Breaking Down the FDA Advisory Board Meeting on SSRIs During Pregnancy With John Miller, MD

John Miller, MD, Editor in Chief of Psychiatric Times, discusses yesterday’s FDA advisory board focus group on selective serotonin reuptake inhibitor (SSRI) use during pregnancy. Miller says he was “perplexed why this panel met to discuss this topic, since we’ve been using SSRIs since 1987 with the approval of fluoxetine.” He noted that there is a wealth of research data on using these medications during pregnancy, but the panelists reiterated that there was not enough data on the topic. But with over 2000 results on PubMed with keywords “SSRIs” and “pregnancy,” Miller feels confident and impressed with the amount of data available on the subject. He said of the panelists that there was a “range of people who are really disconnected from direct care of pregnant patients,” and would have liked to see experts in the field such as Dr Lee Cohen and Dr Marleen Freeman weigh in on the discussion. Miller, as a provider, feels “quite comfortable” prescribing SSRIs during pregnancy. Sites like the Center for Women’s Mental Health provide up to date information and a registry on using medications, including SSRIs, during pregnancy. Depression itself is a risk factor during pregnancy for both the mother and child, Miller says. Even with nonpharmacological treatments, Miller strongly encourages clinicians to provide a risk-benefit assessment to pregnant patients around continuing their psychiatric medication during pregnancy. He also disagrees with the panelists’ claim that SSRI use in pregnancy can cause Asperger’s spectrum disorder or alcohol use disorder. Miller says generally he hoped for a “broader and more informed group of experts” to present on this topic, and there was a lack of understanding for the history of research on the use of SSRIs during pregnancy.

Dr Miller is Medical Director, Brain Health, Exeter, New Hampshire; Editor in Chief, Psychiatric Times; Staff Psychiatrist, Seacoast Mental Health Center, Exeter; Consulting Psychiatrist, Insight Meditation Society, Barre, Massachusetts.