Getting to the Truth About SSRIs and Pregnancy With Marlene Freeman, MD

BRAIN TRUST: CONVERSATIONS IN PSYCHOPHARMACOLOGY

Joseph F. Goldberg, MD, in his first installment of "Brain Trust: Conversations in Psychopharmacology," sits down with Marlene P. Freeman, MD, to discuss the treatment of depression, selective serotonin reuptake inhibitors (SSRIs), and pregnancy.

In this brand new video series, Goldberg will be joined by experts in clinical psychopharmacology to discuss topics that are front of mind, controversial, unresolved, or should be a part of clinical thinking for prescribers. Essentially, they will evaluate what is topical in psychopharmacology and what you need to know.

On July 21, 2025, the US Food and Drug Administration led an expert panel on SSRIs and pregnancy, in which they questioned the validity of psychiatric medication use during pregnancy.¹

"There were a lot of issues that came out of that panel discussion about the potential risks vs safety of SSRIs in pregnancy," said Goldberg. In their discussion, Goldberg and Freeman evaluate what the panel got wrong.

Freeman, a leading expert in women's mental health, specifically discussed the complexities of treating psychiatric disorders during pregnancy, emphasizing the high rate of unplanned pregnancies and the risks of untreated illnesses: "Any prescriber should keep in mind that for women of reproductive potential, the rate of unplanned pregnancies in this country is about 50%.² So whenever we are writing prescriptions or deciding on treatment plans, we want to keep in mind that even if a woman is not planning on becoming pregnant at the time, she might become pregnant at some time."

She highlighted the need for well-controlled studies to understand the effects of SSRIs on pregnancy outcomes. Notably, SSRI use does not increase the risk of autism.

"We always want to keep in mind the reproductive safety of the medications that we are using, and that includes what we select for girls and young women as well. So many of the disorders we treat are chronic or recurrent, and we want to make sure that there is a reasonable plan for medication use across pregnancy," said Freeman.

It is important to note though that a mental health disorder is also a risk factor to pregnant patients: "We know that with with all the major psychiatric disorders that have been studied across pregnancy, the disorder itself carries risk for the individual, the pregnancy outcomes postpartum, and for the baby, and ultimately for child development."

Freeman also addressed the misinformation around stopping SSRIs in the third trimester and the importance of patient-centered, evidence-based care.

"Our job in perinatal psychiatry is to be able to integrate years of studies and be able to explain to patients what seems to be true risk and what is not," said Freeman.

Dr Goldberg is a clinical professor of psychiatry at The Icahn School of Medicine at Mount Sinai in New York, NY and the immediate-past president of the American Society of Clinical Psychopharmacology.

Dr Freeman is a professor of psychiatry at Harvard Medical School, the Abra Prentice Foundation Chair in Women’s Mental Health at Massachusetts General Hospital, the associate director of the Center for Women’s Mental Health at Massachusetts General Hospital, and the medical director of the MGH Clinical Trials Network and Institute.

References

1. FDA expert panel on selective serotonin reuptake inhibitors (SSRIs) and pregnancy. FDA. July 21, 2025. Accessed August 14, 2025. https://www.fda.gov/patients/fda-expert-panels/fda-expert-panel-selective-serotonin-reuptake-inhibitors-ssris-and-pregnancy-07212025

2. Unintended pregnancy. CDC. May 15, 2024. Accessed August 14, 2025. https://www.cdc.gov/reproductive-health/hcp/unintended-pregnancy/index.html