI antidepressants, have increased rates of bleeding.

00:23:59.240 And it's because another cell that plays a crucial role is the platelet,

00:24:06.120 which is important for stopping patients from bleeding.

00:24:09.640 And serotonin has a huge impact on platelet function.

00:24:13.320 The other area that serotonin has a big impact on is the gut

00:24:16.800 and also bone, bone strength and bone health.

00:24:19.780 So patients that are on SSRIs have higher rates of fractures in their bones.

00:24:24.800 They have higher rates of osteoporosis.

00:24:26.520 So what we find is that these chemicals, this chemical ingestion that's going on,

00:24:31.700 it's impacting not just that one system that patients are thinking.

00:24:35.380 It's going all throughout the body and basically impacting cells in a widespread fashion.

00:24:40.820 Remind me what SSRI stands for.

00:24:43.200 Selective serotonin reuptake inhibitor.

00:24:45.840 Okay.

00:24:46.180 So it's right in the name that it's inhibiting serotonin receptors.

00:24:51.460 So like you said, there's not any controversy over this scientifically.

00:24:55.000 It's just a lot of people don't know what that actually means or why we even need serotonin.

00:25:00.600 A lot of times you'll hear people say someone has depression because they have a chemical imbalance

00:25:05.400 and the SSRI is bringing balance to the chemicals that are imbalanced in their brain.

00:25:10.680 Is that an accurate way to describe what SSRIs do?

00:25:13.640 So this is the sort of story that's been told, but it's not accurate.

00:25:19.680 That's not accurate.

00:25:20.940 There's not evidence for that.

00:25:23.040 That's sort of, I tell my patients, that's sort of more like a commercial to get you to use the drug.

00:25:30.540 Some other people call it profit-driven propaganda is basically what it is.

00:25:35.180 It's a way of trying to sell the product to the public, sell the product to the patient.

00:25:40.940 This notion that you're depressed because you've got low serotonin, and then these medications like Prozac or Zoloft,

00:25:48.680 that they work to correct that serotonin imbalance.

00:25:51.180 That hasn't been shown.

00:25:53.040 That hasn't been proven.

00:25:54.060 What does occur is that it's a chemical exposure having a chemical effect, which really creates an abnormal state.

00:26:02.740 It really creates an abnormality in the brain.

00:26:06.160 It's not solving one.

00:26:08.380 But this, what you just described, Allie, this theory or this explanation is what many patients think,

00:26:17.880 and they think it's like insulin for diabetes.

00:26:20.320 They think, I have a shortage of serotonin, just like I have a friend with a shortage of insulin.

00:26:26.160 They take insulin to address their diabetes.

00:26:28.360 They have better health outcomes.

00:26:30.120 I take Prozac to address my low serotonin.

00:26:33.940 I've seen that comparison.

00:26:34.980 Have better outcomes.

00:26:36.120 But that's not, in fact, what's going on.

00:26:38.820 Diabetes, you can address that with insulin.

00:26:42.360 Depending on the type of diabetes, there can be a mismatch between how much insulin.

00:26:46.600 There's not enough insulin, and so that can address it.

00:26:48.740 But with the SSRIs, there is no proven, and Joanna Moncrief addressed this in her paper a couple of years ago in her current book that she has on this.

00:26:58.340 There is no evidence for a chemical imbalance that you're then addressing or correcting.

00:27:04.140 What you're doing essentially is creating an altered mental state for people by virtue of taking the drug.

00:27:11.080 And this is even more so for the developing baby, because the developing baby has no issue going on.

00:27:18.340 And now, at the point where the developing baby needs to have the serotonin system functioning optimally to form the brain, to form the organs, to wire the brain,

00:27:28.700 it's got this chemical, this synthetic chemical compound coming out of a chemical factory and going into its brain and essentially disrupting that development.

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00:29:05.020 I'm wondering why more doctors don't have the concerns that you are raising.

00:29:12.200 You've mentioned that there are more interventions than there were before, and yet we seem to know more about what these SSRIs are actually doing, how they can affect fetal development.

00:29:24.480 And so what is the disconnect there?

00:29:26.620 Why are we seeing more prevalence of the usage of these drugs on pregnant women? 0.99

00:29:32.760 Yeah, I think there's two things pushing this, basically.

00:29:35.520 I think that the pharmaceutical industry is like the 800-pound gorilla in our lives in terms of how we provide medical care.

00:29:45.280 And they're able to kind of shape the debate and shape the thinking around these topics.

00:29:49.940 And so they're able to throw their weight around through finances and through sponsorship.

00:29:56.900 And I can discuss more of that, how they influence medicine.

00:30:00.400 Sorry to interrupt, but does the chemical imbalance message that you just debunked, does that come straight from the pharmaceutical companies?

00:30:08.460 Is that basically just a marketing slogan?

00:30:10.300 I think of that as a marketing slogan, whether how it was introduced or how it was brought about in widespread fashion, probably through some combination of pharma and what I would call the medical establishment, where that message then took hold.

00:30:29.340 And the messages that the public hears, and this is an important lesson for people to understand, is that the messages you're going to get or hear sort of in mainstream media or through a lot of medical establishment sources are going to be messages that are pro-pharma, that are pro-drug because of the disproportionately high influence that the pharmaceutical industry has.

00:30:57.180 And this is across the board with what I would call the medical establishment.

00:31:01.840 So the information, we have a real problem with information and regulation of pharmaceuticals, of drugs in our society.

00:31:10.440 And a big part of that is because of how strong the pharmaceutical industry is.

00:31:15.140 So the way the system should work is you've got a bunch of patients here who are trying to take care of their health, who need good information.

00:31:21.600 You've got the pharmaceutical industry over here who wants to sell them products.

00:31:27.380 But between the pharmaceutical industry and the patients, you should have this great medical establishment that are working on behalf of the public, trying to protect them, trying to inform them.

00:31:40.580 And that would be places like regulatory agencies like the FDA, like the CDC, as well as institutions like our institutions of higher learning, all of the universities.

00:31:55.000 Also in that middle area between patients and pharma would be experts, the experts in a given area, researchers.

00:32:03.880 And then another aspect of that medical establishment would be the media, trying to inform patients correctly, get out proper information on these things.

00:32:12.660 So the model is you've got pharma here, you've got patients here, and between them what we should have is a real protective layer.

00:32:20.500 But that's not what we have in our society.

00:32:23.000 Our society has failed in this way.

00:32:25.040 For years, the FDA, the CDC, the leading academic centers, even the media were all funded by pharma.

00:32:34.900 So instead of playing that protective role, they're essentially playing a role of salesmen.

00:32:40.880 They're basically working for pharma to get the public to take the medications.

00:32:46.020 And we see this again and again with various models, with the serotonin hypothesis, et cetera.

00:32:51.340 And so that's one part of your answer, why we're seeing more and more women using these. 0.88

00:32:57.060 It's just the pure power of pharma and money that has allowed them to shape the message through pharma itself, but also through these other what should be trusted sources who are basically, in a lot of ways, funded by pharma and then parroting that message.

00:33:15.920 The second reason, though, I think, gets to this notion of toxic empathy that you talk about in your book, which is that we all want to help the pregnant woman who's struggling.

00:33:29.340 Depression can be awful.

00:33:31.220 And a woman in distress who's pregnant, it's very sad, and we want to help that woman.

00:33:37.000 And so there's a human desire to tell that woman a story that's going to be shaped like what pharma is actually trying to say, which is that the medication is okay, it's going to make you feel better, and by making you feel better, you're going to end up with better pregnancy outcomes for the baby, better development of the baby.

00:33:58.100 But I would also call that toxic empathy, that that's not what we need to be saying.

00:34:04.280 We need to be telling the truth, as you very well point out.

00:34:07.100 You need to tell the truth, which is telling a patient in that scenario that this is what the medication's risks are, and you can also review benefits, for example, not going into withdrawal during pregnancy, which is part of the counseling, and then allowing that woman to make the best decision for herself and support her.

00:34:23.920 But that second reason, I think, is how a lot of people in society, even if they don't want to be parroting pharma's propaganda, how they'll still end up doing that because they're trying to give a message to depressed pregnant women or depressed women of childbearing age that will be friendly to what they're doing currently.

00:34:44.840 Can you tell me more about what SSRIs can affect when it comes to fetal development?

00:34:53.920 Sure. That's really the nuts and bolts of it. That's a great question.

00:34:56.820 So early along in pregnancy, I will say, when we look at animal data, the animal data is very clear.

00:35:05.720 When we look at animal data, we see pregnancy complications.

00:35:09.440 If you take a group of mice or rats or rabbits and you expose one group to SSRIs and the other group to a placebo, you see poor pregnancy outcomes in the SSRI exposed group.

00:35:20.840 That's clear. When you do it in humans, it gets a little harder to study because you get into things like, are you going to look at how are you going to tell that they were exposed?

00:35:32.340 Are you going to look at prescriptions? If you look at prescriptions, maybe they didn't fill the prescription.

00:35:37.520 Now you're calling them exposed, but they're actually not exposed.

00:35:40.540 So the study in humans gets more difficult and there's some mixed data.

00:35:45.040 But overall, my take on the science is that we're seeing, just like we do with animal data, we're seeing increased rates of miscarriage.

00:35:53.180 So the woman losing her pregnancy early, we're seeing increased rates of birth defects.

00:35:58.340 It's been clearly shown with some of the drugs, things like heart defects.

00:36:03.320 People usually know about Paxil or paroxetine and heart defects, but other SSRIs and other SNRIs as well have been associated with birth defects.

00:36:12.660 Then moving through the pregnancy, we see increased rates in preterm birth.

00:36:16.840 We see increased rates in PPROM, breaking your water early, having the rupture of the membranes.

00:36:23.080 We see increased rates of low birth weight babies, small for size.

00:36:28.080 They didn't grow well, likely because of the impact of the drugs on the placenta.

00:36:33.060 Late in pregnancy, we see an increase in a disease called preeclampsia, which causes high blood pressure in women and proteinuria, protein in their urine.

00:36:42.680 We see higher rates of that in the women on the SSRIs.

00:36:46.500 At the time of delivery, for sure, we see higher rates of postpartum hemorrhage.

00:36:50.800 There's higher rates of women bleeding who are on SSRIs in pregnancy.

00:36:54.280 Because of the platelet thing you talked about with serotonin.

00:36:57.200 That's exactly right.

00:36:58.340 That's right.

00:36:58.980 And we've seen that for years in other areas of medicine.

00:37:02.640 After surgery, the surgeons have reported on that.

00:37:05.660 But now it's becoming clear in obstetrics.

00:37:08.000 And postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality.

00:37:13.860 You want to make sure when you're delivering a baby that your coagulation system or your blood clotting system is functioning optimally.

00:37:23.340 And as a surgeon, I saw him doing these surgeries.

00:37:27.340 I was in the operating room the other night around 3 in the morning.

00:37:30.220 And when the patient's bleeding, you're really hoping that her coagulation system is functioning optimally.

00:37:36.020 And so this disrupts that likely through its impact on platelets.

00:37:41.980 After delivery, what we see is for sure an increase in what's called newborn behavioral syndrome.

00:37:49.420 Or some people call it poor neonatal adaptation.

00:37:53.080 The kids come out and they have trouble adjusting after birth.

00:37:57.620 They're often agitated or irritable or restless.

00:38:01.120 They'll have trouble feeding.

00:38:03.520 They'll have jitteriness.

00:38:05.100 They can have difficulty regulating their temperature, difficulty with feeding.

00:38:09.920 The babies that come out after being exposed to SSRIs in utero definitely are showing an impact.

00:38:15.620 And it's not a small percentage either, Allie.

00:38:19.200 It's not.

00:38:20.020 When the studies have looked at this, the studies quote rates as high as one textbook or one online textbook cites a rate as high as 85%

00:38:29.960 for seeing some impact of the exposure to SSRIs during the pregnancy.

00:38:35.180 So we see high rates of this, more likely to end up going into the NICU, more likely to have what's called a low APGAR score.

00:38:44.700 The APGAR score is a way of assessing how the newborn's doing after birth.

00:38:49.480 And babies that have been exposed to SSRIs in utero are more likely to have an APGAR at five minutes less than seven, which has been predictive of future problems.

00:38:58.700 And that gets into the big area.

00:39:01.360 Well, what are the future problems?

00:39:03.160 Yeah, that's what I was about to ask.

00:39:04.220 Long-term issues.

00:39:05.580 This is a great question.

00:39:06.780 And again, harder to study in humans because of the difficulty with how are they being raised at that point.

00:39:13.940 There are a lot of other factors.

00:39:15.380 But it looks like the offspring who are exposed to SSRIs prenatally have higher rates of depression, higher rates of anxiety.

00:39:28.400 They have higher rates of neurobehavioral abnormalities, difficulties with motor skills.

00:39:33.940 It depends on the study that's looked at it, but they've found difficulties in speech, delays.

00:39:39.920 And autism is the one everyone asks about.

00:39:42.380 Several animal studies, numerous animal studies of exposure in utero or exposure during development show that the mice and the rats have what they call autistic-like behaviors.

00:39:55.220 We see this in terms of they're not socializing in the same way.

00:39:59.620 And so people have said, well, this could certainly be contributing.

00:40:02.980 When you start talking autism, though, it gets very controversial and very murky because how that diagnosis is made, whether you're talking about just a personality difference versus profound autism, which is an IQ less than 50, lack of verbal skills, etc.

00:40:21.800 It's, you're talking about complexity in the diagnosis, but it looks like without a doubt from the reading of this literature, it looks like there's an impact for sure on the baby's developing brain that then shows up as they grow up.

00:40:35.740 A study just came out, actually, in fact, last week, Zani is the lead author, that looked at mice who were exposed during development and then how they responded, what their fear response was.

00:40:54.100 So they had those mice exposed during development and then as they grew up, they did a study where they exposed them to the stimuluses, mountain lion urine, I think is what they use, because the scent of the mountain lion is their predator.

00:41:07.700 And they can see that the ones that were exposed to SSRIs during pregnancy have a different fear response as they grow up.

00:41:16.400 The same study was then done in humans, where they looked at humans who had been exposed to SSRIs during pregnancy, and then at age 11 to 13.

00:41:25.960 So we're not talking newborn period, we're talking 11 to 13.

00:41:29.440 They did MRIs on them, functional MRI, while showing them pictures to induce fear.

00:41:35.360 Sounds like a terrible study. It's really sad.

00:41:39.240 We shouldn't be scaring 11 to 13 year olds that way, right?

00:41:42.280 But they find a difference in the children or in the adolescents at that point who have been exposed to the SSRIs in Europe.

00:41:49.220 Like less of a fear response? It's a suppressed fear response?

00:41:51.900 More of a fear response.

00:41:52.920 More, okay.

00:41:53.560 They have a heightened fear response and they show higher rates of depression and anxiety.

00:41:59.080 Wow.

00:41:59.360 This just came out from Columbia University Medical Center and it's just out now.

00:42:04.560 But this is not the first study showing this kind of thing.

00:42:08.200 I've been following this literature now, the scientific literature, for 20 plus years.

00:42:13.500 And it's study after study is showing this, these effects on the developing fetus, in particular the developing fetal brain, of being exposed to SSRI antidepressants during pregnancy.

00:42:26.480 Yeah.

00:42:27.080 The one I get asked about all the time is, could there be an impact on sexual functioning?

00:42:32.340 And this has absolutely been shown in the animal studies.

00:42:36.900 So if you expose a mouse in development during the period that corresponds to third trimester human development, if you expose a mouse to an SSRI, a male mouse or male rat, and then you study their sexual behavior in adulthood, their sexual function in adulthood is significantly different than the mice or rats who weren't exposed to the SSRI during development.

00:43:03.100 So different how?

00:43:03.900 They do these studies where they will look at the, they'll expose them during development at an early time and then look at them in adulthood.

00:43:13.520 They present them to a female, mouse or rat, and then they look for activity.

00:43:21.200 They look for mounting. 0.88

00:43:23.360 They look for what they call intermission and they look for ejaculation.

00:43:26.940 And those rates are significantly different in the males that were exposed to SSRIs during development.

00:43:36.040 Like less or more or just different?

00:43:38.340 They see less of that.

00:43:39.640 Okay, less of that.

00:43:40.540 That's what I was trying to understand.

00:43:41.840 So it could be that these SSRIs are affecting the sexual function or desire of, you know, the future adults.

00:43:53.000 Like once they become adults, if they were exposed to SSRIs in utero, it is possible that that will affect their sexual desire and function later on.

00:44:01.500 That's right.

00:44:02.340 This is, again, shown in the rodent studies, in the animal studies.

00:44:06.440 It's interesting the way they do these studies, though.

00:44:08.320 One of the early studies on this was by an author named Masiag, M-A-C-I-A-G, in 2006.

00:44:14.500 And that researcher writes in their methods, they say they put them there and they watch them for an hour under dim red light.

00:44:24.000 I'm not sure.

00:44:24.960 Yeah, I don't know.

00:44:25.860 The dim red light to create the mood for the mice or something.

00:44:29.840 Yeah, I guess so.

00:44:30.260 I don't know if that was a joke they put in there into their paper, but that's what they do.

00:44:33.800 And then they do the video and they see how often are the mice or rats mounting.

00:44:39.860 Trying to procreate.

00:44:40.880 You got it, exactly.

00:44:42.000 And then they look for that and they can compare the two sets of groups.

00:44:45.300 So we're seeing this impact now.

00:44:47.220 I think it's coming more to the fore because there are these questions in our own society of sex and sexuality and gender issues and whatnot.

00:44:55.860 And could, the question I often get asked is, could the exposure in utero be affecting things like sexual identity or sexual behavior in the future?

00:45:08.680 And I would say absolutely yes, because those tracks get laid down during development of the brain.

00:45:15.600 And so could it possibly have an impact?

00:45:18.220 Absolutely.

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00:46:26.920 So what I'm trying and maybe this is a redundant question, but you mentioned that a lot of doctors are simply trying to avoid catastrophe at all costs.

00:46:41.540 And so they will make decisions that they feel are more under their control, like maybe having a C-section or inducing labor earlier on to try to mitigate some risk that could happen later in pregnancy.

00:46:52.060 But what you're saying is that these SSRIs that are given to women actually increase the risk of catastrophic events happening to the baby or mother at the end of pregnancy.

00:47:01.860 And so how does that disconnect exist?

00:47:05.760 You're raising a really good point.

00:47:07.120 And it should certainly be more in the fore, I think, of the OB providers' minds that this is not necessarily the safe route because of this increase, this disruption of fetal development, the impact on bleeding, the problems after birth.

00:47:23.820 All of those things need to come to the fore.

00:47:25.740 But I think what many OB providers are concerned about is another catastrophe, which is a mom's mental health spiraling downwards and suicide and that being the catastrophe that they're concerned about.

00:47:42.200 And I would say here also that really this message, what I'm discussing, these risks that I'm discussing, really need to be risks that are understood in women of childbearing age.

00:47:54.540 And it's too late if you're having this conversation at 12 weeks when I often see patients or at six or eight weeks.

00:48:02.920 It's too late for a couple of reasons.

00:48:04.920 One, the woman's already been exposed now for weeks during embryonic development.

00:48:10.740 So it's too late in that sense.

00:48:12.200 But it's also too late because it's a challenge coming off these medications.

00:48:17.080 One thing that's become clear over time is that there's a real withdrawal syndrome that can occur.

00:48:23.200 And patients have an awful time coming off of these.

00:48:26.340 So that gets thrown into the counseling, which is that the mom has to then weigh that as a risk to coming off of her medication during pregnancy. 1.00

00:48:35.200 So this is a message, what I'm saying here today, and in general about the SSRIs and pregnancy that really needs to get out to women of childbearing age and also providers and primary care providers.

00:48:46.960 I see so many patients in my office every day.

00:48:50.300 And I do this every day.

00:48:51.200 I'm a full-time clinician.

00:48:52.420 I'm taking care of patients.

00:48:53.820 I'm delivering babies all the time.

00:48:56.040 I'm actually taking care of patients.

00:48:57.520 And I see this all the time where they'll come into my office and they'll say, I was started on this during college, after a breakup or after some setback in my life.

00:49:08.720 And then they were maintained on this.

00:49:11.100 And at the time they were started on it, I'm guessing pregnancy wasn't on their radar or wasn't on their provider's radar.

00:49:18.240 But now you get down the road five, eight, ten years that they've been on it for, and those patients can have a very difficult time getting off the medication.

00:49:26.780 And now they're pregnant. 0.99

00:49:28.360 And so this becomes a real challenge, which, again, is why it really needs to be a broader message that gets out to the public about the concerns with the use of these drugs in pregnancy.

00:49:37.120 Okay, so if there is a pregnant woman, she's not on SSRIs, but for whatever reason she feels that she is depressed to a debilitating degree or she has crippling anxiety, what is the healthy suggestion for that woman? 0.69

00:49:53.260 Yeah, I think the important thing is that it's a case-by-case issue.

00:49:56.860 The first thing is you treat her with love and compassion as her family or as the provider, the OB provider.

00:50:03.840 You want to take really good care of her.

00:50:05.540 You listen to her.

00:50:06.340 You find out where she's at, what things are causing this, what's going on in her life.

00:50:13.080 And then the discussion, people often focus for treatment.

00:50:17.940 The people that are more pro-drug use will say it's either drug use or medication use or SSRI use versus no treatment.

00:50:26.280 But that's not really the choice.

00:50:29.000 There's other methods of treatment in terms of family support, psychotherapy, exercise, meditation.

00:50:36.620 There's other methods that don't involve ignoring the pregnant woman. 1.00

00:50:40.600 A lot of times people will present this as a choice between either staying on Zoloft or just ignoring the pregnant woman and making her feel guilty about medication and telling her to suck it up.

00:50:52.020 Like, that's not really what we should be doing.

00:50:55.120 The other alternative for that patient you just presented is explaining what resources are available to her out there, what other options are out there.

00:51:02.620 And that can include a discussion of medication as well, going again into risks and benefits and alternatives with her, and then allowing her to make the best choice and supporting her in that choice.

00:51:14.560 Because, again, from my perspective, I'm going to be seeing her multiple more times during the pregnancy, and I want her to know that, like, I'm in her corner, I'm on her dream, I'm treating her compassionately.

00:51:25.360 And then I'm going to see her after her deliveries either in her next pregnancy.

00:51:29.440 I've been doing this in my community for 20 years, so I'm going to see her in her next pregnancy, or I'm going to see her at the coffee shop.

00:51:35.680 And I want her to know that I took good care of her, that I presented her correctly with the options, and then supported her in the choices she made.

00:51:42.780 Yeah. What about SSRIs that are prescribed to women postpartum?

00:51:48.840 I feel like that would be a pretty common thing, because postpartum can be difficult, and so many hormones, so many things going on.

00:51:57.620 I remember after my first pregnancy, it was like two weeks maybe after I got home, and I saw the cup that I brought home from the hospital, and I burst into tears.

00:52:07.740 Okay, that's not typical for me.

00:52:09.660 And so there's just a lot going on, and I look back, and I think, wow, that was a very paranoid and anxious time for me.

00:52:17.500 I didn't go on SSRIs or anything like that, but I can imagine what a woman would feel like if she was told this SSRI is going to make postpartum easier for you, it's going to make you happier, it might even help your strained relationship with your husband, whatever.

00:52:33.400 I think women are basically made to feel in a lot of cases that if you feel bad at all postpartum, something is wrong, you need to get on medication.

00:52:42.320 How much do you see that happening, obviously not in your practice, but just across the board, and is that different?

00:52:49.040 Like, is the calculation different after she's already had the baby?

00:52:51.840 Yeah, I think at that point, the postpartum time can be a challenging time, certainly, with the hormones changing, and a major thing that goes on at that time is sleep.

00:53:03.220 Sleep is so crucial for humans for regulating our mood, regulating so much about how our bodies function, and that's a disrupted time, a disrupted sleep time.

00:53:14.400 And so we see that along with the hormonal changes, as well as changes in the family during that time, a lot, a lot changes, obviously, during the postpartum period.

00:53:22.980 In terms of what that counseling of the patient looks like, there's not exposure at that point to a developing fetus, but there can be exposure to a breastfeeding baby at that point.

00:53:34.420 And so we look at impact of the SSRIs or other chemicals or medications on breastfeeding, and it looks like it does get into breast milk.

00:53:45.260 The medications do get into breast milk. 0.99

00:53:47.180 The medications do go across into the baby.

00:53:49.720 Many of the studies have shown low levels, but the truth is, is we really don't know what even the impact of low levels are on the developing neonatal brain at that point, because the brain is still undergoing development.

00:54:01.660 So it may look like a low level, for example, to, to an adult or checking a blood level.

00:54:07.500 But in terms of like receptor occupancy in the baby's brain, like how many of the receptors have become occupied by the medication, it may be substantial still.

00:54:16.880 Yeah.

00:54:17.520 So that's one consideration.

00:54:19.120 The other consideration is on the mom is her milk production. 1.00

00:54:23.640 The SSRIs, again, chemicals have chemical effects.

00:54:27.780 Does the breast have serotonin receptors?

00:54:30.240 Yes.

00:54:30.460 Can SSRIs impact milk?

00:54:33.240 And the brain has serotonin receptors, certainly.

00:54:35.400 Can it impact milk production?

00:54:37.300 Absolutely.

00:54:38.320 It can impact milk production.

00:54:39.920 So you've got these effects that need to be reviewed with the mom.

00:54:43.440 And then you're getting into a question about whether there's benefit.

00:54:46.960 And the studies that have been done looking at the benefits of antidepressants versus placebo do not show a really significant or dramatic benefit in that, in the use category.

00:55:02.180 It just doesn't.

00:55:03.080 I hear, you know, for my patients, I trust them.

00:55:05.980 I take their word for it.

00:55:07.160 They're telling me they feel that there's been some benefit.

00:55:09.680 Some of them tell that to me.

00:55:11.060 But when we look at the studies, when we do the studies, it looks like the evidence for benefit is very, very minimal.

00:55:18.680 And so the question in that scenario would be, are there other ways to address what the mom is going through first that are non-chemically based, that aren't going to expose her to a chemical and going to expose the baby to a chemical?

00:55:33.380 Things like family support, things like better sleep, are there other ways of addressing that so that there's not chemical exposure?

00:55:41.800 And then the other question is, is that does the serotonin system in the mom impact the way she bonds with her baby?

00:55:50.360 Does it affect how she's bonding?

00:55:52.580 Does it affect that?

00:55:53.400 Like the way that serotonin system has been worked out for millions and hundreds of millions of years in mammals, does that affect that bonding?

00:56:01.680 And it probably does.

00:56:03.560 Do you want to disrupt that with a chemical effect?

00:56:06.920 And so I think all of that would be part of the counseling.

00:56:10.220 But as I've said, at the end of the day, if my patients decide when presented with their options, if they decide, no, I want to be on this medication or that medication, then they started on it.

00:56:21.120 You support them and you follow them up closely.

00:56:23.420 Yeah, a lot of the symptoms, the outcomes that you listed earlier that you see in the newborn in particular, when the child has been exposed in utero to SSRIs, child agitation, difficulty feeding, and then postpartum difficulty with milk production.

00:56:41.180 All of those things in just a mom who is not dealing with any kind of depression can cause anxiety and can make you sad.

00:56:50.240 If you feel like your child isn't bonding with you, if they're agitated, if there are things going wrong with them after they're born, if you're not supplying enough milk, like that already contributes to anxiety.

00:57:01.860 So it actually seems like the SSRIs could potentially make things a lot worse and make women a lot more anxious and a lot sadder than they would have been otherwise.

00:57:12.920 Sure.

00:57:13.220 I think that's exactly right.

00:57:14.720 And as well applied to pregnancy complications, a preterm birth, developing preeclampsia.

00:57:21.060 It's traumatic.

00:57:21.940 Absolutely.

00:57:22.700 It's hard to recover from that no matter what.

00:57:24.760 That's right.

00:57:25.460 Yeah, absolutely.

00:57:26.100 So can we be making a problem worse with it?

00:57:30.000 Worse, yeah.

00:57:30.180 Absolutely.

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00:58:34.240 Tell me where you think the FDA comes into this.

00:58:37.980 Should there be some kind of change at that level when it comes to patients really knowing the risks of these SSRIs during pregnancy?

00:58:46.640 Absolutely.

00:58:47.560 And I think the current labeling is just inadequate.

00:58:50.700 And I think the time has come, or probably we're past the time, where there's enough evidence that's accumulated showing that there's developmental harm, that's showing that it impacts development,

00:59:01.480 that the FDA needs to look at this and really change the labeling and put a warning on there that's not presently on there.

00:59:08.880 Just, it can be simple.

00:59:10.300 It can be as simple as antidepressants alter fetal development, particularly fetal brain development,

00:59:16.060 to let pregnant women, patients, and the public and providers know this so that it can be part of the conversation.

00:59:23.060 I have so many women that come into my office and I ask them, how are you counseled about being on Selexa or Zoloft during your pregnancy?

00:59:31.820 And they'll often say that they were just told that they're safe and they don't affect the baby.

00:59:38.200 Like that is sometimes the extent of the counseling that women have had on this, that they're safe and don't affect the baby.

00:59:45.400 And that's like absolutely just not the case.

00:59:48.740 Not true.

00:59:49.200 Yeah, they affect, they have impact on the baby.

00:59:51.980 They have impact on fetal development.

00:59:53.480 So I'm working with a group right now to try to pull together a petition to the FDA, to petition to the FDA, to change the labeling so that there is a clearer warning about the impacts of the SSRI antidepressants on the developing fetus and to try to make that clear.

01:00:11.120 And then hopefully with that warning and with more public information about this, like coming on your show and talking to more people about this, hopefully with this, the word will get out.

01:00:22.740 The word will spread so that young women of childbearing age, their PCPs, their psychiatrists and whatnot will understand that being on these drugs, what challenges that have.

01:00:33.900 If they can't get off of them and if they stay on them through the pregnancy, that that will alter fetal development, that will disrupt fetal development with unknown or uncertain long-term impacts.

01:00:45.580 Yeah, we've had Dr. Marty McCary on the show and it seems to me like he would be sympathetic, certainly, to your argument, if not in complete agreement.

01:00:54.440 Speaking of the FDA, I just want to quickly talk about this kind of scandal or when you critiqued the FDA's handling of McKenna.

01:01:04.540 Is that how you pronounce the drug or McKenna?

01:01:06.560 Some people call it McKenna.

01:01:07.800 Some people call it McKenna.

01:01:08.720 Okay, so you criticized them basically saying that this drug is safe and we need to keep it on the market for the sake of racial equity.

01:01:16.920 What was going on there?

01:01:18.360 Yeah, I try to tell people, I focus a lot nowadays on antidepressants, but my broader focus is on just medication exposure across the board in pregnancy.

01:01:30.600 So McKenna was a drug hormone, a synthetic hormone, 17-hydroxyprogesterone that we injected into pregnant women for 20 years.

01:01:41.760 Basically from 2003 until 2023, we injected it into pregnant women with the idea that it could prevent a recurrent preterm birth.

01:01:51.200 From very early along though in the process from the first study that came out in 2003, I thought that study doesn't look right.

01:02:00.020 It had a lot of flaws in it and I was opposed to the widespread use, widespread injecting synthetic hormones into pregnant women that might not work.

01:02:10.300 But it was used for years and it had very high sales for a while.

01:02:16.440 Those sales were then, again, getting back to my point about how the pharmaceutical industry can control the message and the information the public gets.

01:02:24.640 The money from the sales of McKenna was used to sponsor, for example, the professional medical societies like the American College of OBGYN, the American Society for Maternal Fetal Medicine, who then recommended and promoted its use, the March of Dimes, etc.

01:02:38.500 So you end up with this system where the more use, the more money gets raised, the more money gets raised, the more they can pay experts and professional societies to recommend it and the cycle continues.

01:02:50.420 This went on for 20 years.

01:02:53.140 In 2019, the follow-up study to the original one showed that it actually didn't work.

01:02:58.720 And that was after several other observational studies were suggesting that it didn't work.

01:03:03.020 So I had been making noise about this for years and then finally, fortunately, it was pulled off the market in 2023.

01:03:09.560 But one of the arguments that was being made at the time was that we needed to keep this drug on the market because black women have a higher risk of preterm birth.

01:03:21.360 This is the company making this argument.

01:03:23.480 The company was making the argument that because black women have a higher risk of preterm birth, it's important from a racial equity standpoint to keep this drug on the market, which just boggles the mind, essentially boggles the mind.

01:03:37.540 But it's this whole idea of toxic empathy, of trying to get the pharmaceutical industry, trying to craft a message, an empathetic message that will get people supporting their product, really not for any reason other than to increase profits.

01:03:54.820 Emotional manipulation.

01:03:55.580 Absolutely.

01:03:56.060 To try to keep the drug on the market for that reason.

01:04:00.780 I wrote an editorial against that in Stat News, one of the online medical sources, and basically completely arguing against that.

01:04:10.460 I think that it got to the point where I think the NAACP actually wrote a letter in support of the drug.

01:04:18.000 This is saying that in order to have racial equity, we need to keep this drug on the market.

01:04:23.980 The argument I was making, I still, I'm smiling, but I'm laughing.

01:04:28.320 It's like, how does injecting black women with an ineffective synthetic hormone, how is that going to help the black community?

01:04:38.320 How is that going to provide racial equity?

01:04:40.080 All you're doing is you're targeting a group that has a higher risk of preterm birth with an ineffective drug that's not going to work and lead to possible increased risks of harm to moms and babies.

01:04:51.000 Yeah.

01:04:51.220 But this shows how strong the pharmaceutical industry is and how they're able to actually craft the message that gets out to the public.

01:04:59.020 Which is exactly right.

01:05:00.060 It's just a good lesson for anything.

01:05:01.800 Whenever we hear the defense of any drug that sounds a lot like marketing, we should at least ask ourselves, but is that true?

01:05:10.040 And dig into who is actually saying it and why they're actually saying it.

01:05:14.100 Also, a lesson that I was reminded of the whole time that you're talking is so often if a patient raises a concern, especially a mom, the doctor or a professional will say, there's no evidence to prove your point.

01:05:26.420 But just because there's no data to prove something doesn't mean there's data to prove otherwise either. 0.99

01:05:33.780 And very often that's used as kind of a mode of manipulation to make a patient kind of sit down and shut up and make them feel like they're stupid. 0.95

01:05:42.240 But you've also proven that there is a lot of data when it comes to SSRIs and how they're affecting moms and babies. 0.95

01:05:48.980 What can people do?

01:05:50.120 Like you're raising awareness about this.

01:05:52.160 So people are listening to this.

01:05:53.400 They're on fire about this.

01:05:54.740 They want to do something.

01:05:55.540 What can they do?

01:05:56.380 Well, I would say our petition should be coming out here in early summer.

01:06:01.860 And so when that comes out, it allows the public to actually like piggyback on that and also to submit once a docket's opened.

01:06:09.760 So that will be coming.

01:06:10.980 That will be in the works.

01:06:11.820 They can support that.

01:06:12.960 They can also spread the word.

01:06:15.320 Just talking, people talking to each other, watching your show, communicating.

01:06:19.220 The other big thing I just wanted to point out about McKenna is that I was basically arguing against the conventional wisdom at the time.

01:06:27.280 And I was making an argument that was, as you were just describing, sometimes patients do in the office.

01:06:32.780 But it's so important that we support dissent in our society because often that's where the truth lies.

01:06:40.780 And this whole move that we're seeing now towards censorship and towards cracking down on misinformation, that's really harmful to our society.

01:06:50.780 And it's really harmful towards coming up with the truth and the right answers because what it really does is it's meant to silence dissent.

01:06:59.600 Whether it's in the doctor's office when the doctor silences dissent by saying you don't have the information or whether it was with me.

01:07:05.980 I mean, I could have been silenced.

01:07:07.540 I wasn't over McKenna, but I was saying things that were against the conventional wisdom at the time.

01:07:13.820 So it's very important for your listeners and viewers to support the free flow of information and support dissenting voices.

01:07:22.580 This movement that we're having, I feel like, in our society towards censorship and cracking down on misinformation or whatnot is really, it's really errant and really going to lead us down a bad path as a society.

01:07:35.680 Well, thank you for being one of those dissenting voices and for speaking up when it would be a lot easier to just go with the flow.

01:07:43.320 So I appreciate you so much.

01:07:45.080 Thanks for taking the time to come on.

01:07:46.560 Sure. Thank you so much.

01:07:47.500 I appreciate it.

01:08:05.680 Thank you.

01:08:26.820 Thank you.

Relatable with Allie Beth Stuckey - May 14, 2025

Ep 1189 ｜ SSRIs Are Rewiring Babies’ Brains — and Killing Their Moms ｜ Guest： Dr. Adam Urato

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