Chemicals Have Consequences: Antidepressants, Pregnancy, and the New York Times

Adam Urato, MD
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Depressed pregnant women need good care.  They should not be made to feel guilty for the choices they make concerning their depression or lectured to by those who don’t understand the area or lack compassion for them.  In that sense, Andrew Solomon does the public a service by turning his attention and writing talents to the topic of depression and pregnancy this week in the New York Times.  However, a crucial part of providing good care to depressed pregnant women is to give them accurate information on the topic.  In this sense, Andrew Solomon falls short, as his article misses the mark in several important areas.  I will address these point by point:

1. Chemicals Have Consequences for Developing Babies

I have been lecturing and writing on this topic for the past decade and one of things that stands out most to me is that there is some public misunderstanding about the fact that the agents that we call “antidepressants” are actually synthetic chemical compounds that are made in large chemical factories.  When pregnant moms take these drugs, these chemical compounds are going into the baby’s organs and affecting essential processes all throughout the baby and for the entire pregnancy.  This “toxic chemical” aspect of the subject seems strangely to be missed in much of the public discourse on the topic.  The key question is:  “What exactly happens when these foreign chemicals are entering into the baby throughout development?”  This is a crucial question for the public and this is the question that we (eg the public, medical science) need answered.  It seems absurd for us to think that there is no effect to the baby from exposure to these synthetic chemical compounds.

I have communicated with Andrew Solomon by phone and email on this topic and I encouraged him to help advance the public discourse on this topic by using his article to talk about the “chemical” aspects of this problem— What exactly does happen when these chemicals are entering into the baby throughout development?  While I don’t think it’s appropriate to quote my communications with him directly, I do feel comfortable saying that he gave me the impression that he wanted to get into this “chemical” area in this current essay but that the “chemical toxicity” aspect is considered too technical for New York Times readers.  I think this is tragic, because this is a major aspect of this topic.  An essay on depression during pregnancy and antidepressant use that does not explore the chemical toxicity aspects is very limited.

To elaborate on the topic of chemical toxicity, I want to focus for a moment on male sperm formation (a little odd for a specialist in Maternal-Fetal Medicine, like myself, but please bear with me).  Several recent studies have shown that males who take SSRI antidepressants will have reduced sperm concentration, more sperm with DNA fragmentation, and more abnormal sperm.  (Again, it appears to be a toxic chemical effect.)  This has now been shown in several studies and it is not an effect of the males being depressed or anything like that (we know this because we see these toxic sperm effects in healthy males who are given the drugs as an experiment or in males who are taking the medications for premature ejaculation—not for depression.)

Most scientists who study this area recognize that these toxic effects of the SSRIs on the development of male sperm make sense.  After all, SSRI antidepressants are synthetic chemical compounds and it likely that they would have a “chemical” effect.  So why would such chemicals (the SSRI antidepressants) that have toxic effects on developing sperm not have toxic effects on a developing baby?

We know that serotonin is a neurotransmitter and cell-signaling molecule that is absolutely crucial for a baby’s development.  We know that antidepressants (ie SSRIs) freely cross the placenta, enter into the baby, and disrupt this serotonin system.  However, discussion of this area of chemical effects or toxicity was almost completely missing from the article.

2. No one Wants a Pregnant Woman to Kill herself.  (Anecdotes have Limitations)

An article in which pregnant women stop their medications and kill themselves while others continue on their meds and have happy outcomes is sure to push readers in an obvious direction.  However, such anecdotes are limited.  For example, the author could have told stories of women who stayed on their medications, weren’t counseled regarding the risks, and had severely impaired babies. Or women who stayed on their medications and increased the doses and then committed suicide.  Anecdotes can be powerful stories and emotionally push readers in one direction or another.  But for every anecdote supporting one viewpoint, there is another one to support some other viewpoint.  That is why we need to be scientific and ask what exactly these chemicals are doing for the moms and the babies.  For example, the scientific research does not support many of Andrew Solomon’s anecdotes.  In the actual studies, the women who stay on their medications are more likely to have pregnancy complications (eg preterm birth, preeclampsia, and newborn complications) than the depressed women who do not take medications.  If the anecdotes reflected the science there would have been more anecdotes about women on the medications who had children with heart defects, preterm birth, seizures, and autism.

Let’s be clear that if a woman is suicidal when she stops her medication, then it certainly sounds like she needs to keep taking her medication.  A dead mother is no help to herself or her baby.  But many of the women whom I counsel and many of the women on these medications do not consider themselves to be in that category.  Finally, we need to keep in mind, that issues regarding antidepressant use and suicide are complex.  It should not be forgotten that the SSRI antidepressants have been found to increase suicidality in young people who take them. That is why the FDA placed a black box warning on them in 2007 and it’s what was found in a 2009 review published in the British Medical Journal.  As far as I can tell from the research studies, the best available evidence shows increased rates of suicide with the use of antidepressants by young women and not a protective effect.

3. Many Excellent Studies in Well-respected Journals are Showing Harm

At one point in the article he writes:  “Many have heard that SSRIs can be terribly harmful from online message boards, from news reports influenced by an individual doctor, or from small studies that have been amplified into universal statistics.”  This suggests to the reader that the scientific evidence of harm is weak (online messages, an individual doctor, small studies) but this is just not the case.  In the list below I am going to hyperlink to numerous human studies that are found in the world’s leading medical journals showing the evidence of harm.  But I want you to understand that I could hyperlink to dozens and dozens and dozens more human and animal studies that show harm when we expose developing babies to these chemicals:  Human studies show that SSRI use during pregnancy is associated with miscarriage (Canadian Medical Association Journal), birth defects (British Medical Journal), preterm birth (PLOS One), preeclampsia (British Journal of Clinical Pharmacology), decreased fetal head size (Archives of General Psychiatry), newborn behavioral syndrome (Archives of Pediatrics and Adolescent Medicine), seizures (American Journal of Obstetrics and Gynecology), neonatal EKG changes (Pediatrics—the official journal of the American Academy of Pediatrics), childhood brain malformations (Neuropsychopharmacology), and long-term neurobehavioral issues like ADHD (Molecular Psychiatry) and autism (Pediatrics—the official journal of the American Academy of Pediatrics.)

4. The Antidepressant-treated Group Never has Improved Pregnancy Outcomes in the Scientific Studies

The model that the public has been sold on this topic by the key opinion leaders in reproductive psychiatry (many of whom have been paid by the antidepressant makers themselves) is as follows (I refer to it as the “helpful antidepressant model”):

A) Depression during pregnancy leads to pregnancy complications (eg preterm birth, preeclampsia, and newborn complications.)

B) Antidepressants are safe and effective at treating depression.

Andrew Solomon’s essay appears to embrace this model.  But if a) and b) are true, then the research studies should show that the antidepressant-treated group has improved pregnancy outcomes (ie fewer pregnancy complications.)  But this is never the case.  What the studies show, again and again (dozens and dozens of them), are worse pregnancy outcomes in the medication group (that is, the group that is chemically exposed.)  The medication group has more birth defects, preterm birth, preeclampsia, newborn complications, etc.

Many defenders of antidepressants like to use insulin and diabetes as a supporting example for the “helpful antidepressant model.”   (“You wouldn’t ever tell a pregnant diabetic not to take insulin would you?” they argue.).  But this example actually works against their argument.  I take care of pregnant diabetics on a daily basis and I can tell you both from first-hand experience and from what the scientific research studies show that proper treatment of diabetes with insulin leads to better pregnancy outcomes—and it is not hard to show this.  The treated diabetics do better with their pregnancy outcomes—they have fewer birth defects, less preeclampsia, etc.  The fact that we keep seeing the exact opposite with antidepressant use during pregnancy shows that the “helpful antidepressant model” above is broken.  And it’s broken either because points a) and/or b) above are not true, or that any benefit of the antidepressants is overwhelmed by their toxic chemical effects on the pregnancy.

5. What about Autism?

Rates of autism have been increasing dramatically and the public wants to know what things may be contributing to this.  Exposure to SSRI antidepressants in utero have been linked to autism in the offspring.  It struck me as somewhat remarkable that the word “autism” doesn’t appear even once in Andrew Solomon’s article.

It is now clear from the scientific research that serotonin plays a key role in brain formation.  The antidepressant chemicals alter that serotonin system, so we should expect these chemical compounds to impact the developing brain.  Animal studies show increased rates of autistic-like behaviors in exposed offspring.  Several human studies have also shown this.  The most comprehensive review of this research was just published.  I will quote the conclusion of the study:  “The findings of this meta-analysis and narrative review support an increased risk of ASD [autism spectrum disorder] in children of mothers exposed to SSRIs during pregnancy.”

If a patient in my office asks me, “Doctor, is there any scientific evidence that using these drugs during pregnancy might lead to autism in my child?” What should I tell her?  How does Andrew Solomon suggest that we answer this very important patient question?

6.  The Power of the Drug Industry

A major “player” that is missing from Andrew Solomon’s story is the antidepressant industry (Big Pharma as some call it.)  I don’t think you can tell the story of antidepressant use in pregnancy without reference to this industry and he basically doesn’t touch on this—aside from mentioning my concerns.

Some facts are clear.  Women of childbearing age are major users of antidepressants.  The drug industry knows this and women of childbearing age have been targeted by drug-industry marketing for decades.  However, one big “obstacle,” from a drug-industry standpoint, to women taking these medications is the “problem” of pregnancy.  Pregnancy could be a reason for a woman to never start up on an antidepressant (“what if I can’t stop when I want to get pregnant?”) or it could be a reason for a woman to stop taking her antidepressant (“what effects do these chemicals have on my developing baby?”)  She may stop and never resume taking the drug.

It seems clear to me that from a drug company sales standpoint, the best case scenario is to downplay risks and have women of childbearing age view these drugs as basically being safe in pregnancy.

I don’t think it’s just a coincidence that throughout the past three decades, as society has been trying to figure out if these medications are safe for use in pregnancy, that the leading centers of reproductive psychiatry and the key opinion leaders have been paid large sums of money by the antidepressant makers.  (This has been reviewed in detail here, here, and here.)  Why were the drug companies pouring so much money into the pockets of the reproductive psychiatrists?  Did that money influence the conclusions of those groups that these medications are basically safe in pregnancy?

Andrew Solomon emphasizes scientific doubt and uncertainty in his article, but he doesn’t mention how the antidepressant industry funds much of the science in this area and how industry uses “sowing doubt” in the public mind as a technique to confuse the public about chemical harms in order to keep selling their product.  This is, like, the oldest trick in the book (from cigarettes to asbestos to benzene.)  The antidepressant industry has been pouring millions of dollars into academic medicine over the past decades and for many in the public there seems to be a lot of doubt about whether antidepressants (synthetic chemical compounds that enter into all of the baby’s organs and alter essential physiology) harm the fetus.  Does anyone believe that it is a coincidence?  What would the science actually look like if it weren’t exposed to (or corrupted by) industry dollars?

7. No One Should be Telling Pregnant Moms What to Do

Depression during pregnancy can be a tremendous challenge for women, their families, and their medical providers.  I take care of patients with depression during pregnancy on a daily basis and I can tell you, first hand, that it is heart wrenching and that I strongly believe that these women need excellent treatment and care.  Part of that excellent treatment, I think, is getting these patients correct information so that they can make the best decisions about how to handle their depression.

Some argue that the “correct” information that pregnant women need is that these chemical compounds are safe for moms and developing babies.  I disagree with that.  I think that these chemical compounds come out of the chemical factories, go into the pregnant moms, and cross over freely into the developing babies.  I think they enter into all of the baby’s organs and act with a toxic effect, disrupting crucial processes that have been a part of fetal development for millions of years.  I think that these “antidepressant” chemical compounds cause injury to these babies.

But, while I strongly believe that the drugs cause harm, I don’t believe that a pregnant woman should be told that she should take a medication or that she should not take a medication.  That is an individual choice and one that should be respected.  What I do think such women need is an honest discussion about what the best available scientific evidence suggests are the risks, benefits, and alternatives to the various approaches.  The woman should then decide what’s best for her (in consultation with her family, mental health providers, other medical providers, and others whom she chooses.)  She should be supported in her decision (whatever it may be) and given the best care possible throughout her pregnancy and beyond.  That is how I care for my patients every day.

30 COMMENTS

  1. You say “Let’s be clear that if a woman is suicidal when she stops her medication, then it certainly sounds like she needs to keep taking her medication.”

    This is one of the biggest mistakes the medical profession makes- mistaking a withdrawal syndrome for a return of the “underlying illness” and an indicator that people do, in fact, “need” their medication.

    If the pregnant women you speak of are discontinuing their medication quickly (as I assume many do, as they’re already pregnant and wish to get the drug out of their body so as not to affect the fetus- most good tapers of SSRIs last for 9 months or longer, which would continue to expose the body- albeit to decreasing levels of the drug over time) – the suicidal ideations and actions are more than likely from abrupt withdrawal/cessation of the drug.

    • Great point Elocin which means another option needs to be presented to pregnant women on antidepressants who are concerned about the drugs harming their baby but have suffered WD symptoms from tapering too quickly that greatly impacts the quality of their life. They should be given the option of going on a tapering plan that is slow enough to not cause WD and hopefully by lowering the dose will lessen the risk of harming the baby long term. Any research on situations like this?

      • no, go to surviving antidepressants they are the best …………
        I been off drugs now 6 months, effexor, the devils tic tacs, had to bridge to that bastard zoloft…… 6 months of praying I will die, but waking up every morning to repeat the agony again……….. I tapered (too quickly) over 3 months……….. Now, I am finally recovering……….. Those drugs are poisons, not only mentally, but on effexor, I had stage 3a kidney disease, stuffed liver, high blood pressure and high cholesterol………… off that poison for 18 months,,,,, all back to normal…… Yeah the doctor wanted to add more, and more drugs…………….effexor for 8 years? lost everything, ended up on disability support………….. Great drugs eh?

        • ang

          I know exactly what you’re talking about concerning Effexor. Yes, it is certainly the devil’s tic tacks, and then some. After being on it a number of years, at a dose that would have knocked a horse to it’s knees (and no doctor thought it was unusual) I began walking out into traffic as I walked down the sidewalk to go to work. I was dead to my emotions and felt nothing for anyone or anything and certainly not anything for myself, and I began flirting to see how lucky I would be on each day that I walked to work. I’d be walking down the sidewalk and all of a sudden I’d turn and walk out onto the street, all without looking. I didn’t even care about how what I was doing might end up hurting someone else, as well as myself. Thank goodness I never got hit but there were certainly lots of angry drivers. And then I tried to kill myself because I was so numb that nothing mattered anymore. Devil’s tic tacks is exactly what they are!

  2. Hi Adam-thanks so much for your post. I hope that you write a letter to the New York Times. You are entitled to equal coverage.

    There are alternatives for treatment of dysphoria in pregnancy. The case for distress being linked to inflammation continues to increase. In addition to the information in my article in Frontiers in Psychology and in my recently published book, an article by Setiawan, Wilson, et al. 2015 JAMA Psychiatry I found particularly convincing. In terms of what to do about inflammation, Charles Serhan, a biochemist who works on lipids, studies how omega-3s influence leukocytes. Omega-3s are anti-inflammatory. There’s also a literature on omega-3s and pregnancy (JR Hibbeln). So there are healthy ways to treat distress.

    • Thank you for pointing out the toxic nature of the antidepressants, Adam. And I agree, I hope you send this or a similar piece to the New York Times. I find it quite staggering that “the ‘chemical toxicity’ aspect is considered too technical for readers of The New York Times.” Just how stupid does The New York Times consider it’s readership to be?

      As one who had the ADRs of a NSAI and the common symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar,” I do agree with the commenters above about the importance of educating the public not only about the toxic nature of the antidepressants, but about the common long run withdrawal symptoms of the antidepressants. Especially since the medical community as a whole is either unaware or not forthright with patients regarding these withdrawal and adverse effects of the pharmacutical toxins.

      I do so hope to see fair and balanced information in the newspapers again some day. Truly, living in a society where the “news” is nothing but pharmacutical industry biased propaganda is not beneficial for the majority within our society. And I’m quite certain the medical evidence of the “chemical toxicity” of the SSRIs is not too technical for most readers of The New York Times.

      Please consider sending in a piece in to The New York Times.

  3. Thank you for this response to what I found a very disturbing article in the New York Times implicitly encouraging the use of meds. while pregnant in my opinion.

    I have mentioned many times that I feel that my young adult son’s difficulties dating back to his early childhood, which have been diagnosed as autism, are related to the Phenergan (used to ‘treat’ my severe morning sickness) I took while expecting him. I cannot tell you how much I regret that I followed my doctor’s advice about this. I found out – with my other two subsequent pregnancies – that there were many options that were not mentioned or tried with my oldest son’s pregnancy. These alternative approaches prevented me from using meds for these two following pregnancies. Medications always come with side effects and they often do not treat the underlying conditions very well, especially with anti-depressants. Discontinuation syndromes are real and often account for the effects of reducing or coming off prescribed drugs. Any and all alternatives should be used before meds, especially for pregnant women.

    Thanks for this article.

  4. Thank you, Adam, for this article. I also think you should submit this to the New York Times or a similar publication.

    One question – considering that Andrew Solomon “emphasizes scientific doubt and uncertainty in his article” – does he consider how much of a problem there is with the reliability and validity of depression as an “illmess”?”

    In the latest DSM field trials (link below), Major Depression received a reliability rating of 0.32; on a scale where 0.2 would be pure chance and 1.0 would be perfect agreement (meaning chance of an agreement between two psychiatrists about whether the same patient “has depression”). Therefore, diagnosing major depression is often little better than chance.

    In practical terms, this means that like many people who did not “have depression” were included in the studies you cited, whereas others who should have been included were excluded. If we are meant to believe in the validity of any of these studies, is this not a problem?

  5. Adam

    I have read and copied (for others to read) many of your blogs exposing the potential dangers of antidepressants for pregnant women and their unborn fetus. I very much appreciate the work you are doing.

    In some of your blogs you have used the word “baby” to describe an unborn fetus. You are a doctor who uses the best that science can offer to critically analyze the current research on this topic. Why do you degrade your analysis by using a politically charged unscientific term that actually appeals to the arguments posed by right wing misogynists to justify opposing a woman’s right to control her own body and her own reproductive rights?

    Rightwing elements use the term “baby” in place of “fetus” to gather sympathy and emotion to oppose a woman’s right to choose an abortion by calling these women and their supporters “baby killers.” We are talking about the absolute essential and necessary human rights for half of humanity when we discuss the topic of abortion. And really, ALL OF HUMANITY, because the freedom of women, in the final analysis, is inseparable from that of men.

    We do not need to stoop to a level of using unscientific terminology and false sympathy to prove our case regarding the harm done by psychiatric drugs.

    Richard

    • Richard,

      Ever seen a sonogram of a “fetus?” Ever met a woman who suffered enormously, for years after an abortion? Because there are some realities there that cannot be ignored. Interesting that Planned Parenthood has its roots in eugenics… Not sensationalism, just facts:

      http://www.washingtontimes.com/news/2014/may/5/grossu-margaret-sanger-eugenicist/

      The Supreme Court has left it up to the states to put some restrictions on abortion – ie, viability, late-term, etc…. Should a woman have the right to terminate a pregnancy after the baby is viable… or worst case. the day before it would otherwise be born? If so, Just how humane is that?

      It seems to me the term “fetus” is reductionist. What about a “being” – maybe not fully human as far as you’re concerned… but, certainly in the process of becoming more fully human… Are we not all in that process? I do not judge someone who has had an abortion… In fact, I’ve known women who have had them. I would ask you to try to understand that being pro-life is not restricted to men… Many women are for the pro-life cause, after having experienced the trauma and grief associated with having undergone one.

      Also, the term “right wing” conjures up images of those who back the status quo of a political tyrrant or system of oppression. Many of us who are deemed to be “right wing” in this country are actually “conservatives” – not interested in protecting tyranny, but quite the opposite; in favor of individual freedom, protecting constitutional rights.

      I find some on the far left to be quite fascinating – demanding a cradle to grave nanny state. “Pro-choice” when it comes to abortion… school choice; the right to work, without joining a union, not so much. Inconsistent, to say the least.

      Duane

      • Duane

        For some women to be pregnant at the wrong time by the wrong man can lead to a life of living in projects – on some type of welfare – subjected to an endless string of dysfunctional and/or abusive men. We must uphold “choice” as a basic human right. The current erosion of this right in today’s world is a tragedy and a major political setback from those advances made in the 1960’s. Abortion on Demand; Without Apology!

        Richard

        • Here is what Wikipedia has to say on this subject:

          A fetus (/ˈfiːtəs/; plural “fetuses”), also spelled foetus or, archaically, faetus,[1] is the term used to refer to a prenatal mammal or other viviparous vertebrate between its embryonic state and its birth. The 2008 Britannica Concise Encyclopedia defines it as the “[u]nborn young of any vertebrate, particularly mammals, after it has acquired its basic form.”[2]

          In humans, the fetal stage of prenatal development tends to be taken as beginning at the gestational age of eleven weeks, i.e. nine weeks after fertilization.[3][4] In biological terms, however, prenatal development is a continuum, with no clear defining feature distinguishing an embryo from a fetus. The use of the term “fetus” generally implies that a mammalian embryo has developed to the point of being recognizable as belonging to its own species; this is the point usually taken to be the ninth week after fertilization. A fetus is also characterized by the presence of all the major body organs, though they will not yet be fully developed and functional and some not yet situated in their final anatomical location.

          • Richard,

            Interesting that you insist the doctor use the term ‘fetus’ – from Latin – offspring.

            I’ve made my religious beliefs known on this site; and although I don’t expect that everyone on this site shares those beliefs, I do think people who are pro-life, such as myself, not be dismissed as not appreciative of science.

            Egg and sperm, two gametes form a zygote – with a combination of DNA from each… A unique DNA. So it seems to be hard to argue that this is part of a woman’s body.

            With that said, the zygote, later embryo, then fetus is not viable until the third trimester (shortly before)… Then things change scientifically – the baby’s chances of living outside the mother’s womb begin to go up… quickly, with each passing week.

            Row v Wade does not say a woman has the right to an abortion during this period – for a reason:

            http://familydoctor.org/familydoctor/en/pregnancy-newborns/fetal-health/your-babys-development-the-third-trimester.html

            Duane

  6. Dr. Urato,

    Re: “But, while I strongly believe that the drugs cause harm, I don’t believe that a pregnant woman should be told that she should take a medication or that she should not take a medication. That is an individual choice and one that should be respected.”

    Of course it’s a individual choice on the part of the pregnant woman. But, it is also an individual choice on the part of the doctor. In short, you could explain that in your professional opinion, the drugs are too dangerous for her and the baby… and that you will not prescribe them.

    What this approach lacks in political correctness, it makes up for in upholding the Hippocratic oath.

    Duane

    • Your telling her you will not prescribe them is not the same as “telling her what to do!”
      It’s explaining what it is * you* are not willing to do.
      Nothing more, or less.

      It would seem to me that a good doctor would take the time to explain why he/she has reached that decision; in this case, educating the patient.

      And then the final decision is the woman’s.
      The more I read from doctors, the less I understand their logic.
      I thought they received medical licenses to assure the safety of their patients.

      I don’t get it.

      Duane

        • I agree based on what I have read that psych drugs should be nowhere near a developing human being or any living thing. It is not as simple as stopping taking them, though. If a woman’s doctor cut off her prescription and she went into a tailspin, the doctor could be liable. Did you read the Andrew Solomon article that was (to my eye) anti-science in its failure to acknowledge what is known about birth defects, low birth weight, and possible other things. The first and the last women’s stories look to me (not just me) like antidepressant withdrawal, both life altering, one lethal.

          Dr. Shipko posted on this page when it was new, calling psych drug withdrawal the 20,000 gorilla in the room, or something like that, and it is. It sure is hard to get the messages we here have received about the drugs out of our gathering places and into the marketplace.

  7. I took zolft for first 8 weeks of pregnancy…. why? Husband had a vasectomy, I wanted to be pregnant again. Buggar, vasectomy failed. I was horrified that I was pregnant and on drugs. I got off those damn pills, cut from 50mg to ZERO in 8 weeks…..too late, wonderful pregnancy, just like my other four…. born? happy healthy, dead in three days…. HLHS………(died in agony)………………
    Happy pills destroy, happy pills destroy marriages, happy pills make you a zombie… My main anger?
    I was on zoloft in 1995…………… and doctor reported it is quite safe to take in pregnancy, there are no reports of birth defects… Why no reports of birth defects? No-one ever tested it on pregnant women………… I will meet those lying drug dealers called big Pharma, in hell… I’ll be waiting for em.

  8. Andrew Solomon is a gifted and intelligent writer, but he is coming at this issue through a particular lens. He is a pharmaceutical industry scion and consumer of mental health services and psychotropic drugs for years, if not decades. He has admitted himself he takes a cocktail of medications to “manage his depression” (Wikipedia).

    As someone who lost a daughter to an antidepressant-induced suicide and has been part of the psychiatric survivor movement for over a decade, I see things very differently. I am dismayed by the number of women who believe that the only solution to their depression is taking psychiatric medication as well as the failure in this article to mention the issues of chemical dependency, withdrawal, and long term harm (such as sexual dysfunction and chronic dysthymia) caused by psychiatric drugs. Mary Guest’s story is indeed tragic, but I do not see it as a story of untreated mental illness, but rather of a misguided abrupt withdrawal from antidepressants followed by an ill advised resumption of treatment. Unless she resumed at an extremely low dose, she would have been at risk of akathisia, a known precursor to suicide. Abruptly stopping and then weeks later recommencing at perhaps the same dose is very dangerous and the behavioral changes caused have little to do with so-called underlying mental illness, but rather the toxic effects of the drug.

    There is no doubt in my mind that abruptly withdrawing from antidepressants is extremely dangerous and therefore women who want to bear children need to consider taking a very long time before getting pregnant to get safely off the drugs. Pregnancy is no time to be undertaking the difficult process of withdrawal which could easily take more than nine months to do safely depending on how long a woman has been taking them. This is only one of many reasons that I think these drugs should rarely, if ever, be given to women of child-bearing age. Evidence cited by Robert Whitaker in his book Anatomy of an Epidemic supports the fact that taking antidepressants is more likely to lead to chronic depression than not. Antidepressants work by a similar mechanism as cocaine and have been described by Joseph Glenmullen in Prozac Backlash as an attenuated form of cocaine. Of course this might feel marvelous over the short term and cause problems to melt away, but it hardly is a recipe for long term health and well being. Women who are struggling with antenatal depression could be responding to birth control pill withdrawal effects as these also cause mood changes. In fact, birth control pills are a segue into antidepressant use because they cause depression. Women are quite simply being taken advantage of as consumers of pharmaceutical products with little to no explanation of what to expect regarding long term behavioral changes caused by chronic consumption of medication, especially psychiatric drugs. The general public greatly underestimates the power of big pharma to promote a distorted and incomplete story about the products they sell. Adam Urato is to be commended for trying to set the record straight on the potential for birth defects. This is only the tip of the iceberg as far as the ways in which the public has been deluded about this most potent of industry money makers, antidepressants.

    A large number of people are known to me personally who have broken free of their labels and their treatment with psych meds who are leading the best days of their lives as a result. I also know people whose lives have been destroyed by psychiatry and are permanently disabled (or dead) from their medications and literally no one who takes the Pollyanna view of treatment described in this article. Those of you suffering, please read the resources out there like Recovering from Psychiatry, Beyond Meds, or Mad in America that give another side to the story of solving the depression riddle. Even Andrew Solomon himself should consider trying to get ever so slowly off his cocktail and see how much better he might feel.

  9. “A major “player” that is missing from Andrew Solomon’s story is the antidepressant industry (Big Pharma as some call it.) I don’t think you can tell the story of antidepressant use in pregnancy without reference to this industry and he basically doesn’t touch on this—aside from mentioning my concerns.”

    Hmmm, I wonder why that is. Could it be because Andrew Solomon is the son of the CEO of Forest Laboratories, which manufactures the third most popular antidepressant – citalopram?

  10. Dr. Urato provides invaluable information concerning antidepressants and pregnancy. It is obvious that these drugs damage the fetus and that the arguments that untreated depression is more damaging are spurious. They started out saying that Prozac was completely safe. Later the standard was that Paxil, clearly the most toxic SSRI, was the safe drug for pregnancy. The ten ton gorilla in the kitchen is that a high percentage of women who get pregnant on antidepressants have been on them for so many years that tapering and stopping the drugs is going to be very difficult. There may not be time to slowly taper the drugs during pregnancy – which requires about a month for every year on the drug. Dr. Urato is cautious, scientific and understated about the risks of SSRIs during pregnancy, and his efforts at educating the public are praiseworthy.

    • Dr. Urato and Dr. Shipko, I wish you would write letters or even Op-Eds, with or without reference to gorillas (though Glaucus, above, wrangled another 20,000-pounder into this sad situation).

      In addition to underemphasizing the…facts…Solomon did not address the gorilla Dr. Shipko mentioned, but I see it featuring in two of his anecdotes. In first one (first one in article), it sounds like the woman had withdrawal symptoms of mania bordering on psychosis. Solomon presents it as the return of her depression. Then…

      –She was sleep-deprived because she often woke up in a panic, terrified that there was something wrong with the baby.
      That’s what I did after going off antidepressants, and other people say the same thing in support groups–hearts pounding and gasping for breath. Sleep-deprivation is not from waking up at 2am, it’s from waking up and not being able to fall asleep again, and watching the sun rise, week after week.

      –Some nights, she spent hours online, poring over descriptions of everything that could go wrong.
      Also typical, but the topics vary. (It’s nothing helpful like learning French or doing an online training for a new job, I promise.)

      –“We could see her spiraling downward,” Kristin said. “The really irrational obsession, the inability to see otherwise, tormented her.

      She was initially thrilled to be pregnant. So…what happened? Is irrationality depression? Is waking in a panic depression?

      There is another case towards the end. A woman started having panic attacks after being at work in the financial district on 9/11. She’d never been depressed, she says. She was prescribed Paxil, which calmed her, and has one of the worst reputations for withdrawal syndromes. She stopped taking it.

      “I went back to being unable to function,” she recalled. “Loss of interest in things, irritability, crying, not wanting to get out of bed. Complete loss of energy or desire to do anything.”
      Sounds familiar for withdrawal, but is unlike her original complaint, panic attacks.

      Solomon says Margaret’s (brand new) depression escalated in the months after she gave birth. She found it difficult to bond with her baby, worried that her short temper and disengagement would damage her marriage.”
      Feeling nothing for loved ones, and an explosive temper–does that sound like withdrawal to anyone?

      I wish these two women hadn’t had such bad experiences, but given that they did, I wish Solomon hadn’t used them to persuade people that antidepressants are more or less safe.

  11. Dear Dr Urato, I am so grateful for this blog entry. After reading Andrew Solomon’s piece in The Times, I was so distressed that I have been reading all about his background, writings, and yes, his family fortune gleaned from Celexa and Lexapro. It is a family saga of Shakespearean scope, and truly I hope someday an investigative reporter takes on this darling of our newspaper of record. But in the meantime, I truly hope you are given equal real estate to print this essay. I have two adult daughters, and while pregnant, knew intuitively to avoid chemicals and any toxic substances. I became pregnant a third time while married, when my IUD failed, and because I had been on an MAOI at the time, discussed it with my OB and terminated the pregnancy. I knew, and know, that it was not safe. I tweeted the editor of the Times Magazine and asked why a Conflict of Interest disclaimer was not included in Mr. Solomon’s byline. He did not respond. Maybe he would be more inclined to answer you. Very grateful for your words. Thanks again.

  12. I’m glad you tweeted the editor and sorry to hear that a MAOI (and a device that failed) created what sounds like a difficult situation.
    About Solomon’s psychology PhD. He got it at Cambridge. Sounds great unless you know what that means. He earned majored in English at Yale and graduated magna cum laude. He went to Cambridge and earned a master’s degree in English. I was told a master’s takes a year there, but haven’t checked. With his English chops, he entered a non-traditional PhD program. Here’s how a student described it on the department’s web site:
    “Coming to Cambridge from the U.S., where science PhDs can take up to seven years, I knew I would have the advantage of an accelerated program. Now looking back on the last two years, I realise just how many opportunities have been open to me that wouldn’t have been available elsewhere. At Cambridge you hit the ground running, thrown into the research process within your first few weeks. As there is no traditional coursework required, the focus is really on learning by doing.”

    I understand that he is a multi-award-winning, highly-praised author and philanthropist, and I don’t mean to diminish that.

    It is possible that he didn’t learn how to read primary sources and question their methods and analyses. His failure to mention antidepressant withdrawal, as well as the problems Dr U reported above, hint at that.

  13. I agree that the use of any pharmacologically active substance during pregnancy is a decision not to be taken lightly. But the article overstated the evidence base and suggests in some cases that speculative harms are widely accepted as proven.

    “Chemical” is a scary word to many people, who fail to realize that 95% of their total exposure to toxic substances comes from natural sources. Peanuts contain aflatoxin, beer contains carcinogenic methyl carbamate as a natural product of fermentation, and tomatos contain methanol which is metabolized to carcinogenic formaldehyde. While maintaining proper vigilance against drug side effects and toxic exposures, its good to also reflect that the dawning of the chemical age has been associated with a decline in childhood mortality from 30% to a fraction of 1%, and increased life exectancy of some 30 years.