A recording of the full FDA Panel on SSRIs and Pregnancy is linked to the last post here. There has been extensive media coverage of this event – and 18 takes on what reporters heard can be found linked to Unsafe Safety Systems on RxISK.
Roger McFillin was on thin ice, at the recent FDA Panel on SSRIs and pregnancy, when he told us that women have emotions and maybe should not go along with a system that suppresses their emotions by labeling them as a disease for which we have no diagnostic test and no great evidence any medicines work.
If what Roger is referring to are emotions, they are emotions of distress. No woman is going to thank a man for telling them to put up with distress. Or telling them to avoid messages saying they can be helped. See Damsels Dying from Distress or Dysphoria. So do women have diseases or distress?
Disease or Distress?
We have very little evidence pregnant women get a mood disease. Unquestionably some women once got, and still get, Melancholia, which is a medical disease. In contrast to claims often made about no physical basis for psychiatric disorders, Melancholia comes with a medical test, the Dexamethasone Suppression Test (DST). The DST stress tests our cortisol system and semi-establishes the presence or otherwise of melancholia.
Women with melancholia did not go out drinking alcohol, snorting cocaine or engaging in risky activities – the reasons cited now for the need to ensure pregnant women who might be depressed get SSRI antidepressants. Before antidepressants came onstream, there was no evidence linking melancholia – the most severe form of depression – to birth defects.
Women’s bodies defend a pregnancy from infections, starvation, and the raised cortisol found in melancholia. What their bodies have not been equipped by evolution to manage are drugs like alcohol, SSRIs, acetaminophen or anticonvulsants.
Many pregnant women in situations of deprivation, low income etc, have elevated scores on a Hamilton Rating Scale and get diagnosed as depressed. This does not mean they have a disease that is going to respond to antidepressants. Rating scales like this and DSM Diagnostic Criteria are only supposed to be applied after an act of judgement has decided that the person does have a medical disease. Using them without knowing the person is dangerous and risks rendering the person consulting us invisible.
Older tricyclic antidepressants or electroconvulsive therapy (ECT) did, and still can, offer benefits to people with melancholia or endogenous depression, which shades into melancholia. Before 1990 and the advent of SSRIs, they were not used to treat numbers.
Are we not being more scientific now, ensuring we track changes with a rating scale? Not really – doctors applying Hamilton Rating Scales can score you as getting better when in fact you are becoming homicidal and/or suicidal. An interview does better than a rating scale.
If you are let track your mood on a Quality of Life Scale, which is very similar to the Hamilton scale, then no benefit from an SSRI shows up. Companies went to great trouble to produce QoL scales aimed at showing their SSRIs did much better than older tricyclic antidepressants that have lots of side effects. The QoL scales were quietly abandoned when you rated yourself as worse not better on SSRIs compared to older drugs or placebo. See Let Them Eat Prozac.
Besides being done in situations of deprivation, the studies now cited as supporting claims that leaving pregnant women untreated causes more problems than treating them were done before we learnt that SSRIs trigger alcohol use in pregnancy, and likely cocaine and amphetamine use also. See Antidepressants, Alcohol and Anne-Marie and Canadian Guidelines on SSRIs and Alcohol Use Disorder. The earlier studies all need revisiting – but this is unlikely to happen.
Distress or Disease?
There is an extraordinary historical twist to these debates about treating nervous problems in pregnancy. Through to 1990, depression was rare. We had anxiety disorders rather than mood diseases. The difficult point to grasp is that most cases of depression in US office practice involved a condition called neurotic depression.
As the word neurosis tells you, this was viewed as an anxiety disorder, linked to states of deprivation and distress. It was not a disease, and was not viewed as appropriately treated with antidepressants but it could give rise to what was called illness behavior.
In line with company interests to segment the marketplace, in 1980, DSM-III divided a monolithic Anxiety Disorder into multiple different conditions – panic disorder, social anxiety disorder, PTSD etc, This should have been good for business and Upjohn colonized panic disorder, GSK pushed out the social anxiety boat and Pfizer and others claimed PTSD.
In contrast, a bunch of different depressive states – neurotic depression, endogenous depression, melancholia, atypical depression were collapsed down into Major Depressive Disorder. See The Antidepressant Era.
The depression changes should not have been good for business and were not good for science.
The DST looked like it was going to give clinical psychiatry a diagnostic test making it medically respectable. Created in the 1970s, this test distinguished between the relatively rare Melancholia and much more common Neurotic Depression – distinguished in other words between a depressive disease and an anxiety state.
In line with this, tricyclic antidepressants (TCAs) and ECT can help melancholia and other DST positive states but are not treatments for neurotic depression. SSRIs, in contrast, are ineffective in melancholia or do not work in any states that are DST positive.
Business and Science
What happened next is Business eclipsed Science. The DST and melancholia vanished. Neurotic depression was always where the money was and now rebranded as Major Depressive Disorder was a magnet for the SSRIs.
Companies like Lilly began thumping their chests at their heroism in tackling one of mankind’s greatest afflictions. ‘’’MAJOR depression’’’ rapidly became the second greatest and then the greatest source of disability on the planet and has been getting more and more common the more SSRIs we consume.
The upshot is few women who are pregnant and diagnosed as having Major Depressive Disorder have a depressive disease. The social conditions they are dealing with are not going to respond to an SSRI. Deprivation can lead to low birth weight for their babies and substance abuse disorders in them but these are likely to be compounded by SSRI drugs that cause low birth weight and substance use disorders in both women and pregnant animals.
Depressed and Pregnant
If we want the best for women and their offspring, screening for depression and prescribing SSRI agents is not the best way forward for a number of reasons. The first is that 50% of SSRI takers are unlikely to benefit and therefore they and their offspring can only be harmed by the substantial risks these medicines pose. In addition, their doctor is likely to diagnose someone who is not suited to an SSRI as treatment resistant and needing double the usual SSRI dose.
Some women will have a disease like melancholia that is more likely to respond to TCAs than other depressive states are likely to respond to SSRIs. TCAs are not risk free but are safer than SSRIs in pregnancy and there is more likely to be a benefit to offset against those risks. Again, however, these women need monitoring and if not responding should have the treatment stopped.
If we want a drug to treat a distressed state, less potent benzodiazepines are likely better than SSRIs. They are much more likely to work than SSRIs, and work instantly, and at present there are fewer indicators that they will cause problems. This would be a Back to the Future moment – giving women the drug they were given before neurotic depression was rebranded to Major Depressive Disorder.
There’s something about Mary
Finally to come back to Roger and valuing emotions. There is a parallel which might seem extreme. Finnish men in the winter regularly take saunas and rush out and plunge through the thin ice Roger is skating on into freezing water – hoping their blood pressure will rise from a normal 120-80 to something more like 300-200.
Most doctors would faint at the sight of a blood pressure this high, but the Finns do it because maintaining a full range of bodily responses to stress helps us live longer. When our blood pressure doesn’t vary much in response to stress or isn’t let vary by tight blood pressure control, we are more likely to die earlier.
We’ve got incapacitatingly neurotic about variations from the norm – we have a dangerous measurement neurosis. Drug companies are too nervous to advise Finnish men to take a blood pressure medicine before their sauna. They’d be told to get lost. Company doctors would not dare say think of your wife and family if something should happen to you.
But There’s Something about Mary when she gets pregnant that allows companies and others to shamelessly guilt-trip her about her unborn child. Not forcing chemicals on her is viewed as worse than treating her like a second class citizen.
There are occasional stories about marvelous male soccer players who break a bone in mid-game and play on. The European Women’s Football Championship that finished on Sunday had a woman, Lucy Bronze, who played every, and all of every, game in the tournament with a broken leg. No man has ever done this. Men rarely rise to the motivational heights women are capable of.
In my experience, as regards researching conditions and treatment options including non-treatment, no group of people on earth does more or better research than women who are pregnant or about to get pregnant. Excellent researchers though they are, they are not being helped by drug labels designed to misinform.
As regards balancing risks and benefits, no group is called on to do it more often or for a more important mission or does it better than women who are pregnant or thinking about a pregnancy.
While antidepressant prescribing has risen in pregnancy, most women still opt to stop treatment if they can – See Patterns of Antidepressant Prescribing around Pregnancy.
Given the effects of SSRIs on men, it is not clear the scenes that gave the Something About Mary movie its name would have been possible if the men involved had been on SSRIs.
There’s something about Marty
‘Blind Spots’ enabled him to call on the FDA panel of experts on SSRis and Pregnancy
https://www.amazon.co.uk/Blind-Spots-Medicine-Wrong-Health/dp/1785126911/ref=sr_1_1?
”A dose of healthy skepticism may be the healthiest attitude when information seems contradictory, whether it’s about a decades-long practice or newer, faddish procedures.’ – The New York Times
‘Quick, compelling, and something all clinicians will want to read.’ – Psychiatric Times
Given the effects of SSRIs on men, it is not clear the scenes that gave the Something About Mary movie its name would have been possible if the men involved had been on SSRIs.’
That won’t be lost on us.
Very creative and powerful piece. I am reminded of much of the literature in my field on emotion regulation. There is a paradoxical effect with regulating emotions- the more we accept and lean into them the less intense they are experienced. They become signals for us to better understand ourselves and the world around us. But what happens when we judge them? Cultivate fear around them? Fail to acknowledge their presence or worse… believe they are diseases? Well as you would expect we would increase the intensity and look outward for some solution- such as the medical system and a drug. This appears to manufacture the disorder the antidepressant claims to treat. We should be very mindful of those consequences and of course the consequences on the unborn. There are better ways. – Roger McFillin
This is well-put Roger. Thanks for responding
On our willingness to say one thing to pregnant women but not the same thing to others, a recent article repeats a well-known finding – psychiatrists have the highest suicide rates in healthcare.
https://onlinelibrary.wiley.com/doi/10.1111/acps.70018
Should they all be told to start SSRIs prophylactically on entering training?
D
‘and the founder and CEO of Data Based Medicine in North Wales, which operates a website where patients directly report the effects of drugs.’
https://www.msn.com/en-us/health/other/fda-weighs-warning-labels-on-antidepressants-for-pregnant-women-despite-safety-consensus/ar-AA1Jwqiq?ocid=BingNewsSerp
hey. hey.
This story was reported on-air by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.
Mothers’ Little Helpers
A small study on how women make decisions about antidepressant use during pregnancy concluded:
“Perceived ability to cope is an important factor in decision-making.”
https://bjgp.org/content/bjgp/early/2024/10/07/BJGP.2024.0068.full.pdf
This study reflects the current situation in the UK which is doing relatively well compared to the US.
In America, a very recent study points to rising maternal mortality and figures that are worse than other developed countries linked to deprivation – https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2834318?guestAccessKey=34776585-5282-4bb2-ad57-b984aa76d938&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=052725
Linked to factors that adding antidepressants are more likely to aggravate than relieve
D
FDA Panel Warns of SSRI Pregnancy Risks as Media Rushes to Shield Big Pharma
https://www.freedommag.org/news/fda-panel-warns-of-ssri-pregnancy-risks-as-media-rushes-to-shield-big-pharma-c3b968
Yet in response to the panel’s urgent, science-backed warnings, shared in an effort to protect the health of Americans, the news media launched a full-scale, frothing-at-the-mouth assault.
“FDA panel on the use of antidepressants during pregnancy is alarming experts,” the Los Angeles Times fumed.
“The FDA held a misinformation fest about antidepressants in pregnancy,” Mother Jones ranted.
And NBC News sneered: “FDA panel promotes misinformation about antidepressants during pregnancy.”
Media even went out of their way to track down “experts” who weren’t on the panel itself, but who were all too willing to offer quotes negating the proven dangers of antidepressants.
But why would the media viciously attack an FDA panel sounding the alarm to protect our children?
Because Big Pharma’s money talks—and the media listens.
In 2024 alone, pharmaceutical companies spent $10 billion on drug ads. That advertising keeps the worldwide antidepressant market booming—valued at $18.7 billion last year and expected to grow 7.5 percent annually through 2034.
Only two countries in the world, the US and New Zealand, allow direct-to-consumer drug advertising—a practice the Department of Health and Human Services has considered banning.
The prospect alone sends media outlets into a panic—which tells you everything you need to know about how to interpret their “reporting.”
As long as Big Pharma keeps shelling out billions, their mouthpieces will dominate the headlines, their critics will be dismissed, their victims will be silenced, and the hard science will be ignored—all at the expense of public health and our children’s futures.
We guarantee it.
I contemplated not posting this as it appears to be from a Scientology outlet. There are 21 media reports linked to Unsafe Safety on RxISK.org – all hostile bar one which is Fox News.
It’s something new to be linked to an event where the only supportive comments from Scientology and Fox News. What strange times.
D
The cherry-picking of testimony in the media was hard to miss. They zeroed in on Roger McFillin for one comment, about “women just naturally experiencing their emotions more intensely,” which might be a “gift” rather than a problem. This was ripped out of context to make his remarks appear both patronizing and sexist, which was definitely not the case.
Even more striking, however, was the total non-coverage of panelists with direct expertise in maternal-fetal medicine. Particularly Dr. Adam Urato, whose testimony can be seen here:
https://x.com/AdamUrato1/status/1947601575871975623
If Dr. Urato is OK with it, I’d love to see his testimony transcribed and further distributed – along with links to the studies both he and David cited as backup.
I’d also love to see someone take on the increasingly popular rhetoric about “perinatal mood disorders” utilized by Dr. Ross. This exploits the public’s vague awareness of two post-birth problems that actually are linked to the physical changes of childbearing: post-partum depression, which can range from mild “baby blues” to severe distress; and post-partum psychosis, a rare and time-limited but always serious condition which has been associated with suicide and infanticide.
Those conditions are mashed together with anxiety or depression *prior to* birth, whether mild or serious, recent or longstanding, based on a real-life crisis or more subjective. The aim is to create the impression that any emotional distress between the start of the pregnancy and the child’s second birthday is a potentially life-threatening medical crisis. To me at least this seems incredibly dishonest.
Ofc I totally agree with Johanna – again.
‘The aim is to create the impression that any emotional distress between the start of the pregnancy and the child’s second birthday is a potentially life-threatening medical crisis’ – aka KRR’s ‘mood disorders’ litany.
We are targeted remorselessly for our gender stereotyped, hormonally imbalanced ‘EMOTIONALITY’ at every life stage opportunity. I’m horrified to learn that NICE recommends screening EVERY pregnant woman for ‘depression’ in pregnancy at her first contact with primary care and postnatally.
‘Pregnancy and having a baby can be exciting but also demanding as women adjust to the change in their lifestyle. It’s not uncommon for women to feel more anxious and ‘down’ at this time. Some go on to develop a mental health problem.
Some women who have a mental health problem stop taking their medication when they find out they are pregnant. This can make their problem come back or get worse.
’https://www.nice.org.uk/guidance/cg192/ifp/chapter/mental-health-in-pregnancy-and-the-year-after-giving-birth
But, if we look at the NHS info on causes of, for example, postnatal depression the majority are obvious social and interpersonal issues. That’s surely where the support needs to be.
‘No close family /friends to support you, difficult relationship with your partner, recent stressful life events, such as a bereavement, physical or psychological trauma, such as domestic violence.
They seem to have forgotten about living in deprivation, real hardship- a fundamental as we know.
A ‘history of mental health problems’ tops the list. Reading this in conjunction with the qualitative study Peter posted – note a particular cohort (most higher education, with partners, jobs, white etc.) – it’s clear that some women have decided they’re more comfortable in life leaning away from their emotions (to quote Roger’s insight) and taking pills to cope or regulate their feelings. Some had ditched their pills in pregnancy, at least for a while:
“When I’m not on my medication I have … well I call them episodes … where I’m very anxious or the other end I’m very depressed, I can’t really function very well on a day to day basis and obviously that’s not- you’re not in the best place to look after yourself let alone if you’ve got a baby.”
My bet is a lot of pregnant women who stop taking their pills are more likely to be in withdrawal than as they perceive it – relapse. But I suppose the leaning away means you want to control your feelings about your feelings within a particular bandwidth – the very opposite of those wild Finnish chaps.
A thought about ‘emotionality’. Although there’s debate about women’s emotional ‘expressiveness’ vs men’s – and it’s dead murky, muddled up with cultural expectations. There is no debate that women are mostly more emotionally intelligent than men – that is to say better at recognising and using emotions, both our own and others. This is our power. It’s an entirely different quality from the implied uncontrolled ‘emotionality’ that underpins the lurking ‘life threatening medical crisis’ Johanna rightly challenges.
New post on Rxisk.org
https://www.nytimes.com/2025/07/30/opinion/fda-pregnancy-antidepressants-prozac.html?unlocked_article_code=1.ak8.xb8j.TN6Sa5lGEcGu&smid=url-share
After the panel he published a truly bizarre newsletter, a failed attempt at humor purporting to be a PowerPoint from Satan, in which the devil himself says: “This isn’t about medicine. This is about souls. Every woman we convince to depend on our chemicals instead of trusting her divine inner guidance is a soul we’ve successfully separated from her creator.” OK, then!
Lizzy Lawrence, who covers the F.D.A. for the health and medicine website STAT, reported: Nine out of 10 panelists have either been paid witnesses in litigation involving antidepressants, run media platforms rooted in S.S.R.I. skepticism or have published research pointing to the drugs’ potential risks in developing babies. Many share the views of health secretary Robert F. Kennedy Jr., who has called S.S.R.I.s harder to quit than heroin and has falsely linked them to mass shootings.
This is not how F.D.A. expert panels have generally been conducted under previous administrations.
Er. that is the whole point of Marty Makery setting up the FDA panel on SSRIs and Pregnancy.
Leaked: The Devil’s PowerPoint on How to Drug Pregnant Women
Exclusive: Our sources obtained this leaked transcript of a strategy meeting preparing pharmaceutical representatives for the expert panel on SSRIs in pregnancy
Pregnancy.https://drmcfillin.substack.com/p/leaked-the-devils-powerpoint-on-how
‘This is not how F.D.A. expert panels have generally been conducted under previous administrations.’
‘Entertainment’ goes a long way in Pharma..
Annie has come up with something wonderful here.
As she mentions over on RxISK there is a New York Times review of the FDA panel by Jessica Grose who lambasts Roger McFillin for treading on women’s emotions. How dare a man tell women anything about how to handle their emotions.
This sets the stage for talking about his truly bizarre segue into what she calls his truly bizarre powerpoint presentation featuring Satan. At this stage enough has been said to believe anything about Roger, and the entire panel and the current FDA to think they might be conducting Black Masses or whatever. There is no hint that the McFillin Satan skit might be worth digging out and checking out. It couldn’t possibly be sensible
Well it turns out it is pretty sensible, Its naive in the sense that irony and humor are very risky in these settings. This is part of what the internet does to us – Roger meets Jessica without either of them really meeting or having much sense how to reader each other. What some will see as reasonable attempts at humor look like trolling to others. We’ve lost context.
We end up in opposing camps. Nuance is lost and is not possible. We have our science and you have yours as the current White House press secretary says. We desperately need to find ways to have conversations again rather than endlessly talking past each other.
With A.I. things look set to get worse. The New York Times had a wonderful piece by Meghan O’Rourke on what A.I. does to creative writing and investigative journalism. Jessica Grose’s NYT opinion piece is a great illustration of what Meghan is worried about and what we all need to grapple with
I need to thank Grace Jackson for sending the O’Rourke article – a highly recommended read.
https://www.nytimes.com/2025/07/18/opinion/ai-chatgpt-school.html?rsrc=ss&unlocked_article_code=1.X08.K8d_.tInCVNBvR0hu&smid=nytcore-ios-share&referringSource=articleShare
DH
Another body blow on Rxisk
The Conversation, that isn’t a conversation
https://theconversation.com/how-fda-panelists-casting-doubt-on-antidepressant-use-during-pregnancy-could-lead-to-devastating-outcomes-for-mothers-261825
‘Should the FDA, as a result of this recent panel, decide to place a black-box warning on antidepressants in pregnancy, researchers like us already know from history what will happen. In 2004, the FDA placed a warning on antidepressants describing potential suicidal ideation and behavior in young people.
In the following years, antidepressant-prescribing decreased, while the consequences of mental illness increased. And it’s easy to imagine a similar pattern in pregnant women.’
What is missing are the thousands of GPs who are prescribing thousands of antidepressants who are mostly oblivious to the harms and deaths they have caused and are causing.
I would have thought that a psychiatrist who has been an expert witness in legal cases worldwide should have been the magnet on the panel.
Who Framed Roger Rabbit, with Jessica Rabbit.
‘We desperately need to find ways to have conversations again rather than endlessly talking past each other. ‘
AI is pretty useless at answering questions about SSRIs and Pregnancy. Ask them a question and they will routinely answer with most of the articles on the Rxisk site. That is not creative writing. It is a gathering box.
Pregnant women can be boxed in to a corner. A normal pregnant women could be led astray by interfering medicals who put things in to her mind that just weren’t there or in her orbit. That seems to be the way it is going, and so there are several choices as to just who has the Satanic verse.
There is a quite extraordinary feature to the Conversation article above that Annie lists. After reading it and thinking it was particularly misinformative – especially on the question that the Black Box warning put on Antidepressants for minors in 2004 had led to thousands of suicides – I was left wondering.
My wonder might have been triggered by Jeff Lacasse musing about who this Anschutz outfit are – he figured a lot of this kind of stuff was coming from there. This might have caught my attention along with the name of one of the authors Andrew Novick.
The name seemed familiar. And it turned out ‘Andy’ had emailed me about the Psychopharmacologists interviews 53 weeks before the FDA Panel meeting. He had he said been highly influenced by them. He interviewed me about how they came about and thanked me for such a meaningful discussion.
He especially liked my point about the American Psychiatric Association (APA) suicide not in 2004 – used in lots of posts and talks since – APA believes Antidepressants Save Live – which as I keep saying should read – APA Believes Psychiatrists Save Lives.
Anyway he wrote a piece that nodded to The psychopharmacologists but went on to a lot of biobabble – something ‘clinical’ neuroscientists specialise in and this Conversation article is full off
David
“Research shows that SSRIs work by promoting brain plasticity. This in turn allows individuals to perceive the world more positively —”
Beneath this is a coloured graphic of starry neurones and a synapse, with a shower of neuronal and intra-synaptic orange beads – presumably a neurotransmitter.
The subtitle to this graphic states:
‘SSRI antidepressants are thought to work by restoring healthy communications between brain cells’.
No references are given.
Tim
Thanks for this – its complete Biobabble. It’s hard to credit the extent to which American doctors resort to things like this rather than looking at, listening to and crediting the reports of people who come to them having problems on these drugs.
David
Agreed.
“Listen to your patient. He is telling you the diagnosis”. Sir William Osler.
Not just the American doctors – though granted they excel at biobabble – I’ve heard the brethren from other nations babbling on about antidepressants – and ECT – as promoting brain plasticity, neurogenesis etc.
When asked why they might think this – leaving aside the category error challenge – they effectively say – well, if you look at the brain on this treatment, stuff seems to be changing. Um-it’s called adaption, it’s what organisms do all the time.
I absolutely love this paper from a Mexican team. Hot challengers in the biobabble Olympics.
‘The therapeutic effect of antidepressants involves complex mechanisms that go beyond the traditional hypothesis of monoaminergic deficits to include changes in neuroplasticity. Neuroplasticity is the adaptive ability of the brain to reorganize and form new connections under normal and pathological conditions [1]. Depression is associated with dendritic neuronal atrophy and a reduction in glial cells and dendritic arborization in neurons of the prefrontal cortex and hippocampus, among other brain structures. In addition, an increase in dendritic branching of neurons of the cerebral amygdala was observed..’
https://www.mdpi.com/2227-9059/12/12/2744
Seriously – though reading this malarkey does make me light-headed – I think what’s happened is that the marketing of these drugs – essentially rating scale diagnosed diseases underpinned by random biobabble – has completely untethered them from the therapeutic principles that you know about and clarified even for science dummkopfs like me in ‘Psychiatric Drugs Explained’.
Once you understand that SSRIs are serenics, developed to damp down the impact on the person of their sensory system, a lot becomes clear. The fanciful notion of improved neuroplasticity seems even more far-fetched. But #PSSD, the emotional deadness that some patients hate, gut, vision, balance problems – or more positively, ‘taking the edge off’ – all make sense.
I think demystifying the way SSRIs work might be an important reality fix for patients too. As Jeff Lacasse’s research showed, the majority still believe the chemical imbalance myth. No surprise given the $bn spent embedding it in the culture. But what if they actually knew that the drugs were muting their senses not fixing their brains? How would that affect the ‘relapse’ narrative?
And concerns for possible adverse effects on the unborn child make sense too. Sensory reactions – either hyper or hypo – are characteristic of those with ASD – as are the well-known difficulties with social interactions, eye contact etc. You made this link in the FDA Panel- but I wouldn’t mind betting that most people in the room – non pharmacologists – had never heard of it.
It does really need to be where the story starts.
I gave one of my babies wind by eating wholesome organic acidophilus yogurt. You can’t be too careful.
An article in The Telegraph last month was accompanied by the headline “Antidepressants during pregnancy doubles the risk of autism”. The information had been taken for the most part from a Canadian study which concluded: “Use of antidepressants, specifically selective serotonin reuptake inhibitors, during the second and/or third trimester, increases the risk of ASD in children, even after considering maternal depression.”
http://antidepaware.co.uk/citalopram-and-the-unborn-baby/
Cheryl said in an interview last year: “I will not be a hypocrite and blindly continue taking a medication I don’t need. I’m not ‘depressed’. I’m sad, of course, and extremely angry, but these emotions are what make me human, and I have a right to feel sad at the loss of my child and everything that has come along with it.
“I also have a right to be angry, knowing that, had psychiatry and Big Pharma not wormed their way into my life at such a young age, I would not be in this position just now. But I cannot change the past; only use what has happened to me to try to help others.
“I think that’s what my daughter would have wanted.”
Parents
“This news made my heart sink with dread as I anticipate there will be many people who stand to suffer unnecessarily.”
“This panel was composed primarily of non-specialists who are on the record against the use of SSRIs,” adds Dr. Basch.
https://www.parents.com/evidence-backed-benefits-of-antidepressants-during-pregnancy-11783865
Meanwhile, psychiatrist David Healy, MD, opened his remarks with the jury award from a lawsuit years ago against the maker of Paxil — as if civil trial results are what determines a drug’s true teratogenicity. In the hierarchy of medical evidence, litigation outcomes prove only what plaintiff lawyers can or cannot sell to a jury box. Here with the Paxil narrative we can once again see Bendectin’s tenacious ghost.
More fundamentally, how should medicine respond to increasingly ersatz federal institutions? For SSRIs, pregnancy is likely just an opening salvo rather than end goal unto itself. Much of the meeting strayed from obstetrics into broad jeremiads against SSRIs in non-pregnant adults and children.
https://rxisk.org/blog/
Oh, Harriet, thank goodness David Healy writes blindingly searingly oppositionally fragrant letters.
LAS: If they took Paxil during pregnancy, their antennae should go up?
KG: Absolutely!
Baum Hedlund initiated its investigation of Paxil-induced birth defects based on information they found in documents GSK produced for the suicide cases. Since then, Baum Hedlund has been joined by several other firms that are jointly litigating the birth defects cases around the country.
While Gillespie’s cases primarily focus on Paxil and its manufacturer GlaxoSmithKline (GSK), issues related to birth defects and SSRIs are not limited to that particular drug. Just two years ago, the FDA issued a health advisory for Celexa, Fluvoxamine, Lexapro, Prozac and Zoloft, based on a study that suggested there might be additional risks associated with SSRI medications during pregnancy.
https://www.lawyersandsettlements.com/legal-news/paxil_birth_defects/kate-gillespie-interview-10882.html
Dear Healthcare Professional:
GlaxoSmithKline (GSK) would like to advise you that it is changing the Pregnancy subsection the PRECAUTIONS section in the labels for PAXIL®(paroxetine HCl) and PAXIL CR®(paroxetine HCl) Controlled-Release Tablets.
https://paxil-birthdefects.blogspot.com/2011/07/original-letter-from-gsk.html
The letter from Glaxo SmithKline can be read on the FDA website here – Original GSK Letter
That’s two FDA Health Advisory notifications on SSRIs and Pregnancy that I didn’t hear Marty Makary mention which might have swayed things somewhat and given the FDA panel a whole new direction of travel.
Amongst the tsunami of (apparently vested interest driven?) criticism of the FDA Expert Panel addressing the adverse outcomes of SSRIs I pregnancy, the following advocacy for antidepressant use was made: –
“The use of SSRIs in pregnancy is extremely well studied”. – – –
“We have data on hundreds and thousands of individuals exposed to SSRIs in pregnancy”.
In that case, it should be possible for us to be informed of the prevalence of SSRI induced AKATHISIA in pregnant women taking these drugs, and the effects of maternal AKATHISIA on the developing foetus/infant in utero?
Tim
Whatever about the effect on the fetus, there are increasing suicide rates among women of child-bearing years and pregnant women. It is very difficult to see how anyone could think this group of drugs would reduce this.
There is so much else not being looked at – SSRIs have effects on all sensory systems but I doubt if anyone has thought to see what this might mean for the baby.
It is hard to see how they can dismiss the effects of SSRIs on alcohol intake during pregnancy especially given the studies showing increased numbers of women drinking when pregnant.
David
Pogo has commented:
Well. Eleven days on from this FDA meeting I’m pleasantly surprised by
how widely it got reported. Of course, some of the coverage may be due
to many of the news making movers & shakers being on vacation at this
time of year, leaving the poor hacks with little news to report in
their usual lukewarm Yellow Journalism style.
Hopefully, these articles about this FDA expert panel meeting prompted
a good number of the right people to watch the video which stands at
13K views so far. I think watching the panel members present their
evidence is more informative than just reading the transcript as the
latter lacks the subliminal body language information which is a
useful guide to the ‘expert’s’ expertise and true convictions.
I was left wondering though how Nestlé of all companies manage to plug
their Nestlé Pure Life Still Spring Water by having a bottle of
it before each panellist.
When Lizzy Lawrence (July 25, 2025 FDA Reporter) writes: “The
panels are unusual because they’re being planned very quickly, and
with little input from career staff” does she mean ‘those’ staff
of the three letter agencies that used to control the narrative,
information and regulatory process to the liking of the pharmaceutical
industrial complex until they show they are loyal and knowledge enough
to pass through the revolving door into a six figure position in said
industry? People who know the weaknesses and Achilles heels of the
regulatory system are valuable to the healthcare industry.
There may have been exceptions in the resent resignations though, such
as Dr. Fiona Havers, who told colleagues at the Centers for Disease
Control and Prevention on Monday that she no longer had confidence
that the COVID and RSV data would be used “objectively or evaluated
with appropriate scientific rigor to make evidence-based vaccine
policy decisions,” according to an email seen by Reuters. But I leave
that up to you to judge.
https://www.reuters.com/business/healthcare-pharmaceuticals/us-cdc-official-charge-covid-rsv-data-resigns-ahead-vaccine-meeting-2025-06-16/
Another complaint I read reported is that representative from the
usual outside expert groups haven’t been invited. I think maybe
because they tend to act as lobbyists for their many pharmaceutical
sponsors and that type of ‘consensus’ is what the new style FDA
wants to get away from.
As has been mentioned many times now, there is currently little
inclusion of pregnant women in research trials. To address this short
coming of data, the FDA as a founding member of the International
Council for Harmonisation (ICO) have published a draft of guidance for
Inclusion of Pregnant and Breastfeeding Women in Clinical Trials with
a request for comments (ends:Sep 19, 2025).
https://www.regulations.gov/docket/FDA-2025-D-1797
I see on Line 350 it says: “It is recognized that the follow-up may
extend until past the clinical trial completion date.”
and on Line 872: “[…] neurological and physical developmental delays
or conditions may not be visible until later in life.”
I seem to remember that up till abut 8/9 yrs years of age the immune
system is still developing and I think neuron pruning in the brain is
still taking place. It was also mention at the FDA meeting that some
behavioural problems in children exposed to SSRIs don’t appear until
puberty. Therefore, I hope in the final draft it will ‘explicitly’
provide the length of follow-ups expected. Trials may be very
expensive to do but pharmaceutical profits are very high. These cost
should be considered as part of their ongoing marketing licence fees.
Another often voiced complaint is the lack of proper and meaningful
Informed Consent. Well, US Congress representatives Gus Bilirakis,
Jack Bergman and Keith Self have just introduced the Written
Informed Consent Act. This legislation would require the VA to
provide Veterans with clear, written information about the potential
side effects of antipsychotics, stimulants, antidepressants,
anxiolytics, and narcotics prescribed through the VA healthcare
system. The proposed bill mandates a standardized written consent form
outlining potential adverse effects, ensuring Veterans are fully
informed before medications in these categories are dispensed.
As the VA healthcare system is a competently different type of
organization to the FDA a similar Bill for expectant or pregnant women
would not be appropriate, but I think the FDA ought to now consider
how, when and which patients should get offered Written Informed
Consent. Think too, it is important to make full written consent
mandatory for any treatment granted an Emergence Use Authorisation.
https://bilirakis.house.gov/media/press-releases/bilirakis-bergman-and-self-introduce-bill-enhance-transparency-va-prescribing
Pogo
There are two problems with what you outline here. FDA don’t do science or clinical practice. They are not in the business of writing informed consent forms the way the VA does. They overview what companies write for their labels. Companies can be sued for a failure to warn – FDA can’t. VA could be sued but they would then just sue the companies if they were found guilty.
The international harmonization committees get nowhere unless the companies involved in the process agree to what is being proposed.
You’re delegating narcissism to FDA
David
I finally read the EMA draft ‘Guideline on inclusion of pregnant and
breast-feeding individuals in clinical trials’ – assuming this is industry dictée and the FDA version is in harmony.
https://www.ema.europa.eu/en/documents/other/ich-e21-guideline-inclusion-pregnant-breastfeeding-individuals-clinical-trials_en.pdf
It’s not an easy read. Not tap dancing. Not even lively lap-dancing. An endless routine of pirouettes en ‘ethicalese’ that leaves the reader quite dizzy. You’re desperate for substance and purchase. But there is almost none.
‘It is necessary to assess the non-clinical studies on how informative these studies would be on the safety of the investigational product for the intended patient population and make necessary adjustments to the type of studies needed and/or the study design.’
‘Ensuring ethical conduct of the trial therefore requires additional considerations regarding any need for appropriate safeguards related to pregnancy or breastfeeding (including risk mitigation measures implemented in the protocol and stopping criteria), as well as additional considerations regarding informed consent…’
‘The duration of follow-up should be considered on a case-by-case basis and will depend on the investigational product’s half-life, indication, nonclinical data, mechanism of action, timing and duration of exposure, and time to manifestation of outcomes of interest, taking into ICH E21 Guideline 13 consideration that birth defects and functional or neurodevelopmental disorders may be diagnosed beyond birth.’
I emerged thinking – this is a recipe for disaster. I’m sure scientists – including probably you, Peter, Adam U, the Bauer gang etc. – will tighten specific trial criteria into strangleholds. But even the ‘Guidance’ said one sensible thing:
‘Generally, clinical data that support safety and prospect of benefit in non-pregnant study participants could reasonably be expected to be applicable for pregnant individuals.’
Exactly – the main difference between pregnant and breastfeeding mothers and fertile women without children – is the baby, not the swirling hormones.
So leave the kids alone.
Why hasn’t the relaunched FDA thrown this out? I did hear Marty Makary observe that 90% of products that tested safely on animals were not proven safe in humans – so how about babies in the womb? But I also watched half of the Menopause Panel and thought he’d totally overlooked the risks in his enthusiasm to medicalise.
Maybe the Pope could make himself useful and give you a hand with this one?
RCPsych goes belly-up on Rxisk
The Royal College of Psychiatrists has semi-stepped into the frame also?
https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2025/07/24/postnatal-depression-harming-up-to-85-000-new-mums-in-england–warns-rcpsych
The Footnote:
https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antidepressants
‘Stopping antidepressants suddenly can lead to a relapse in your mental health problems. It can also cause unpleasant side-effects. You need to think about the severity of your previous illness before deciding whether stopping medication is safe. Many women relapse after stopping medication in pregnancy.’
Their continued monologue on ‘Relapse’ is what keeps them going. ‘You need to think about the severity of your previous illness’ sounds almost sinister..
a grandiose sense of self-importance seen time and time again – do they seriously think mothers-to-be -or-not-to-be roam anywhere near them. A Cult that cultivates civil obedience gone too far..
Annie
Putting things together like that does sound almost sinister. It does not seem designed to support anyone, least of all pregnant women.
David
STAT comes back
“Not traditional”
“Not surprising the FDA panel would have this bias”
Adam Urato, MD @AdamUrato1
This @wbur segment is titled “What is the risk of taking antidepressants during pregnancy?”
https://wbur.org/hereandnow/2025/08/01/pregnancy-antidepressants
In 6 min. @LizzyLaw_@tongscott don’t clearly note ANY risks – & even walk back Paxil concerns.
This is an example of what I mean when I say that the public is not being accurately informed re: risks of SSRIs in pregnancy.
Those risks are miscarriage, birth defects, preterm birth, low birthweight, preeclampsia, postpartum hemorrhage, & poor neonatal adaptation. The SSRIs also alter fetal brain development, with evidence showing long-term effects on the children including speech/language difficulties, depression, & other neurobehavioral issues.
Patrick Hahn comments:
Mice whose mothers are given SSRI’s during a certain critical time window during pregnancy exhibit behaviors reminiscent of depression and anxiety in humans:
https://www.baltimoresun.com/2017/06/23/are-drug-companies-grooming-new-customers-in-the-womb/
The drugmakers are grooming new customers in the womb.
Baltimore Sun is not available in our region
The drugmakers are grooming new customers in the womb.
By Patrick D. Hahn
UPDATED: June 7, 2019 at 8:46 AM EDT
In March, drugmaker GlaxoSmithKline agreed to pay $6.2 million to settle a class-action lawsuit on behalf of children born with congenital defects whose mothers used GSK’s blockbuster drug Paxil while pregnant. Just days before the agreement was announced, an updated analysis of the Quebec Pregnancy Cohort in BMJ Open, an online journal, showed that for the period 1998-2009, antidepressant use during pregnancy in the study population more than doubled, and the rate of major congenital malformations increased as well, by more than 50 percent. The rate of maternal depression in the study population also went up — odd, given that these drugs are supposed to be relieving depression.
The study reconfirmed the well-established link between paroxetine (the active ingredient in Paxil) and congenital heart defects, and also showed a link between venlafaxine (the active ingredient in Effexor) and congenital lung defects. In fairness, it should be pointed out that the absolute increase in risk is modest, on the order of one in a hundred — although this is cold comfort for mothers of babies born with holes in their hearts or unable to breathe on their own.
Moreover, these figures no doubt underestimate the true numbers of pregnancies affected since they omit those that end in spontaneous abortion, and those that end in therapeutic abortion after detection of fetal abnormalities via ultrasound. Antidepressants during pregnancy have been linked to increases in both spontaneous abortions and therapeutic abortions.
Is anyone surprised? These drugs inhibit the uptake of serotonin, an evolutionarily ancient signaling molecule that predates the origin of animal life itself and which plays an essential role in the development of the heart, the lungs, the brain, and probably every other organ in the body. It’s no wonder monkeying with serotonin uptake during development occasionally turns out badly. And could these children with major birth defects be just the tip of the iceberg? What about more subtle effects that may take years to manifest themselves?
We don’t know for certain, but studies on rodent models give us a hint. When researchers gave antidepressants to mice during the developmental period corresponding to the third trimester of pregnancy in humans, they found the mice as adults were reluctant to explore new environments, preferring to hide in the dark rather than walk in the clear light of day. They lost interest in eating and were slow to move to avoid a painful electric shock or to escape when imprisoned in a cylinder full of water. In short, the mice appeared fearful and despondent — precisely those conditions for which antidepressants are prescribed to humans. These effects could not be replicated by giving antidepressants to adult mice, indicating the effects are exerted during a specific time window during development.
David Healy, professor of psychiatry at Bangor University and the author of “Pharmageddon,” told me “The usual rule of thumb is that if a drug causes a gross birth defects like a cardiac defect, it will cause behavioral changes, also.”
A study by Finnish researchers published last year supports this. They examined national health care records and found offspring exposed to antidepressants during gestation had a threefold increase in the incidence of depression, compared to those whose mothers discontinued antidepressant use before pregnancy. Compared to offspring of mothers with a psychiatric diagnosis who never took antidepressants, the increase was fourfold.
Are the drug companies grooming the next generation of customers in the womb?
Why do doctors prescribe these drugs to pregnant women — or anyone, for that matter? Because they are safe and effective remedies for depression, of course.
Or are they? Last January BMC Psychiatry published the most comprehensive meta-analysis ever of antidepressants for major depression, reviewing 131 studies involving 27,422 patients. Researchers found that antidepressants reduced patient scores on the 52-point Hamilton Rating Scale for Depression by less than two points — an improvement far too puny to be noticeable in a face-to-face assessment of global functioning by a trained clinician. They also found that every one of the studies was at a high risk for bias, that the bias most likely favored the drug over placebo, and that antidepressants caused a 37 percent increase in the rate of serious adverse events. Moreover, only six trials reported data for suicides, and only eight for suicidality — odd, given that suicide prevention routinely is used as justification for dispensing these drugs.
This is getting close to saying the emperor has no clothes. Why do we even call these substances “medicines”? Perhaps what our society needs is less “mental health care” and more plain old-fashioned care.
Patrick D. Hahn is an affiliate professor of biology at Loyola University Maryland and a freelance writer. He can be reached at patrickhahn@hotmail.com.
Originally Published: June 23, 2017 at 1:20 PM EDT
In response to ‘There’s Something About Pregnant Mary, and the Urato post on RxISK Blog: –
“Doctors are trained to ensure that the medication they prescribe is as safe as possible to take while pregnant or breast feeding”
.If pregnant patient and foetal/neonatal safety is genuinely afforded utmost priority by Professional Associations and Royal Colleges, why have they apparently felt the need to deny all credibility to those doctors with a medical lifetime of Specialist Clinical Experience and Invaluable Scientific Expertise?
Might their (Cage Rattled?) media statements appear to be more concerned with protecting guild interests and prescriber’s professional status than maintaining the pregnant patient’s safety?
Those lost, maimed, and destroyed by ADRs to psychotropic drugs afford no credibility to these defensive media pronouncements. Neither do their families.
Pronouncements that perhaps GEORGE ORWELL addressed: –
‘IN OUR TIME POLITICAL SPEACH AND WRITING ARE LARGELY THE DEFENCE OF THE INDEFENSIBLE’.
We TRUST RxISK above their propaganda, and welcome sincere attempts to increase knowledge and awareness of all Adverse Reactions to these drugs.
Prescribing based upon Full, Fair and Informed Consent is surely a Medical Human Right?
Tim
The Orwell quote – political speech and writing are largely the defence of the indefensible – is so appropriate. What we get is Newspeak. What is missing is leadership.
David
Fempower Health – Georgia Kouacs
“Who owns Women’s Health?”
Georgia brings up some important points, quite close to Consultant360, a more softly, softly approach, bringing it altogether
https://www.youtube.com/watch?v=WCfTYQUS7A8
Improved interprofessional coordination (e.g., between OB/GYNs, psychiatrists, and primary care) can enhance preconception and prenatal care quality.
https://www.consultant360.com/exclusive/fda-panel-discusses-safety-use
RSV vaccine cuts hospital risk for newborn babies – report
7 August 2025
https://www.bbc.co.uk/news/articles/c62w8xq3zxjo
Leadership requires more than BBC News calling Robert Kennedy Jr. ‘capricious’, or ‘baby news’ ..
https://www.statnews.com/2025/08/05/mrna-vaccine-development-canceled-by-kennedy-hhs/
Vaccine experts and people steeped in pandemic preparedness expressed horror
Who owns Women’s Health..
Leadership is key.
At present we are being led by a vacuum – company trials which are called evidence but with no access to the data in these trials and a failure to collect the data we have no access to – the data on either mother or child And no follow-up of the children afterwards.
We need a bunch of women to take control of this – Our Bodies Our Selves – and set up registries that can be interrogated by all women who want to weigh up the risks and benefits. Only individuals can make a risk benefit assessment. Neither experts nor FDA can do this for them – and the old Boston Collaborative that gave rise to the original Our Bodies Our Selves have been captured by pharma.
D
“From a national standpoint, the more antidepressants we prescribe, the more depression there is,” said FDA Commissioner Dr. Marty Makary without providing evidence for that claim.
I have noticed the above sentence repeated several times as if these media outlets all got the same boilerplate rebuttal emailed to them from the same source. I won’t bother to provide evidence either. Instead I’ll point to some strong correlations (which aren’t evidence in themselves but red flags) to possible causes for rise in self harm, depression and anxiety as recorded by the CDC in 2017 and published in JAMA. This, I ought to point out is mainly applicable to Generation Z, the eldest of which are about 28 now and so maybe useful for doctors of middle aged and upwards to be aware of in order to avoid going up the wrong treatment route.
I suppose it starts just over a decade and a half ago when a British researcher Susan Greenfield started warning of the dangers to children of too much computer screen time (ironically, whilst trying to launch her own computer software aimed at children).
https://en.wikipedia.org/wiki/Susan_Greenfield,_Baroness_Greenfield#Impact_of_digital_technology_controversy
A little later, Jean M Twenge Ph.D. cast around for explanations for the ‘sudden’ rise in self harm, depression and anxiety as recorded by the CDC. The correlation with the best fit she found was that these phenomena rose in line with the explosive rise of Social Media, which she explains very well in this Psychology Today article.
https://www.psychologytoday.com/us/blog/our-changing-culture/201711/5-reasons-why-self-harm-and-depression-have-tripled-in-girls
This article was back in Nov 2017 and social psychologist Jonathan Haidt has since found this rise became a world wide phenomenon.
https://jonathanhaidt.com/social-media/
We just have to get our dopamine rewards one way or another even if those socially normalised options in our modern world generates unhelpful inner tensions and negative emotions.
In such circumstance, trying to correct for dopamine hunger with a serotonin reuptake inhibitor seems obviously dangerous and pointless.
There may be nothing wrong with our social media use per se and there is little evidence it creates dopamine hunger. It is full of metrics – the latest being Whoop which tracks your every eye blink and if you deviate from the norm puts pressure on you more than – as Haidt and Blanchflower say – see Damsels in Distress some months back – and causes distress leading to an explosion of SSRI use in this age group and SSRIs definitely cause suicides.
When you started off giving the Makary quote and saying if featured in post of the media reports of the panel – my thought was one reason for that was Chat GPT or related wrote the stuff for them making them all much the same. We have been inclined to this as a bitter Democrat v Republican split – but is social media – A.I. – significantly aggravating the divide in all sorts of ways.
David
“There may be nothing wrong with our social media use per se and there is little evidence it creates dopamine hunger.” you say. What is it then?
Here is why I think social media technology tends to create dopamine hunger, albeit with some awkward phrasing in an attempt to be expansive yet brief.
There maybe nothing wrong with most people’s social media use, as I imagine their synaptic terminals have a healthy dynamic range of serotonin to call upon as needed. Thus, most are able to effortlessly ‘displace’ (sort of ignore) anxiousness about what people say about them and ‘keep a clear thinking head’ and react appropriately. In other words, stand up for themselves.
As an aside: Psychologist Jordan Peterson points out that it is the lobsters with the highest serotonin levels which always wins the fight.
However, what about those emotionally immature individuals who are totally naïve about the social media algorithms leading them ever deeper into the pseudo-random cycles of puzzlement, confusion, anxiety, relief, resolution and so on. Don’t such users become conditioned to finding relief because the algorithms which weave through SM provide a never ending stream of irresistible dopamine-paired cues and negative emotions delivered to them by SM’s ubiquitous serotonin fuelled alpha influencers?
Over time they become desensitised and hunger for evermore dopamine as their addiction deepens. The usual questions the doctor asks one by one, slowly increases epinephrine step by step, whilst nothing in the consultation compensates enough to boost dopamine levels back up to what one would expect in whom should be an excited expectant mother. The negative expressions flickering across their faces may be triggered not just by the thought that their doctor is now questioning their sanity but because subconsciously they recognise their doctor’s word patterns are also used by SM’s Alpha Vixens as they probe for their next victims vulnerabilities. All this tension drives them into deep dopamine withdraw. Gosh, doesn’t his patient now look like they need a stiff drink?
Through circumstances or rolls of the dice over many years they may have drifted very far from ‘ancestral environments’ which would normally provided sufficient healthy life experiences and dopamine rewards in return for performing and maintaining the right ‘ancestral’ social interactions.
However, I hear that give their constitution a few weeks to rebalance in isolation from SM and apparently (it is said) that their heightened anxiety state fades as well.
Finally, I think (tentatively) the dynamic range of serotonin levels in some brain regions are dependant on how harmonious some important neural networks are matched to the environment in which the organism dwells. In the evolution of homo-sapien, grandparents have gained an important role in specie survival. Grandparents may not know of the German philosopher Friedrich Nietzsche nor his aphorism “What does not kill me makes me stronger” (German: Was mich nicht umbringt, macht mich stärker) but they have learnt its truth from life experiences. Being at the top of the family hierarchy they take as their duty to speak frankly, honestly and with compassion to grandchildren they know very well. They can venture not only into areas where doctors fear to treat due to thin ice but can sometimes walk upon water. They help to ensure their grandchildren develop mental compatibility with the environment in which they have to survive and thrive. This brings with it resilience, confidence and with it I think (tentatively agin) a healthy dynamic range of serotonin, dopamine and strengthens wilful control of epinephrine/norepinephrine ratios. If however, in the modern world, these grandparents are absent (or are themselves too naïve about the SM technology), then I think it would help a troubled and pregnant individual if their own unordered naïvety be programmed with suitable neural network patterns with the aid of some sort of external assistance.
In short and in a perfect world, the anxious pregnant patient just needs enlightening, training, physically close human interactions and a good diet. Ah! I think Dr Abraham Maslow may have beat me to this last bit by a few decades.
Pogo
The onus on you, Haidt, Lembke and others who go on about dopamine hunger to establish that this is not just biobabble. Having read all this stuff it sounds like biobabble to me. The Americans are great at moving from one form of babble to another – picking up on the latest science reported in the lay media and using the words without understanding much if anything.
Your riffing on serotonergic harmony sounds like biobabble. There is vanishingly little serotonin in our brains. There is comparatively more by weight in our eyes and vestibules.
The increasing use of social media is a fact not babble. The increasing use of antidepressants in this age group and women especially is a fact not babble. The increasing rate of suicides in this age group and especially women is a fact not babble. Do we think there is differential dopamine hunger in women?
D
If you agree that a quantity of mass as measured on bathroom weighing scale is no good indication to an observer of how it will make the owner of that mass feel, which may not even be in the same ball park of an observer’s estimation between anorexia to morbidly obese, can you not substitute kilograms for picograms and consider this may be true for dopamine too — even if only as a thought experiment?
Anyway, I expected that by emphasising the phrase ‘dynamic range’ it would be clear that I didn’t mean absolute quantities of any of these neural chemicals. I thought it would be taken as read that their half lives are measured in minutes and that ‘dynamic range’ was more expressive than the say the word ‘flux’ and any other interpretation of meaning would be meaningless in a context of being created or destroyed as required.
I was hoping to indicate that with out the benefit of (say) radio-ligand studies, there have been many observations which seem to bare out that the fluxes of metabolic synthesis and turnover of everything, the whole shebang, including the 5-HT family of receptors, serotonergic agonists, phosphatidylinositol derivatives, enzymes, regulation of neurotransmitters by Glial cells. increased blood flow to active parts of the brain, the fitness of those vessel’s tunica media muscle cells, etc., etc., changes in response to the chronic work load habits which the brain is under. Everything has to have a mechanistic action and even when the details are unknown the subject feels what only can be described as hunger for stimulation. Someone on the panel even pointed out ‘feelings’ are real. So why are you implying that these feeling from cessation of SM activities are not real or don’t exist? What do you think these signs and symptoms are result of if not dopamine hunger (or if it has to be in Latin ‘fames’)?
A clear understandable conceptual model could help a prescribing doctor to navigate between the societal, psychological, psychobiological and the physical.
For evidence of the suitability for the phrase — dopamine hunger. Look over the shoulder of a teenager whilst they are on social media. Before your very eyes you’ll see them going round in circles.
As proof of Youtubes algorithms being subtly able to re-direct my attention, this video has just come up in my feed (which by the title you can see I wasn’t even looking for such a video, so it may have been watching my dictionary inquiries and getting meta-data key words that way) where Chase Hughes describes these circles as ‘loops’ and simply labels them as fear-hope-guilt-belonging (as in acceptance and belonging to a tribe) and back to fear again. I don’t however, think I’ll bother to watch the rest of it. But it has succeeded in rousing a little anxiety as to how easy the algorithm can prove my point for me.
‘The Book the CIA Copied Word for Word, Then Tried To Erase’ linked to the timestamp where it explains loops.
https://youtu.be/2iDI-un8WGo?t=346
Are Haidt, Lembke, Chase Hughes and myself all appear to be witnessing the same phenomena which causes a ‘feeling’ of hunger for stimulation rather than us all sharing in folie à plusieurs.? If the feeling is ‘experienced’ and the signs are externally witness-able, then that sensation is real and therefore can not be a somatic hallucination.
Finally: Many things in science were slowly accepted, not because they were proven but because the maths of the conceptual models worked and could be used to predict outcomes. So for example, the concept of the atom was first invented to make chemistry work on paper. Agreement of a standard nomenclature also took time. I think that current uncertain nomenclature around SM usage and effects is very much work in progress so well may sound like biobabble to some.
The sex dependant differences resulting in gender biased harmful behaviour perhaps may come to light if only the algorithms could be inspected by independent psychologists.
So now for your homework: Find teenager; obtain informed consent; watch over her shoulder; take notes; do the same with a male subject; report back your interpretation.
Pogo
For Haidt, Lembke and others there are some sensible things in what they say or write and a lot that is just speculative and babble. The dopamine stuff is entirely babble – you close to concede it yourself when you say you are substituting dynamic range for flux etc. Americans find it close to irresistible to drift into this kind of language that like Freudian libido bore little or no link to real libido. In the same way, the serotonin as in lowered serotonin levels bears no relation to real serotonin. Fluxing it or dynamically ranging it this way or that will make no difference.
This has nothing to do with things that are later recognized to be real – this is pollution of words that sound sciency. There are undeniable facts but nothing you mention here links to facts.
D
Pogo
Walter Hess a Nobel Prize winner for physiology would challenge his students doing early work on neurotransmitters – How do you think this will help you work out why you fall in love with a girl?
Benzodiazepines work among other things on GABA and undo conditioned reflexes – things we have learnt to be anxious about.
Antipsychotics which help by blocking dopamine among other things which undoes some unconditional reflexes – linked to things we are tense about – they undoing reflex moving for instance as in agitation. But they stimulate reflex eating or at least increase appetite.
Dopamine agonists which also act on serotonin among other things kill appetite and are used for this purpose. They can cause stereotypy but this is not an increase in appetite.
Invoking dopamine as thought this somehow solves questions is invoking a mystical not real world dopamine. It makes more sense to look at the behaviour and ask is an appetite being created or reduced, while stereotypies (tics) are being increased.
When a woman drops an anticholinergic drug in her eyes, I am more likely to think she’s beautiful because her pupils dilate which means she likes what she is looking at – me – which is a strong factor in how attractive she will look to me. Likely my eyes dilate in response to the anticholinergic drug in her eyes. Does it add or subtract from what is going on to talk about dynamic cholinergic harmonies or fluxes?
D
The problem with Danny’s confident economist’s correlations is that they lead to inattentional blindness – aka missing the whopping great pachyderm in the room.
Ofc cyber bullying – being psychologically demeaned in front of a host of strangers – is destructive. Feeling forced to create and expose your self online as a confected social identity – rather than just be – can be tough. Kids probably need to spend more time playing with their mates than glued to their smartphones.
But why are the correlationists missing the obvious? Why are young people – in fact all people – but especially young women at an accelerating rate (the Aussie antidepressant incidence figures you point to) experiencing ‘mental health’ problems and taking their own lives? Because Zoomers are the most pathologised and medicalised generation in human history. You nailed it in ‘Damsels’. And Freya India, real life Zoomer, clearly sees what is happening to her own generation of young women:
‘Prescriptions for antidepressants, particularly for girls, have soared in recent years. In the US, antidepressant usage has surged by nearly 65% in the past 15 years, with women twice as likely to take them as men. In the UK, antidepressant prescriptions for children aged from five to 12 increased by more than 40% between 2015 and 2021. Here, one in three teenagers have been prescribed them.
And all over the internet, girls are so casual and blasé about these pills, even glamorising and fetishising them. We have antidepressant TikTok filters and SSRI phone cases. We have Prozac-shaped pillows, Hot Girls Take Lexapro sweatshirts and Stay Sexy, Take Sertraline artwork. Under hashtags like #mentalhealth on TikTok, which has nearly 88 billion views, girls describe SSRIs as silly little pills, call brain zaps from Zoloft withdrawal “the zappies” and put their medication in Disney-themed sweets dispensers. And these girls are absolutely convinced that they have a chemical imbalance in their brain, lamenting that they are “wired this way for life” and “won’t ever get better”. ‘
https://www.freyaindia.co.uk/p/why-are-so-many-girls-on-ssris
I’m far less concerned about the ‘scourge’ of smartphones, than the fact that we have been enculturated by industry to believe that any negative blip in the happiness-ometer is a ‘mental health’ issue. That drugs that mute our sensory system – to the point of anaesthetising our genitals or our urge to live – are the way to regain the joy that is the ‘normal’ state. If, as we know, and saw the numbers in Jeff Lacasse’s presentation, the majority still believe in the ‘serotonin deficit’ marketing myth, then how can we ever hope to dispel the destructive nonsense that unhappiness and stress are abnormal states of being that need to be medicated away? The whole point about the human condition is emotional dimension.
Calling out the risks of the pills, as you do, is a fundamental battlefront and one road to enlightenment. As is emphasising other safe and healthy alternatives like exercise and diet. The research keeps telling us, quite rightly, that exercise especially in social settings is more effective than pills. What world do we live in when we need research to tell us what my granny knew?
And, obviously, we need social policies that address the emotional and material needs of those living in deprivation– whose lives are unarguably depressing and amongst whom antidepressant prescribing is notably upweighted . That’s a correlation that actually means something.
Q: Do SSRIs cause suicide?
A: From Grok
The relationship between SSRIs (Selective Serotonin Reuptake Inhibitors) and suicide is complex and has been the subject of extensive research and debate. Here’s a breakdown of what the evidence shows:
Increased Risk in Certain Populations
Children and Adolescents: SSRIs have been associated with an increased risk of suicidal thoughts and behaviors in people under 25, especially during the first few weeks of treatment. This led the U.S. FDA to issue a black box warning in 2004 for antidepressants used in younger populations.
Early Treatment Phase: The risk of suicidality tends to be highest in the first one to two months of starting SSRIs. This may be due to patients gaining enough energy and motivation to act on suicidal thoughts before their mood improves.
Why This Happens
SSRIs increase levels of neurotransmitters like serotonin, but they don’t immediately resolve the underlying emotional distress.
As depression begins to lift, some individuals may feel more energized but still hopeless—creating a dangerous window where suicidal thoughts can become actions3.
Mixed Evidence in Adults
For adults aged 25–64, SSRIs may have no effect or even a mild protective effect against suicidality.
For those over 65, SSRIs appear to reduce suicide risk.
Some studies suggest SSRIs may be no more effective than placebos for many patients, raising questions about their overall benefit-risk balance.
Personal Experiences Vary
Some individuals report a temporary worsening of symptoms, including suicidal thoughts, when starting SSRIs—even if they hadn’t experienced such thoughts before.
These effects often subside after the initial adjustment period.
If you or someone you know is starting SSRIs, it’s crucial to have close monitoring, especially in the early stages. Would you like to explore alternative treatments for depression or ways to manage side effects safely?
Powerful antidepressants taken by millions ‘linked to more than 1,000 deaths – including children under ten’
By CAMERON ROY
Published: 10:31, 9 August 2025 | Updated: 10:34, 9 August 2025
https://www.dailymail.co.uk/health/article-14903225/antidepressants-taken-millions-linked-deaths-analysis.html
Snappy headline
‘None of the fatalities, however, are proven to have been caused by SSRIs, a category of drugs including sertraline and fluoxetine. Many may have been caused by existing illnesses and conditions.’
The great divide between AI and the Daily Mail reporter is not universally wide.
I think Katinka could have done it better, and AI could have done it worse.
Millions stuck on pills that can wreck lives: Years after experts admitted crippling side effects of quitting antidepressants, we reveal doctors are STILL not following these crucial steps to help patients
By JOHN NAISH and JO WATERS
Published: 01:28, 12 August 2025 | Updated: 05:49, 12 August 2025
https://www.dailymail.co.uk/health/article-14990737/Millions-pills-wreck-lives-quitting-antidepressants-doctors-patients.html
https://archive.ph/Mm4u5
Meanwhile, in the US a new network of specialist clinics called Outro launched last month, co-founded by the UK-based tapering pioneer Dr Mark Horowitz – a clinical research fellow in the NHS who experienced problems withdrawing from these drugs after taking them for 15 years.
Congratulations to Mark Horowitz on his new title ‘tapering pioneer’.
I still think Katinka could have done it better.
This neurocognitive scientist is on a similar track re dopamine – describing the supposedly therapeutic effects of dopamine fasting as #neurobollocks.
‘Dopamine is a chemical that transmits signals between brain cells. It is released during rewarding experiences and helps to reinforce behaviours. For instance, getting all those likes, comments and reshares on your social media post!
It’s overly simplistic to say that every pleasurable activity triggers a massive dopamine release, though. Many everyday actions, including moving, learning or achieving goals, also involve dopamine. And dopamine isn’t something you can “fast” from. You can’t just turn it off or reset it by avoiding tech, eating bland food, and minimizing social interactions.
Your brain constantly produces and regulates dopamine to keep you functioning. Even when you’re doing something mundane, like taking a walk or reading a book, your brain is still releasing dopamine. It’s not about the intensity of the activity, but rather the brain’s ongoing need to regulate motivation and reward.
This idea of “resetting” your brain by fasting from dopamine-triggering activities oversimplifies how the brain works. In other words, the concept of “dopamine fasting” is #neurobollocks – it is based on a misunderstanding of how dopamine works in the brain. The real issue isn’t dopamine itself, but the behaviours associated with it.’
https://www.linkedin.com/posts/joseph-t-devlin_brain-dopamine-neurobollocks-activity-7242079936612610048-6oKp
As a general principle, it’s fair to say that overly neat theories of how human beings work are – overly neat. It’s a bit like Jaws the movie – just when we think we’ve left one ludicrously simplistic theory behind – the ‘chemical imbalance’ – up pops another wild one.
Nobody could have made the case for the need to inform pregnant Moms of SSRI risks with greater clarity and scientific precision than Adam Urato in his recent Psychology Today post: https://www.psychologytoday.com/us/blog/chemically-imbalanced/202508/antidepressant-risks-in-pregnancy-what-women-need-to-know
In sharp contrast to the emotionalism of much of the pushback, viz a maternal fetal medicine specialist on tiktok:
‘When I heard what expert FDA panel said I was OUTRAGED.
As a maternal and fetal medicine specialist when IB heard what this supposed expert panel in the FDA said about ad use in pregnancy I was outraged. But thie ‘expert’ panel of 10 people 9 of which have openly come out against antidepressants, questioned the safety of antidepressant use in general are going to sit there and talk about how SSRIs are not safe in pregnancy.
Many of the studies they mentioned were crap studies as any of us who actually knows how to read and interpret studies can tell you ,and some of them couldn’t actually accurately interpret the studies they were using to defend their argument. And only one member of the panel was an actual expert in maternal mood disorders.
The facts are this, No 1 the leading cause of pregnancy related maternal mortality is suicide and overdose related to undertreated or untreated MATERNAL MENTAL HEALTH DISEASE. Post partum depression occurs in up to 20% of individuals. Untreated depression can lead to substance use, preterm birth, preeclampsia, limited engagement in medical care and self-care, low birth weight,with their infant and suicide…. ‘
https://www.tiktok.com/@babies_after_35/video/7530366803369905422?q=taking%20ssris%20in%20pregnanacy&t=1755300952405
Or picking some keywords from Lauren Schneder’s JAMA piece:
‘lifesaver’
‘the risk of untreated mental illness’
‘might pass the condition on to their children’
‘ modern understanding of the causes of depression implicates multiple neurotransmitter systems and brain processes’
‘do not appear to increase the risk of autism when you take into account maternal mental health and psychiatric disorders.’
‘no long-term neurodevelopmental consequences of neonatal adaptation syndrome.’
‘Outlandish and unfounded claims’
Observing the to and fro, the obvious occurred to me. The biomedical model of ‘depression’ belief system is completely divorced from the pharmacology you and Adam articulate. I totally understand why practising maternal and fetal medicine specialists become, frankly, hysterical at the thought of taking their pregnant patients off SSRIs – highly likely they would ‘relapse’ – inotherwords risk being overwhelmed by their sensory input. New babies make extraordinary demands on our maternal sensory system. But this isn’t a disease state – and certainly not an hereditary one.
Looking at some slightly old maternal mortality data adds perspective too. The six most frequent underlying causes of pregnancy-related death — mental health conditions, haemorrhage, cardiac and coronary conditions, infection, thrombotic embolism, and cardiomyopathy — account for over 75% deaths. Black Moms are more likely to die from cardiac and coronary conditions, mental health conditions dominate amongst White and Hispanic Moms. Mental health conditions include –‘deaths of suicide, overdose/poisoning related to substance use disorder, and other deaths determined by the MMRC to be related to a mental health condition, including substance use disorder’ I’m sorry, depression does not *cause substance abuse as some would have us believe – hardship and adversity do.
The other pertinent contextual point is that the US, still the wealthiest country in the world, continues to have the highest rate of maternal deaths of any high-income nation. Post partum care is generally much poorer than other high income countries, 2/3 of pregnancy–related deaths occur post partum – and inequities in the care of black Moms are shameful.
https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison
There’s a much bigger story here than simply depression is the leading cause of pregnancy related deaths. Which is not to say that, as you put it – ‘It’s a good idea to treat people who are depressed,” panelist David Healy, MD, told JAMA Medical News. “It’s not necessarily a great idea to give SSRIs.’
Missing link fort maternal mortality stats:
https://www.cdc.gov/maternal-mortality/php/data-research/mmrc-2017-2019.html