Lullaby

David Healy, MD
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16
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Hush, little baby, don’t say a word,
Mama’s gonna buy you a mockingbird.
If that mockingbird won’t sing,
Mama’s gonna buy you a diamond ring
If that diamond ring turns brass,
Mama’s gonna buy you a looking glass.
If that looking glass falls down,
All the better for the sweet little babies in town.

Note: Another study published this week suggests that the issue of birth defects on antidepressants rather than suicide or homicide may yet end up as the Mark of Cain by which these drugs are remembered. This post first appeared on RxISK.org.

In The Beginning 

The first report of antidepressants causing birth defects goes back to 1972.

In the 1980s the companies making SSRIs undertook animal studies to look at the behavioral effects of antidepressants on the offspring of animals given the drugs during pregnancy. These were difficult studies to do because the companies at the same time had to avoid generating evidence of major birth defects, when there was good reason to think the drugs might cause birth defects. The studies that were done gave evidence of both developmental delay and birth defects. This evidence never saw the light of day.

Then a strange study appeared from Motherisk in Toronto claiming there were no behavioral problems in children borne to mothers on SSRIs. The methods used were just what you might have used if you didn’t want to find a problem. This was such an unconvincing study it almost came labeled with Smell a Rat.

In the last five years several decently done studies have been published all pointing to problems such as increased rates of Autistic Spectrum Disorder (ASD) or Developmental Delay (DD) in children born to mothers who have been on antidepressants, primarily serotonin reuptake inhibitors through pregnancy. Aside from the Motherisk study, there is no study saying there is no problem.

A New Study and New Concerns

On Monday a new study by Harrington and colleagues was published with the finding that there is a three to four-fold increase in the rates of Autistic Spectrum Disorder and Developmental Delay in children, especially boys born to mothers who have been on antidepressants through pregnancy. This has already had considerable media coverage.

There are further studies with comparable findings in the offing.

Added to all the evidence from animal studies and epidemiology studies that SSRIs double the rate of major birth defects, double the rate of miscarriages, and increase rates of voluntary terminations, this extra evidence really suggests that these drugs should all be pregnancy category D if not category X.

Not only this but it looks as though the SSRIs may redefine what it means to be a teratogen. Other teratogens produce their effects in the first trimester of pregnancy when organs are first being formed. But it looks like antidepressants used in the third trimester can lead to autistic spectrum disorder and developmental delay.

Pregnancy Category D

Pregnancy drug category C which is what most antidepressants currently are means ‘Use with Caution’. Category D means ‘Do Not Use’. Here’s what a Category D warning would look like:

Category D: (See WARNINGS sectionPregnancy Teratogenic Effects: Pregnancy).

SSRIs can potentially cause fetal harm when administered to pregnant women. If LEXAPRO-PRISTIQ-CYMBALTA  is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Because of experience with other members of the SSRI class, LEXAPRO-PRISTIQ-CYMBALTA is assumed to be capable of causing an increased risk of congenital abnormalities when administered to a pregnant woman during the first trimester. Because use of these drugs is rarely a matter of urgency, their use during the first trimester should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physicians about the desirability of discontinuing the drug.

When these issues have come up before on RxISK we have tried to engage Mumsnet and anyone else who thinks that putting material like this into the public domain is just scare mongering. We should be much more responsible. (See I’m not Pre-Pregnant, I just have a Womb, and linked posts – The Dark is for Mushrooms, not for Women, and Preventing Precaution and Mumsnet).

A warning like this does indeed look off-putting and scary. There has been almost no response from women.

Why Benzos and not SSRIs?

But the extraordinary thing about it is that this is the warning that’s on benzodiazepines in the USA. Substitute benzodiazepine for SSRI and XANAX for LEXAPRO-PRISTIQ-CYMBALTA and you have the XANAX warning.

Even more amazing is the fact that there is not a fraction of the animal studies or epidemiological data pointing to pregnancy risks on benzodiazepines comparable to the data there is for the antidepressants.

The MHRA is Britain’s FDA equivalent. Asking them about the pregnancy risk of benzodiazepines turns up no evidence in the last 20 years that they are aware of indicating a risk from benzodiazepines. According to MHRA, they have been advising women not to take benzodiazepines from the get-go and the warnings were strengthened when the marketing of SSRIs got into full swing in the 1990s and SSRI companies were doing a great deal to blacken the name of the benzodiazepines.

There is nothing about the UK warnings that looks half as scary as the FDA warning, but FDA provide no link to the evidence base for this warning.

The best explanation for this warning is that it’s a hang-over from efforts twenty years ago by SSRI companies to elimination benzos and replace them with a group of drugs that cause as many if not more problems. This was a supremely successful marketing campaign to make Valium seem darker and scarier than Prozac. On the street Valium sounds almost as dangerous as Heroin – while within mental health care if forced to take Valium or Prozac for life, nine out of ten staff would take Valium. Prozac – and other SSRIs – are by far the darker drugs.

Meanwhile Back in Denmark

Meanwhile Back in Denmark, as elsewhere, there is a drive to screen all pregnant women for depression and get them on antidepressants.  Women are being bullied and harassed into treatment by unfounded claims that leaving a depression untreated will cause birth defects and developmental delay.

Peter Gotzsche, one of Denmark’s leading epidemiologists, a longtime skeptic about many screening programs,  and more recently someone who has been publicly wondering whether  psychiatry needs to be compulsorily detained because of the risk it poses to people in general (Psychiatry Gone Astray), gave a lecture 6 months ago to Danish doctors on the insanity of screening for depression in pregnancy.

A video of his lecture can be found here.  The Transcript of the screening part is here.  The section on screening is almost at the start.  The horror on the video wonderfully transcends translation and perhaps is all the better because of Peter’s lack of training as a stand-up comedian.

Hush little baby don’t you Cry
Momma’s gonna buy you an SSRI.

* * * * *

16 COMMENTS

  2. Hello,

    These findings are both deeply painful and validating at the same time. My son has a form of autism and learning disabilities which I have long felt were caused by the Phenergan (Category C) I took ( for 5 months) while expecting him. Although I was repeatedly reassured that these meds were “very safe and necessary,” given my severe morning sickness, I feel now that they probably contributed to or completely caused his difficulties. The problem is that Phenergan, like the SSRIs and numerous other drugs given to pregnant women have never been adequately tested, so drug companies keep selling them and women keep using them. I consider this lack of testing of drugs given to pregnant women a crime; I wonder when we will wake up and rein in our out of control capitalistic economy that allows this sort of thing to happen to children and their families. My son and thousands upon thousands of others are paying the price for the lack of objective oversight by our FDA.

    Breaks my heart,

    Cindy

  3. I want to point out that critics of so-called ‘anti psychiatry’ advocates will point out the devastating toll on the children of mothers who have untreated depression and mood disorders. Mothers who are struggling mentally and emotionally can abuse or neglect their children. There is a need to expose the truth about these potentially harmful medications on pregnant women and their unborn children; for that I am truly grateful to you Dr. Healy. We have expose not only the cover up by Big Pharma but we have to equally expose the truth about the lack of support that mothers are receiving during and after a pregnancy, especially low-income mothers in the U.S.
    Let’s avoid being single issue advocates and fight not just for full disclosure before medicating, but lets lobby for a generous pregnancy leave act, supporive workplaces, a single payer health care system, Doula care, and respite care for all new mothers.

    • Madmom.

      The problem is that the vile “Mother’s Act” was an evil Big Pharma ploy to find new markets for SSRI’s that have been shown to be almost no better than placebo with a host of nasty effects including the ones described by Dr. Healy here. And worse, many treacherous women served as Big Pharma hacks to push for this horrible law to get all new mothers screened for this bogus depression, bipolar and other bogus illnesses that would only get them a stigma for life and toxic drugs that might lead them to even kill their children with Andrea Yates serving as the poster child.

      The so called depression and bipolar mood disorder “illnesses” were nothing but biopsychiatry/Big Pharma marketing inventions/ploys to push the latest lethal SSRI’s on patent when they came out after the prior big push for anxiety drugs before that for the same purpose. See Dr. David Healy’s great book, Mania: A Short History of Bipolar Disorder, that exposes this vile fraud and predation on mostly women as usual that makes their lives much worse in the short and long run. Also, See Dr. Joanna Moncrieff’s article on MIA just posted that laments about so many people being hooked on so called “happy pills” that are not only useless, but destroy people’s confidence in themselves to cope with typical life challenges. The problem with your post is that like any DSM stigmas, they can lead to self fulfilling prophecies due to the brain washing of supposed doctors who are really wolves in sheep’s clothing.

      • I agree with what you said. But you didn’t address my concern for the welfare of the children. Mothers whose depression is so bad that they cannot get up out of bed to feed their children and support their children emotionally is a serious problem because then you have children who will develop bad coping mechanisms to deal with neglect and the cycle of depression continues.

        I believe that SSRI’s can make things worse and cause harm to children in utero. That is what the evidence shows. But what are we going to do to replace medication therapy with? Yes, we need whistle blowers but we need more than whistle blowers; we desperately need to help mothers today! Are we connecting vulnerable mothers and children to people who will cook and clean for them and change their children’s diapers and play with their children while they are in bed and miserable? Many of these moms are single.

        In my state, my grandson’s mother has had her son on the waiting list for Head State (meaningful daycare) for over 2 years! There are still forty kids ahead of my grandson and he hasn’t developed speech yet! I had to quit a full time job so I could fill in as his babysitter Without me, my son’s ex girlfriend would be posting ads in Craigslist for a babysitter so she can work!Then she falls in bed exhausted too exhausted to support her son emotionally. This is how abuse and neglect starts. It is a social economic problem.

        Are there any Doula organizations in your state for teen parents? If so, I would recommend that anyone who criticizes SSRI’ use during pregancy make a donation today to the local Doula organization because it is good to be a whistleblower but it is better to do something concrete today to help a young mother.

  5. As much as I usually appreciate Dr Healy’s insights, this seems to be quite a one-sided view of this article–a retrospective study, with a “finding” that comes with a lot of caveats and has to be taken in context w/ other literature on the topic. The authors note this and note the problem of recall and other biases in their study. They also note that depression itself is a risk factor for autism. As with any drug treatment, a consideration of the risks vs benefits needs to be considered for each patient who is considering pregnancy or who is already pregnant.

  6. To claim that science has betrayed humanity would be wrong. Not science but scientists. And not all scientists. Just those that have been bought. But from the look of it that amounts to quite a few scientists. Clearly the pharmaceuticals can not be trusted.

    I am not sure psychiatrists should be called scientists. They may have gotten some of the training but in their practices they more resemble merchants wanting to move a lot of product. In this case drugs. They must also have muzzled their consciences. Think of all the damaged children.

  7. Once we accept the fact that drugs are not a solution then we can put full energy into something that is. America presently as a society is a bad one. That is a fact. It’s depressing. If a pregnant woman is depressed that is a communal problem. Does she have friends? A husband? Etc. Prescribing a drug is farcical. A bad joke. No solution is preferable to a dangerous one.

    They say she seemed to get better. We have no alternative. They saved my life. Etc. People also promote the drug. Henry gets out of bed now and does things. Maybe staying in bed was a better solution. I doubt he would spend the next fifty years there. No one can know if a drug saved someone’s life. There are alternatives. Seemed to get better is not got better. Prove she is really better now. You mean she is less of problem to you.

    People are not machines. Would you put random stuff in a new BMW that was not working well? Psychiatrists are not nearly as observant as a good car mechanic. Even if we were machines a psychiatrist would be the wrong person to see. They hardly notice who you are. They are in a trance as far removed from sanity as you are.

  9. To all, First of all somehow find a way to move on to these sources :
    The book ” Healthy Healing ” by Linda Page who happens to be a Traditional Naturopath ! Also the website http://www.herbdoc.com !
    Study Russell Blaylock M.D. retired neurosurgeon his writings and youtube videos. Regardless of what it’s opponents say Homeopathy works ! So does Naturopathy ! So does friendship ! So does http://www.yuenmethod.com so does Hal Huggins protocol dentistry ! Check out Peracelsus Klinic (google it) just to be aware of what they do there. Fight for real organic gardening organic produce and foods and for pure unadulterated water.
    Sadly what Doc Healy is writing about sounds to me like organized eugenics .If that is so revolution is called for. Civil disobedience to the best of our ability without getting caught by authorities becomes obvious. Read Thomas Jefferson ,Thomas Payne,Abraham Lincoln, George Washington, Benjamin Franklin. Rebelthecartel
    Just my opinion,
    Fred

  10. When I saw the video from Denmark about the SSRI pressure on expecting mothers, I didn’t believe it. The doctors are mad.
    David, what about Research on Records from years ago, before SSRI’s, came into use, what do they show up in terms of extreme behavior in people that might have taken SSRI’s or psychotropics if they were around then?

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