A few weeks after the birth of her first son, Mikaela Rodkin, a D.C.-based mom who works in management consulting, started to notice something was “seriously wrong.” She was so overwhelmed by worry that she had trouble bonding with her baby. She felt like she “wasn’t doing motherhood very well,” she said.
Rodkin had never experienced anxiety before; her pregnancy itself was relatively smooth. But after her baby was born in the spring of 2022, things had taken a turn. “I felt like I was having an out-of-body experience a lot of the time,” she said. When Rodkin, her husband, and their infant had to temporarily relocate due to a gas leak in their home, she started feeling “paranoid.” She feared that someone from the neighboring house would attack her family. She described how she felt as though she was “living in a horror movie.”
“It got to the point where I was just panicked, and my whole body hurt and ached from the stress. And I just broke down,” she said. She’d taken online quizzes about postpartum depression, but found that particular shoe to be ill-fitting. Without much more to go on, she simply didn’t know what was wrong. When she went to the doctor, however, the answer she sought was at hand: She was suffering from postpartum anxiety. The doctor prescribed her Zoloft, a common SSRI. “It made all the difference,” she said. “It allowed me to enjoy motherhood and not be living in a state of panic and fear.”
Rodkin had always wanted a second child, but she didn’t want to risk the nightmare experience she’d had with her first. Fortunately, her doctor reassured her that staying on Zoloft was safe and that the benefits far outweighed the minor potential risks to the baby. “I think it has been invaluable,” she said. “My second pregnancy was so smooth, the postpartum was so smooth, the delivery was smooth. Everything was easier, and I think a huge part of that was Zoloft.” Her son is now one year old.
Postpartum depression and anxiety are common in moms, with about 20 percent of perinatal women suffering from each. There is well-documented evidence that antidepressants—specifically selective serotonin reuptake inhibitors, or SSRIs, a newer generation of antidepressants that includes Prozac and Lexapro—are indicated and safe for use in pregnancy and postpartum for people with moderate to severe depression and anxiety.
“We have a substantial and overwhelming body of evidence that shows that there are risks to both mother and child if you don’t treat psychiatric illness,” said Dr. Lauren Osborne, vice chair of clinical research at the Obstetrics and Gynecology Department at Weill Cornell Medicine and chair of the National Curriculum in Reproductive Psychiatry.
These risks include suicide—the leading cause of pregnancy-related deaths in the United States, according to the Centers for Disease Control and Prevention—as well as adverse cognitive and emotional development of the child, and poor bonding and attachment between mother and baby, according to Osborne.
Despite the fact that the American College of Obstetricians and Gynecologists, or ACOG, supports the use of SSRIs during pregnancy for those who need them, some doctors counsel their patients to stop their medication. A large study found that around half of women on SSRIs before pregnancy went off them when pregnant.
Now Robert F. Kennedy Jr.’s Department of Health and Human Services is sowing more doubt about this evidence-based treatment on a national stage. Alongside making vaccines more difficult to get and cutting research funding for them, RFK Jr. has made reducing use of psychotropic medications a policy priority. He has suggested that people who take antidepressants—some 11 percent of the population—should instead be sent to government “wellness farms” to wean themselves off, and claimed that people taking these meds are more likely to develop addiction or become school shooters.
Late last month, RFK Jr. took his first major step toward this policy priority. On July 21, the Food and Drug Administration convened a hearing to discuss the safety of SSRI use during pregnancy. Most of the panel’s participants, a mix of researchers and psychologists, presented clear biases and lacked basic knowledge about reproductive psychiatry, according to Dr. Osborne. Some of the panelists wrongly claimed that using SSRIs in pregnancy can lead to higher rates of autism and birth defects.
“You can cherry-pick and find some studies that show some risks, but the more recent studies that are done with appropriate control groups overwhelmingly support that the risks are minimal,” said Osborne.
Whereas typically such a hearing would feature experts from the FDA, this one brought in outsiders, many of whom had clear conflicts of interests. Rather than focusing on the issue at hand, some questioned the validity of depression itself. At one point, a panelist, psychologist Roger McFillin, asked if women simply experience more intense emotions, which are “gifts,” not “symptoms of a disease.” There was talk of issuing a black-box warning on SSRIs for pregnant and perinatal women.
“Unfortunately, the many outlandish and unfounded claims made by the panelists regarding SSRIs will only serve to incite fear and cause patients to come to false conclusions that could prevent them from getting the treatment they need,” said Dr. Steven J. Fleischman, president of the American College of Obstetricians and Gynecologists, in a statement after the hearing.
“Limiting women’s access to SSRIs, it will cost lives,” said Rodkin. “I have no doubt about that.”
The hearing came at a time when reproductive health care is under attack: Trump’s recent “one big, beautiful bill” decreed that Planned Parenthood would no longer accept Medicaid as insurance, though that effort was recently indefinitely blocked. In the wake of the end of Roe v. Wade, reproductive care is more difficult to access than ever, especially in rural and underserved areas, and women are in danger of being criminalized for having miscarriages and dying from them at higher rates. The administration is also targeting gender-affirming care.
Cuts to Medicaid and Affordable Care Act subsidies will mean millions of Americans will lose their health insurance—and about a quarter of Medicaid patients are women aged 15 to 49, as of 2023. That’s not to mention the seven million children and hundreds of thousands of pregnant people enrolled in the Child Health Insurance Program. According to the Centers for Medicaid and Medicare Services, Medicaid covers 41 percent of births. And now, pregnant people may be barred from getting Covid shots for themselves or their children.
In a country that already has the highest maternal mortality rate in the developed world, with no required maternity leave, it’s difficult to read these moves as anything but openly hostile to pregnant people and their kids.
“We don’t seem to care about the fact that we’re killing moms,” said Osborne.
Yet the administration claims to be concerned about the country’s record-low birth rates and is pushing women to have more babies amid rising right-wing pronatalism. To encourage this, Trump’s recently passed bill promises a one-time $1,000 contribution per child for parents to start a trust account for their kids. His bill also modestly raises the child tax credit, though his version excludes many of those who need it the most. And while he’s promised that he’d support making in vitro fertilization more affordable, he is already reneging on that pledge.
Christine, a paralegal and parent to an 18-month-old boy in Richmond, Virginia, who asked for only her first name to be used, was very upset by the hearing. She has taken Prozac since she was a teenager for her anxiety, and delayed getting pregnant due to conflicting information she’d heard about its safety in pregnancy.
While her condition is manageable with therapy, a good support network, and Prozac, she said, without the medication her symptoms are so all-consuming it is hard for her to eat or sleep. She was worried in part about getting pregnant because her mom had been counseled to go off her antidepressants while pregnant with Christine and had been “miserable.” Fortunately, Christine’s ob-gyn and psychiatrist told her that it would be safe to remain on the medication, which helped her through a difficult pregnancy.
“We shouldn’t have people who have no medical expertise or have this sort of anti–Western medicine agenda making decisions for people that they’ll never meet,” Christine said of the hearing.
Panelists charged that patients are not adequately counseled on the risks of taking antidepressants while pregnant. But the mothers I spoke with all said that their doctors educated them about the potential risks.
Laura DiNardo, a mom in Pittsburgh and manager at a professional membership association, started taking antidepressants before she got pregnant, and continued using them for her anxiety through her pregnancy. DiNardo said her doctor told her that there was a small risk the baby could go through withdrawal-like symptoms from the drug for a few days after birth, meaning they could be crankier than typical. This “seemed like a relatively low-stakes side effect for me, knowing that babies, especially newborn babies, are prone to be cranky or fussy,” she said.
After her baby’s birth last June, DiNardo started feeling some symptoms of postpartum depression and was advised to increase her Zoloft dose, which she found extremely helpful. Her doctor told her that only a very small amount of what she took would be transferred to her baby through breast milk, so it was still safe.
“The message that I got was … a healthy mom is the most important thing for the baby,” DiNardo said.
Osborne fears that casting doubt on the necessity and safety of SSRI use in pregnancy and postnatally in such a public forum could discourage struggling pregnant and postnatal women from seeking care. “There’s going to be a whole new set of patients who were OK with taking [psychiatric] meds or will stop their meds abruptly or not want to take their meds. And that’s really disheartening because I know the risks to both mother and child if you don’t treat the illness.”
In her practice, Osborne tells her patients, “having depression or anxiety in pregnancy, that’s a chronic illness just like having diabetes in pregnancy or having hypertension in pregnancy”—it needs to be treated, and that treatment sometimes includes medication.
Rodkin said that having a supportive doctor and not feeling judged was key to her decision to take antidepressants because there is a lot of pressure on moms to do things “naturally.” Going on Zoloft drastically improved her ability to care for and bond with her child.
“I think the last thing we need is to stigmatize mental health issues,” DiNardo said. “People need to have access to all the tools that they can in their tool box, and people also need the support of their medical team to make informed decisions; to make sure that they’re going to be the best parent they can be.”
But the administration clearly has other ideas. In stripping away health care access, it is also jeopardizing mental health care like psychotherapy, which is often the first line of treatment for people struggling with depression and anxiety, before they consider medication. But talk therapy remains inaccessible to many because insurance has long covered it at a lower rate than physical health care, so many therapists don’t take it at all. Mental health care is “already such an access issue, and this is exacerbating that instead of expanding that needed care,” said Dr. Osborne.
And this lack of health care access will disproportionately impact low-income women, women of color, and people in rural areas. But even with a supportive partner and co-parent, good insurance, and a well-paying job, becoming a mother comes with many stressors, explained Rodkin. “It’s hard enough as it is, and we don’t need to make it harder,” she said.
One thing already posing new difficulties is the mainstreaming of anti-vaccine sentiment and policy under RFK Jr.’s HHS, which puts kids and families at risk. The HHS head has specifically singled out pregnant people and children in his undemocratic policy announcements restricting access to Covid-19 vaccines, even though pregnancy is considered a high-risk condition by the CDC and experts recommend pregnant people get vaccinated to protect themselves and their infants. Barring healthy children and adults from Covid-19 vaccines will also certainly increase transmission, hospitalizations, long Covid, and death within families, as I recently wrote in these pages.
According to KFF, the conflicting guidance on Covid shots has caused widespread confusion among Americans. And casting doubt on vaccines has consequences: Only around 40 percent of the population plan to get Covid shots in the fall, if they even can. And now, RFK Jr. has cut off research funding for mRNA vaccines—including development of a bird flu vaccine.
DiNardo said she worries about sending her child to daycare amid the wave of vaccine hesitancy, especially because her mother-in-law is immunocompromised. Amid an unprecedented measles outbreak, the vaccine for human papillomavirus, or HPV, is also in the administration’s crosshairs.
“Everything [the administration is] doing are things that harm pregnant people, harm children,” Christine said.
Somehow, amid all this, backed by right-wing “pronatalist” activists, Trump wants to become the “fertilization president.”
“It makes no sense,” said Rodkin. “It’s like, ‘Let us remove the support systems and then expect women to have more children. But like, don’t give them health care, don’t give them access to critical medications, take away funding from schools’. It just doesn’t check out.”
As Osborne put it, the administration wants people to have more babies—if you “have a completely healthy white person with plenty of resources.” So it might follow: not if you have a mental illness requiring the use of SSRIs.
“This is a push to increase the birth rate for certain types,” said Osborne. “It’s not a push to increase the birth rate overall, because we’re already not supporting the families that we have.”