In a powerful episode of Relatable, conservative commentator Allie Beth Stuckey sat down with Dr. Adam Urato, a maternal-fetal medicine specialist, to shine a light on an issue many in the medical community hesitate to confront: the potential dangers of prescribing antidepressants, specifically selective serotonin reuptake inhibitors (SSRI), to pregnant women.
Dr. Urato, who has worked closely with expectant mothers throughout his career, voiced concerns that are often buried beneath pharmaceutical lobbying and clinical oversimplification. According to him, most women are not fully informed about what these medications actually are—and what they could mean for the developing fetus.
The Trouble with SSRI Medications
SSRIs, which include widely known names like Prozac, Zoloft, and Lexapro, are synthetic chemicals designed to alter serotonin levels in the brain. While serotonin is known as the “feel-good” neurotransmitter and plays a critical role in regulating mood, it is also fundamental to fetal development, influencing everything from brain structure to cardiac formation.
“These drugs are not naturally occurring substances. They’re made in factories—places where workers need to wear protective gear to handle the materials,” Dr. Urato pointed out. “That alone should tell us something.”
More importantly, SSRIs are capable of crossing the placental barrier, which means that a fetus is directly exposed to the active compounds circulating in the mother’s bloodstream. This has raised significant red flags in medical literature, though such warnings often don’t make it into standard patient counseling.
What the Research Says
Citing a range of studies, Dr. Urato detailed several documented risks associated with SSRI use during pregnancy. Among the most concerning:
- Increased risk of miscarriage
- Higher rates of congenital birth defects, particularly involving the heart
- Premature birth and low birth weight
- Greater likelihood of respiratory distress in newborns
- Postpartum hemorrhage in mothers, due to the drugs’ known effect on blood clotting.
He emphasized that many of these outcomes are not rare anomalies but consistent trends observed across multiple peer-reviewed studies.
Yet, despite the growing body of evidence, antidepressants remain a routine prescription for pregnant women in the U.S. and many other parts of the world. “There’s a huge disconnect between what the science says and what patients are being told,” Dr. Urato remarked. “And that disconnect can have life-altering consequences.”
Pharmaceutical Influence and the Question of Consent
At the core of the issue lies what Dr. Urato calls a systemic failure in medical ethics—driven in large part by the pharmaceutical industry’s grip on medical research, education, and even treatment guidelines. Many obstetricians and general practitioners continue to prescribe SSRIs to pregnant women without fully discussing the potential risks or exploring non-pharmacological alternatives like cognitive behavioral therapy, lifestyle interventions, or temporary social support systems.
He criticized what he sees as an overreliance on medication as the default option and urged medical professionals to pursue a more nuanced, individualized approach to maternal mental health.
“True informed consent means laying out all the risks and options, not just handing over a prescription,” he said.
The SSRI Bigger Picture: What This Means for India
While this conversation primarily centers on the United States, the implications resonate globally—especially in countries like India, where mental health awareness is growing, but systems of regulation, patient education, and clinical oversight often lag behind.
In recent years, India has seen a dramatic rise in antidepressant usage, including SSRIs, with increasing prescriptions among young women. According to a 2022 report by the Indian Journal of Psychiatry, depression during pregnancy is often underdiagnosed, and when diagnosed, treated primarily with medication—without adequate psychological counseling or follow-up.
Unlike the West, India also grapples with a lack of specialist access in rural and tier-2 cities, where general physicians often serve as the first—and only—point of medical contact. These doctors may not have the training or resources to communicate the risks associated with psychiatric drugs in pregnancy.
Furthermore, the influence of international pharmaceutical companies in the Indian drug market cannot be ignored. SSRIs are widely available over the counter in many areas, with minimal checks or prescription oversight. In such a context, pregnant women may unknowingly be exposed to medications that have long-term implications for both their own health and their child’s development.
Where Do We Go from Here?
Dr. Urato’s message is clear: the conversation about SSRIs and pregnancy needs to be louder, more honest, and led by those who prioritize patients over profits. Whether in Boston or Bangalore, expectant mothers deserve full transparency and support when it comes to their mental and physical health.
For India, this means investing in mental health infrastructure, expanding access to non-drug therapies, and enforcing stricter regulatory oversight of drug prescriptions during pregnancy. It also means empowering women with the information they need to make truly informed choices about their bodies and their babies.
Because in the end, it’s not just about treating symptoms—it’s about safeguarding the future.
