Pregnant, Not a Pristine Vessel: The FDA’s Handmaid’s Tale Moment on Antidepressants

Antidepressants in Pregnancy: Why the FDA’s One-Sided Narrative Puts Women at Risk

The FDA’s Missed Opportunity on SSRIs in Pregnancy

Last month, the FDA convened an expert panel to review the use of SSRIs (selective serotonergic reuptake inhibitors) during pregnancy. Instead of presenting a balanced, evidence-based discussion, the panel veered into one-sided territory—highlighting only potential risks of antidepressants while ignoring the well-documented dangers of untreated maternal depression and anxiety.

This wasn’t just incomplete. It was dangerous.

What the Panel Got Wrong

A one-sided narrative

Decades of research show the relative reproductive safety of SSRIs in pregnancy. Yet the panel leaned heavily on risks while neglecting the fact that untreated psychiatric illness is among the leading causes of pregnancy-related death in the United States.

Lack of expertise

Of the ten panelists, only one actively treats pregnant patients with psychiatric illness. The majority were outspoken critics of psychiatric medications in pregnancy—hardly representative of the nuanced, evidence-driven field of reproductive psychiatry.

Risk of public harm

As ACOG President Dr. Steven J. Fleischman stated:

“For pregnant people who need SSRIs, they are life-changing and lifesaving… the outlandish and unfounded claims made by the panelists will only serve to incite fear and cause patients to come to false conclusions that could prevent them from getting the treatment they need.”

Risks of Untreated Depression Is Often the Greater Risk

No medication is risk-free. But leaving psychiatric illness untreated in pregnancy carries profound, measurable risks:

• Poor prenatal care and nutrition

• Elevated stress and low physical activity

• Higher rates of complications (preterm birth, low birth weight)

• Strained maternal-infant bonding

• Increased postpartum depression risk

• In severe cases, self-harm or suicide

Mood and anxiety disorders are already the leading cause of pregnancy-related death in the United States. Ignoring this reality in favor of fear-based rhetoric is irresponsible and harmful.

What Patients Deserve: Evidence-Based Care for Antidepressants in Pregnancy

Pregnant women and their clinicians are not seeking simplistic answers. They deserve:

• Balanced, evidence-based information about risks and benefits

• Collaborative decision-making rooted in medical expertise, not ideology

• Compassion, not stigma, when medication is the safest choice

Non-pharmacologic approaches—such as therapy, integrative care, and lifestyle interventions—are valuable. But for women with recurrent or severe illness, antidepressants may be not only necessary, but lifesaving.

Our Take

The FDA has a duty to present information that is accurate, balanced, and clinically useful. When respected organizations like ACOG publicly call out its approach as “outlandish and unfounded,” it underscores how far this panel veered from medical reality.

Perinatal psychiatric care is about nuance, compassion, and evidence. Women deserve nothing less.

Bottom line: SSRIs and other antidepressants in pregnancy are not without risk—but neither is untreated illness. Pretending otherwise is misleading, stigmatizing, and harmful.

Learn More

For a deeper dive, watch this video from Psychiatric Times, featuring Marlene P. Freeman, MD, Associate Director of the MGH Center for Women’s Mental Health: Watch here

Next Steps for Patients and Clinicians

If you are navigating pregnancy and mental health, you deserve more than stigma and fear.

You deserve evidence-based guidance and collaborative care.

• Read more on our [Perinatal Psychiatry page] (link to your site).

• Download our infographic: Risks of Antidepressants vs. Risks of Untreated Depression in Pregnancy.

• Follow us on LinkedIn and Instagram for updates on women’s mental health, perinatal psychiatry, and integrative care.

• Reach out for a consultation: Our team specializes in reproductive psychiatry and integrative support for pregnancy, postpartum, and beyond.

Women should not have to choose between fear and silence. They should have access to informed, compassionate care.

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About the Author

Julie Brownley, MD, PhD

Dr. Julie Brownley, MD, PhD, is a board-certified psychiatrist and leader in reproductive psychiatry and women’s mental health. She completed her residency at The Johns Hopkins Hospital and has published peer-reviewed research spanning molecular medicine to clinical psychiatry. As founder of Psychiatry for Women and Balance360, Dr. Brownley specializes in integrative perinatal psychiatry, women’s mood and anxiety disorders, and metabolic medicine.