Radically Genuine Podcast with Dr. Roger McFillin 217. The Harms of SSRI's During Pregnancy Debate w/ Dr. Adam Urato and Dr. Robert Chen
Jan 29, 2026
Dr. Robert Chen, psychiatry researcher focused on biomarkers and therapeutics, and Dr. Adam Urato, maternal-fetal medicine physician and FDA panel expert, debate SSRI use in pregnancy. They tackle serotonin’s role in fetal brain development, how SSRIs cross the placenta, limits of the evidence, newborn risks, informed consent failures, and the need for clearer patient conversations.
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Prefer High-Quality Cohort Designs
- When RCTs aren't feasible, prioritize large cohort studies with propensity matching and internal controls to approach causality.
- Seek studies that control for shared genetics, environment, and depression severity before drawing strong conclusions.
Relapse Versus Withdrawal Confound
- Distinguish withdrawal symptoms from true relapse when patients stop SSRIs during pregnancy, because mislabeling can bias study conclusions.
- Early SSRI discontinuation studies (e.g., Cohen 2006) did not account for withdrawal and had industry ties that complicate interpretation.
Half Stop SSRIs In Pregnancy
- About half of pregnant women stop SSRIs during pregnancy, and Urato sees varied outcomes in his clinic.
- Some do well off medication while others struggle and later resume treatment.