← Culture Apothecary with Alex Clark
Culture Apothecary with Alex Clark
Are Common Meds Harming Babies? Tylenol & Antidepressants In Pregnancy | Dr. Adam Urato, MD
01:06:37
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- [00:00]
A
What does a baby's brain show when a mom is taking antidepressants while she's pregnant?
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B
Serotonin plays a crucial role in fetal development, particularly development of the brain, and the SSRIs disrupt the serotonin system. We see increased jittery movements, agitation in utero, postpartum constant crying, difficulty feeding. So the MRI studies are showing structural changes in the brain. Some of them show smaller brain volume, differences in motor development even years later. All of this evidence is pointing towards impact of the SSRIs on the developing fetal brain.
- [00:37]
A
I mean, the evidence is stacked. Women are told it's too dangerous to stop taking antidepressants during pregnancy, but they're not being told the Full story today, Dr. Adam Jurado, chief of maternal fetal medicine at MetroWest Medical center and Attending Physician at Tufts Medical center in Framingham, Massachusetts, joins us to share mind blowing evidence about what SSRIs and even Tylenol can do to a baby's brain and development in utero. He recently testified before the FDA Psychopharmacologic Drugs Advisory Committee, delivering a powerful message the science is undeniable and regulators silence is unacceptable on SSRIs and pregnant women. Dr. Jurato combines decades of clinical experience with deep research and advocacy and he firmly believes expecting mothers deserve the full picture before making such critical decisions. This is a conversation that every woman needs to hear who has ever taken or is currently taking antidepressants. Watch this episode on the real Alex Clark YouTube channel or culture Apothecary on Spotify which has video thank you to Wirefi for letting us record in their studio since a tornado blew through mine and sucked up all my furniture. Please pause Leave a five star review which is incredibly important to do especially when we are sharing non politically correct info like the ones in this episode. Don't forget to join the Cute Servatives Facebook group. If you haven't yet to continue the convo after the episode, please welcome Dr. Adam Urado to Culture Apothecary. What is one thing that you wish every woman knew before starting an antidepressant?
- [02:26]
B
They're known to increase pregnancy complications and that they alter fetal development and that this has been shown through various scientific studies. There's a lot they should know prior to taking a medication, but in terms of impact on pregnancy, those would be the take. That would be the take home message.
- [02:40]
A
Now is that only if you're taking SSRIs while pregnant or even before you get pregnant. If you've been on SSRIs, they could impact your pregnancy.
- [02:48]
B
Most of the study and the focus is on exposure during the pregnancy. There's questions about whether there could be residual effects or whatnot. But most of what actually, or what we're looking at is, is using medications during the pregnancy.
- [03:02]
A
Are pregnant women in America told it's perfectly okay to be on an antidepressant?
- [03:06]
B
That often is the message that is getting out, and that is really what I'm trying to address. That's sort of my, my goal. I, I always tell people from the start that my purpose is informing patients in the public, but not giving anyone a guilt trip or pill shaming or any of that. That's not the purpose of, of what I focus on. Inform patients about risks of medications, which is what we should be doing with, with any medication. And so it's important to get that information out there right now. I don't think that's getting out there. And that's actually reflected by some of the media coverage that's happened since we just had the FDA meeting on this, which basically a lot of the mainstream media has reported on that. And, and they often don't talk about risks. You can come away from their articles with this feeling that there aren't risks to that, and that's a major problem because pregnant women in the public need to realize that, yes, there are risks to taking these medications during pregnancy.
- [04:07]
A
Are pregnant women who have historically dealt with mental health issues told, oh, it'll be actually more dangerous for you to try to get off your SSRI during pregnancy?
- [04:15]
B
There's a lot of information coming out to pregnant women. As far as what the actual counseling is, sometimes that counseling is just that there's no. That there's no risk whatsoever, and that staying on the medication is associated with better outcomes. That is, when we look at the science or the research studies, we're not actually seeing improved pregnancy outcomes. When women stay on their medications during pregnancy. That idea that if a mom stays on her medication during pregnancy, it's going to prevent complications, and it's more of a, of a. I would call it wishful thinking or pharmaceutical industry propaganda is what it amounts to, because the actual data doesn't show that. When we look at the data sets of women, the studies that look at women who stay on their antidepressants during pregnancy and what those outcomes are, we tend to see higher complication rates. And the complications that we see are things like miscarriage, preterm birth, low birth weight, preeclampsia, birth defects, postpartum hemorrhages, and then after the Baby's born, we see increased rates of newborn complications. And then the big question is, long term, what is. What is going on? What is going to happen long term? And some of the long term studies have shown increased rates of speech and language problems in the kids, as well as things like mood disorders, depression. There have been studies on that. And then there's a question about autism, which is a complicated area to study. The other question I get asked a lot about is whether there's impacts on sexual function in the future for. For exposed children that were exposed prenatally or in utero. And that's an area that is, we really don't know. The animal studies do show that when you expose, for example, pregnant mice to SSRIs, the offspring, particularly the male offspring, when they grow up into adults, have altered sexual behavior.
- [06:16]
A
Like, what does that mean? Altered sexual behavior? Like weirdo freaks or what is. What does that mean?
- [06:22]
B
So the altered sexual behavior, what they look for in the studies is they look for mounting the mice, mount the male mice, mounting the females, and then copulation, ejaculation. And they measure those, and they find that those behaviors are different. In the mice that were exposed to SSRIs in utero, they're. They're less sexually active, so to speak, on these studies.
- [06:44]
A
Oh, my gosh. They're kind of like impotent.
- [06:48]
B
It's more that there. There's fewer. They grade them or rate them on how many episodes of mounting they have, how many episodes of intramission. And it varies from studies. But there's a. There's pretty consistent effects in multiple studies for altered sexual behavior in the particular male offspring when their moms were treated with SSRIs during pregnancy. And again, these are the animal studies. Humans, we don't know what that's going to be.
- [07:16]
A
What does a baby's brain show when a mom is taking antidepressants while she's pregnant?
- [07:21]
B
What we see during the pregnancy itself, we can actually see effects during the pregnancy. I try to simplify this for, For. For patients in the public. So serotonin plays a crucial role in fetal development, particularly development of the brain, and the SSRIs disrupt the serotonin system. So if you just put those two facts together, and this is something all scientists agree about, that serotonin plays a crucial role in fetal development and that serotonins disrupt the serotonin system. If you put those two facts together, the conclusion's inescapable that the SSRIs will disrupt fetal development. And that's in fact what we see when we use them during the pregnancy, for example, and we do ultrasounds on the pregnant moms. We see altered behavior in the babies in utero. This is in utero. This is me doing an ultrasound, or the researchers doing an ultrasound and looking at fetal movement. We see increased fetal movements, more examples of what they call, like, jittery movements, agitation in utero. And this is something then that gets reflected postpartum as well. So postpartum, what we see are increased rates of newborn behavioral syndrome, things like jitteriness, agitation, constant crying, difficulty feeding, increased rates of admission to the neonatal intensive care unit. And so we're seeing these examples of, like, impact on the brain just from the behavior in utero with the ultrasound studies and then after delivery with the newborn behavioral syndrome are also called poor neonatal adaptation. But now what researchers are doing is they're doing MRI studies where they're actually imaging the baby's brain. And we're finding changes, differences in the group that have been exposed to the SSRI antidepressants. So the MRI studies are showing structural changes in the brain. Some of them show smaller brain volumes, others show brain alterations. And then they do studies that are called functional connectivity studies, looking at how the brain, sort of different parts of the brain interact. And they're showing that those functional connectivity studies show differences between the groups that were exposed to SSRIs in utero versus unexposed. And so we have the MRI studies now showing this. And then we also have EEG studies that are showing this. There's actually 12 MRI studies. So this isn't just like, well, maybe it was a mistake. Maybe it was.
- [09:44]
A
Yeah, I was gonna say this is extensive. I mean, the evidence is stacked.
- [09:49]
B
The evidence is stacked. Anyone that spends time digging into these studies, and I've been doing this for about the last 20 years following this literature, following the scientific research on a weekly basis, looking at what's coming out. And anyone really looking at this is going to see, yes, serotonin does play a crucial role in fetal brain development. Yes, the SSRIs do disrupt the serotonin system. And yes, we're seeing fetal impacts. The last aspect I was going to say is that the EEG studies that are done so EEG, EEGs, people usually know about those as being a study that are done on patients that are having seizures. Studying the brain waves, when we do newborn EG studies or child EEG studies, we can see that there's a difference in the brain waves and the brainwave patterns between the children that were exposed to SSRIs in utero versus the unexposed. It's clear. So my point about this is all of this evidence is pointing towards impact of the SSRIs on the developing fetal brain. We have ultrasound studies showing altered movement. We have newborn evaluations showing that the children are jittery, constant crying, difficulty feeding, going to the newborn intensive care unit. And then we've got the imaging studies. We've got 12 consecutive MRI studies showing that, yes, these drugs alter fetal brain development, and three EEG studies showing the brain waves are different. The evidence, as you were just saying, Alex, is stacked, showing that these drugs do impact the development of the fetal brain.
- [11:21]
A
Do you have any idea approximately how many pregnant women in America are on SSRIs?
- [11:27]
B
The numbers are kind of all over the place. The rough number people use is 5% or 5 to 10%, but it varies by community. But that's a substantial amount. 1 in 10, 1 in 20. That's a large number of babies that are being exposed to these medications.
- [11:43]
A
Why don't obs tell women this?
- [11:45]
B
I think it varies in terms of how much counseling women are getting on this. And so I think it's hard to paint with a broad brush. Some physicians in their offices put, likely do a lot of counseling on this. But it's important to remember that the information that's coming out of the medical establishment or the professional medical societies is also really downplaying risks. And so the, in general, the message coming out from the professional medical societies, from the key opinion leaders, and also from the media is a very reassuring message. And it's actually not correct. It's not correct in a couple of ways. One, it's not really showing what the. What the risks are. And there is a good reason for that for, for some doctors wanting to support their patients or encourage their patients. But it's still important. I always say that compassionate care is essential, and part of compassionate care of the patient is accurately counseling them regarding the medications that they're on, regarding the risks, the benefits, and the alternatives, that's just something that we have to do and get in the habit of. But when we look specifically at what information OBs are getting about risks, if you look, for example, at the professional medical societies, the American College of ob, gyn and others, and also the media, what's coming out is a message basically that there really are no significant risk. That's often what the message of these articles is.
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A
Why, why would they be saying that?
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B
I think there's probably a good reason that they want to try to support their patients and their concern. They know some of these moms are on these, and they don't want them to feel pill shamed or guilty or bad about. I think that there's. There's. There's a good. There can be a good motivation. I think the other big problem, though, is that the pharmaceutical industry, pharma, plays such a significant role in setting what the scientific consensus is. And so the. The pharmaceutical industry promotes this idea that what they do in the same playbook, basically from drug to drug, which is to downplay risks, essentially get. Get patients to take their eye off the ball on risks, reassure them that there aren't many risks or aren't risks, and then overemphasize or oversell benefits. And then the other big thing that the pharmaceutical industry does is to try to take everybody's eye off the ball of the drug problems and focus more on the condition. And this is sort of a diversionary technique. And so what ends up happening is. And you can see this that's occurred after the FDA meeting is a lot of the focus has been on depression, trying to get the focus onto depression during pregnancy. And I would say that the focusing on depression is important. Depression is an important issue, and pregnant women that are suffering with depression need very good care. And it's something that's important to focus on. But the emphasis on depression doesn't really answer the question, what's wrong with the drug? That's exactly right. So when a pregnant woman's in my office and she asks me, Dr. Jurato, what are the risks of these medications? I owe it to her. She deserves an answer to that question. What are the risks to the SSRI of the SSRI medications in pregnancy? I can't just talk to her for the next 10 minutes about depression and depression in pregnancy. That's really not fair. Some of the discussion can be about that. But at the end of the day, we need to get back to her question, the question about risks of the antidepressants in pregnancy. And this is what's really missing from the discussion. If you watch the media coverage after the FDA meeting and if you watch the FDA meeting itself, what you'll see is that many of the SSRI advocates spend most of their time, first of all, just talking about depression. And again, depression is important, but it's not answering the question about what the risks are of the SSRI and which.
- [15:36]
A
Is depression is one. Right. A risk of taking an SSRI is, is higher rates of depression and anxiety in some cases, for the Babies? Oh, no, no, sorry for the, the person taking it, yes.
- [15:48]
B
I mean that the, the evidence, I'm not a psychiatrist, I try to not venture too far into that. But the, the evidence for antidepressants in terms of treating depression, there's a very minimal increase in the studies, a very minimal increased benefit. So on the 52 point Hamilton rating scale, it's about two or three points, which many people have argued is really not clinically significant. This two or three point difference overall. And some people feel that that's mostly due to what's called an active placebo effect. But there is some evidence of benefit in the scientific literature. There is some evidence of benefit for antidepressant use. As far as the benefit though, to the pregnancy, is that reflected in what the studies are showing? No. And again, I go back to that point. There's no evidence, for example, what, what getting out to the public is that if a mom has depression, she may be at increased risk for these various pregnancy complications like preterm birth and others. If she takes the medication, medication, she's going to improve her mood, she's going to be doing better. And that then is going to result, be resulting in a better outcome for mom and baby. But that's not actually what the research shows. That's not what the science shows. We're not actually seeing better pregnancy outcomes in study after study. When you look at the data, the group that's doing worse in terms of obstetrical outcomes is the group that's exposed to the antidepressants. What it looks like and what it is is a chemical effect. It looks like the group that has chemical effect, which is the SSRI antidepressants, that they're having complications resulting from chemical exposure during pregnancy.
- [17:28]
A
So if we have this ample evidence that babies exposed during pregnancy to SSRIs have worse outcomes, why is there not a warning explaining this on the box?
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B
This is what I really, I think where this is going and that there, there should be. I think that my point in this is that we really need to strengthen the warnings that are getting out to pregnant women in the public right now. On the FDA label. On the label right now they're only warning about postpartum hemorrhage risk, which there is an increased risk of postpartum hemorrhage in women on SSRIs. And they're warning about newborn behavioral syndrome or poor neonatal adaptation. Part of that also they're warning about persistent pulmonary hypertension of the newborn, which can kind of go be lumped into newborn problems. That's really all that they're warning at on the SSR on the label to these medications. But what needs to be added in are warnings regarding miscarriage, birth defects, preterm birth, low birth weight, preeclampsia, and then the alterations in fetal brain development that we see in the studies looking long term at how these kids do. And also in the imaging studies that I was talking about, the MRI study.
- [18:42]
A
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- [21:18]
B
I think the FDA needs to review this is what is what the next big step is for the FDA to sit down and review this and review this evidence. I will say, in the interest of fairness and balance, that the studies in humans also somewhat the animal studies, but the large human studies are somewhat mixed on some of those issues. But it's a very difficult study topic to study cleanly because pregnant women will often be given a prescription for antidepressants, but they don't necessarily fill the prescription. So for studies, for example, that look at prescriptions given, a woman might be classified as an SSRI user, but she's not actually been using. And then some of the studies classify women as being users if they just use it for a little while during the pregnancy. But it looks from the evidence that the longer women are using it, the higher doses that women are using it, the more complications. So that's why the literature on. The scientific literature on some of these outcomes is mixed. But overall, when you look at the entirety of the data, the entirety of the scientific information, you see that the basic science is showing that SSRIs affect serotonin and have this impact. Then you look at the animal studies, and the animal studies are showing impact on the pregnancy, and then you move to the human studies and you're finding the same. The same impact. I just wanted to add, though, in terms of warnings, I feel very strongly that the FDA needs to have better warnings, put better warnings on the label, including a boxed warning to let pregnant women in the public know about this, that these Drugs, when used during pregnancy, are associated with increased rates of pregnancy complications and that they alter fetal brain development. That's my main issue that I focus on. But some people will ask me, but what about an individual woman who comes into your office who's at 20 weeks and says that, that she's been on SSRIs for 10 years and that she knows herself that she can't come off of them and that she's stable and wants to remain on them. So that's not the question that I'm answering. That's a question I answer in my office that has to do with a specific patient and specific counseling. My point is that we need to address point number one, which is get the information of risks out to pregnant women in the public. But what is an individual patient does or should be doing? That's a separate question. That's an entirely separate question. And that needs to be addressed with good counseling in the office by the provider and a discussion about the risks, the benefits and alternatives. And then the mom should make the best decision for herself and be supported in her decision. But that's not the same as the question I'm trying to address, which is what are the risks of these agents? What are the risks of the SSRIs in pregnancy? And is the public being adequately warned about these risks?
- [24:14]
A
You mentioned a recent FDA hearing that you were a part of. For those listening who have no idea what you're talking about, can you give like a brief synopsis of what this recent FDA hearing was about?
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B
The FDA called an expert panel together to discuss this topic of SSRIs and pregnancy. And it was about a two hour panel discussing various aspects of, of SSRIs in pregnancy, including whether or not there should be increased warnings on that. And I think if people look at that, you can see it, it's on YouTube, you can see the video. And you can also look at the subsequent media coverage or news coverage. But what's been unfortunate is that much of the media coverage or news coverage has focused on saying that the panel was supplying, or much of the panel was supplying misinformation. But when they've tried to actually point to what the misinformation, they, at least in my case, they, they haven't found any. One article from National Public Radio made the argument that I provided misinformation when I said that the SSRIs are associated with postpartum hemorrhage and with miscarriage. But I actually called them out on this and I, I said, you need to correct Your article, because that wasn't misinformation, that in fact, these drugs are associated with postpartum hemorrhage and they are associated with miscarriage. And now, to their credit, NPR did correct their story. They said, actually, in fact, yes, that this is correct. There is evidence showing this association with postpartum hemorrhage and with miscarriage. But what you find in so much of the corporate media coverage of this is this desire to, again, follow the sort of, I call it the pharma playbook or pharma propaganda, which is to call into question anyone raising concerns about these drugs, saying that this is misinformation, and then divert attention away from the risks of the drugs and focus on depression. And again, depression's important, but we can't just focus on depression. We have to answer the question at hand, which is, what are the risks? And is the public being adequately counseled regarding the risks? And then many of these articles spin this discussion about depression into what is essentially propaganda saying that depression can lead to certain pregnancy outcomes. And there is some evidence for that, but the evidence is not very strong that depression leads to the these outcomes. There's mixed studies, but then they say, well, if this is the case, then treating depression, they're giving the impression to readers that then treating the depression will be associated with improved pregnancy outcomes. But that's not, in fact, what we see at all from the studies.
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A
It's true that these medications that women often take during pregnancy can cross the placenta and affect a baby's brain, correct?
- [27:08]
B
Yes.
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A
And this can also end up affecting serotonin.
- [27:12]
B
Yes, that's correct. It's really complex. It's really complex when you get into the science on it. So the drugs themselves are affecting the mom, they're affecting the mom's serotonin system, and they're also crossing the placenta, and they're affecting the baby, the baby serotonin system. And serotonin is this chemical that's playing a crucial role in embryonic and fetal development or embryo fetal development. You can think of it as a bunch of workers putting together or helping to construct like a city. And what the SSRIs are doing are coming in and disrupting all of them, altering how they're able to perform or do their work. And because serotonin plays such a crucial role in fetal development, it leads to this widespread disruption. One of the biggest areas where we see the serotonin receptor, which is where the SSRIs impact most on the serotonin transporter, which is, is where it's believed to have its most significant effect is in the placenta. So the mom's serotonin should be crossing, should be going into the placenta. The SSRIs disrupt that. They disrupt that by blocking the serotonin transporter. And this is just one way the serotonin plays crucial developments in the development of the baby's brain, in the development of the baby's gut. It plays crucial roles in the functions of our body, the development of, of the, of the nervous system, of our bones, et cetera. And so when you disrupt that system, which the SSRIs do, you'd expect to be able to get widespread effects, which is what in fact we see.
- [28:47]
A
Does the average OB GYN know any of this?
- [28:49]
B
I think it depends on the OB gyn. And I would say that my colleagues, I take care of patients full time. I'm a full time clinician. I know what it's like to be counseling patients. And I would say that it's a challenge because you're trying to get this information out to patients in a limited amount of time. But also in terms of the information that's coming out to the primary OB providers, the information, whether it's from the professional societies like the American College of Ob GYN or from the fda, is not really going into all of these complications. And this is why I'm really active and why I have so much motivation in this area is because is we're getting this wrong. The bottom line on this is we're getting this wrong. We're getting the information wrong. What the science is showing about the impact of SSRI antidepressants on mom and baby during pregnancy, we're getting it wrong. We're not accurately informing patients and the public about what's going on. And that includes the doctors that are trying to do this counseling at the bedside or in the office for patients.
- [29:56]
A
So if you are talking to a woman in your office who is currently pregnant, she's been on SSRIs for a while and she wants to get off, what would you say?
- [30:05]
B
When I talk to patients in the office, I try to figure out where they're at, have a good conversation about them, about their mental health history, how long they've been on it, what's going on, and then where they're at in the pregnancy, and then I review with them the risks, the benefits, the alternatives, like we're supposed, like we should be doing with all medications so that they can actually provide informed consent one way or the other. If the moms want to stop this. And many of them do. It's about roughly 50%. Roughly half of pregnant women stop their Medicare or the antidepressant, their SSRI when they become pregnant. But if a mom wants to stop these, what we really recommend is doing this in a slow taper because many women will have great difficulty in trying to come off quickly because of withdrawal or discontinuation effects. And this is information that's become more and more obvious over time, is that patients are having a. Many patients, not all, but many patients will have a great deal of difficulty in coming off these medications. What happens, I think, for patients that have been on these for a long time is that their brain has made. Their brain and bodies have made so many adjustments of this chemical exposure chronically that then immediately stopping that medication leaves the patient with a lot of these adjustments that have been made. And now it becomes very challenging for how they're doing. And so it really is something that needs to be done gradually under the supervision of a professional, under the supervision of someone that can help them kind of through this process. And we recommend not just suddenly stopping. That's not the best approach to do this. But this is why also that the message I'm trying to get across about the impact of these drugs in pregnancy, that's why this message really needs to get out out to women of childbearing age. By the time a pregnant woman sees me at, I often see them at 12 weeks for the nuchal translucency ultrasound, or I see them at 20 weeks for what we call the fetal anatomical survey ultrasound. At that point in the pregnancy, they've been pregnant for a while. I would say that it's never too late to make decisions about what you want to do in terms of your medications. But really the message needs to get out to women of childbearing age and to doctors who care for women of childbearing age, because this is something that needs to be on everyone's radar. I see patients come into my office who are 32 years old and they were started on this when they were 25, and now they've been on it for seven years. But back when they were started on the drug, there was no thought to what the impacts were going to be on on pregnancy. And so I think that needs to change. I think think we as a society need to recognize that these drugs are hard to come off of. Many patients who start them stay on them for a long time, and then if you start a young woman of childbearing age on these medications, she very well, may end up on these medications through the time period where she's pregnant, where she's having, where she's having children. And so then that initial discussion needs to take place about what's the impact going to be so important.
- [33:14]
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- [35:33]
B
This is again a patient to patient question. And I would say I tell my patients all the time that there's no one size fits all answer to these things. And it really depends on how she's doing, what her assessment of her mental health is of what her assessment is of the impact of the drug on herself in terms of trying to get to a point where she's off the medication and pregnancy. Pregnancy. The sooner she can start, the better because it can take a long time in terms of withdrawal. In the old days, we thought withdrawal from SSRIs was something that was just going to happen over a couple of weeks. You halved your dose for a couple days, you half your dose for a couple days, you come off. But it's become apparent now from a number of patient stories that, that these can take a long time to come off of. Not on the order of days or weeks, but more like months or years. So this is an important thing for, for patients that them to keep in mind if they're looking at an upcoming pregnancy.
- [36:32]
A
What is your response when drug companies say, well, the risks of untreated depression are worse than the drug itself?
- [36:39]
B
Yeah, this is again the sort of pharmaceutical propaganda or pharma ganda that gets put out there. It's really up to the mom to weigh these risks or, or, or take a make the assessment. That's up to the mom to make the assessment about, about risk. Not up to the pharmaceutical company or not up to the professional medical societies. Again, the drug companies tend to with their products to focus on the condition because what focusing on the condition allows them to do is basically do what's called fear mongering about the condition to take your eye off the ball about risks of their drugs and often lack of benefit and focus instead on the condition and often scare patients in the public about this and that.
- [37:27]
A
You've said this is similar tactics to what they did with oxycontin, correct?
- [37:30]
B
Yes, I think it's the same playbook that you, you see from the pharmaceutical industry with OxyContin. Whenever the discussion came up about what the risks were about using these drugs in the communities in terms of addiction and other problems. Etc, they would divert that conversation to a discussion about the epidemic of pain in our society. And so what that does, by diverting the discussion to the condition in this case pain, is get people sympathetic and feeling like, oh, the pain is awful, we've got to do something. And then it ends up leading you back towards wanting more use of that drug, of the drug. But without ever really focusing on the risks of the drug and on whether the drug is even beneficial, you take our eye off the ball. We saw the same thing with a drug called Makena. Makena was used in pregnant women. It was a synthetic hormone injected into pregnant women for 20 years. And it was designed, the idea was that it would prevent preterm birth. It didn't work. And I argued against that and I petitioned the FDA to pull it off the market because it didn't work.
- [38:36]
A
Is it still available?
- [38:37]
B
It got pulled off the market. Unfortunately, it got pulled off the market in 2023 after 20 years of use in pregnant women from 2003 to 2023. But oftentimes when I would argue this point that it didn't work, people would respond about the risks of preterm birth and how bad that can be for the baby and what kind of morbidity and mortality is associated associated with that. All of which is true. It is true that preterm birth has these problems, but again, that almost serves as a distraction from the issue at hand, which is, does the drug, in this case McKenna work? We're seeing the same thing with discussion about the SSRI antidepressants. What we need to focus on, like a laser, is what are the risks of these chemicals going into pregnant women? What are the risks to the babies of these? And is the public being correctly warned about them? A discussion about depression and pregnancy is absolutely worthwhile, but that still doesn't answer the question about whether or not the drugs or what the risks are of the drugs and. And whether they're beneficial. So it's important to focus on that.
- [39:44]
A
You just told us about what the MRI show in a baby's brain when a mom is on SSRIs. Do babies act differently in the womb? Just their behavior when the mom is on an antidepressant?
- [39:55]
B
Yes. We see different activity on the ultrasound studies. There have been two separate ultrasound, at least two separate ultrasound studies, to my knowledge. One was done by Mulder in 2011, looking at ultrasound by ultrasound at babies that were exposed to SSRIs versus not exposed to SSRIs, and another study done by Salisbury more recently, I believe it was in 2023. And both of them came to the same conclusions, which is that when the mom is taking an SSRI and you do ultrasound and look at their activity, you see differences. The babies that have been exposed to the SSRIs are moving and behaving differently. Their movements are more jittery, more agitated, and there's less quiescence in utero. Babies should be going through periods of activity and quiescent activity and settling down. The babies where the moms are taking the SSRIs have less quiescence. It's like more agitation, more irritability. So we're seeing this on ultrasound, and this is why it's an important thing to remember, because many people who are SSRI advocates say, really the only thing that we're seeing in the studies are these newborn effects. But that's not correct. It's not just newborn effects that we're seeing. These chemicals, the SSRI chemicals are going into the mom, they're going into the baby, and they're causing chemical effects throughout the entire pregnancy, including effects on movement that we're seeing. Then when they're born, we're seeing these same kind of effects. We're seeing what looks like irritability, agitation, disruptions in behavior during the newborn period. And it's not just. Just a short time. Also, many of the news reports on these said, well, it just lasts a day or two and then goes away. In some children, it looks like that happens. But other studies have looked at this for up to two weeks. Salisbury did another study on this, looking at how long these effects can last. And they found motor effects lasting up to two weeks.
- [42:00]
A
Wow.
- [42:01]
B
And there's further information, which is that when we do longer term studies on these children, we're seeing that there are motor differences, differences in motor development even years later. So it's an effect that is not just during the newborn period. It's an effect that represents a chemical exposure, basically chemical disruption of development, which then has ramifications not only in the newborn period, but also down the line for these babies.
- [42:31]
A
I have a controversial question. You have these women coming in, they're asking you about risks of SSRIs during pregnancy and then what that can do with development and. And all of that long term. Do you also get women asking you for the full risk profile on things like Pitocin or epidural and what do you say?
- [42:49]
B
Some are, some aren't. I think there maybe is a little bit more of a movement now towards people thinking about these things, towards people thinking about what Chemicals are going into me. And I actually support this movement because. Because I think the drug industry has done this rollout where they get us to take our eye off the ball. The drugs or chemicals, medications have this sort of halo of goodness around them. Oh, it's a medication. But really what a medication is, for the most part, at the end of the day, what a medication is is a synthetic chemical compound that's being made in a chemical plant. It's made in a chemical manufacturing facility. You know, the workers. If you look at a chemical plant, the workers are wearing. Wearing protective equipment. They've got protective goggles. And then these medications are synthetic chemical compounds. When they come out, they get bottled up, and then they get brought over to the hospitals or the prenatal clinics and they go into the moms and babies. And so it's important for us to keep that in mind, really, about anything. And so that applies as well to issues about epidural, issues about oxytocin, issues about other exposures during pregnancy.
- [43:56]
A
Have we ever chemically altered fetal brain development at this scale in human history?
- [44:01]
B
No, that's a very good point. And that's the. The point that I try to make on this. Absolutely. No, we haven't. And. And this is something very different. And I think it's important, important to point out that we in the United States right now are the most, I would say, pharmaceuticalized population probably in human history. We just take it for granted that it's okay to be on in that people are on 2, 3, 5, 10 medications. But this was typically, you know, never. Never the norm. And with more and more medication use in the population, we're going to naturally see more and more medication use during pregnancy. But in pregnancy, those medications are crossing the placenta and they're going into the fetus, and they're affecting fetal development, particularly development of the fetal brain. And so we've never really chemically altered brain development in this way. If serotonin is playing this really important role in development of the brain, which it is, and which any embryologies would tell you that it is. And if SSRIs disrupt the. The serotonin system, which they do, which any pharmacologist will tell you that they do, then they must be disrupting or altering the brain development. And because we've got 5% or 10% of pregnant women on these medications, that's a lot of. Of of altering brain development that's going on. And it's not just the SSRIs. I see patients in my office every day on other medications, on medications for adhd, on medications for antiemetics, for nausea and a variety of other medications. And all of these are medications that cross the placenta and go into the baby. It doesn't mean. Though my message doesn't mean that a pregnant woman can't take a medication. That's actually not what I'm saying. The point is that before she takes it, she just needs to be properly informed regarding what risks there are. And then she can balance that out to the benefits to her, what alternatives there are, and then make an informed choice. And so that really is what it comes down to, is proper counseling. My message isn't one of I'm telling pregnant women what to do. I'm telling them that they can't take SSRIs in pregnancy or ADHD medications or anything. That's not my message. My message is that they need to be properly informed so that they can make the best decision for themselves.
- [46:25]
A
Let me tell you something, Brenda. I've tried it all. The saunas, the cold plunges, the green powders that taste like lawn clippings. But only one of those things has actually stayed in my routine. And that is red light therapy. Specifically my JOOV that's J O O V. And yes, it looks like I'm being interrogated by a spaceship every morning, but I swear this thing works. I use it right after I wake up. 10 minutes bathing in red and near infrared light like a reptile that pays tax.
- [46:51]
B
Axes.
- [46:51]
A
It's clinically proven to support cellular function, so your body literally runs better. I noticed faster recovery after workouts, less inflammation, better sleep. And my skin looks incredible. Joovv is the only true medical grade red light panel that I trust. They use safe, effective wavelengths. Clinically proven, third party tested. This isn't some knockoff chicken heat lamp from the Internet. Okay? And they have a ton of size and device options, so depending on how intense you want to get. I've been using a juve machine for like four years. I believe it's now gonna. It's changed my life. Okay, head to Joovv.com. that's J-O-O-V-V.com, alex. For an exclusive discount on your first order. It'll pop up in your checkout. That's juve.com, alex. Real talk. Would you go to your friend's house for dinner if she was serving grilled labuboos with cranberry sauce and corn pudding? No. Yeah, same. But guess what? You already consume microplastics all day long. Microplastics are in your food, your water, even the air you breathe. It's like the universe decided, hey, let's sprinkle tiny plastic shrapnel on everything. The average person eats up to 200,000 of these particles every year. That's not a diet. That's a toxic hostage situation. That's why I take UTSI Naturals Microplastic Daily Detox. It's got black kale extract from central Italy. Fancy, right? Green tea. All clinically studied to help your body detox this plastic nightmare. Go to otsy.com Alex use code low talks for 30% off whatever is in in this. It's all natural and clean. They even throw in a free detox guide from some science genius. Because if you're gonna eat microplastics anyway, you might as well clean house while you do it. That's utsyutzy.com Alex Code Low talks for 30 off. What do women taking Adderall during pregnancy need to know?
- [48:34]
B
Again, A lot of what I've had to say about SSRIs applies to Adderall in terms of it being a chemical compound that's crossing the placenta, that's going into the developing baby, that's going into the developing baby's brain. We don't have as much information about it because it's not used in as widespread a fashion as the SSRIs. But there is data on, wait till.
- [48:54]
A
Gen Z starts getting pregnant. You're going to see this change. Dr. Yurado, I'm telling you, they are all on Adderall.
- [48:59]
B
There's data from animal studies and there's data from human studies that it does have an impact, it does affect the developing brain, which it would be expected to. My other point on this is that this is really common sense when, when people think about this and I have a lot of patients who will say when I talk to them about this and others colleagues will say, yeah, of course it's affecting the brain. It's something that we, we all would just. It makes common sense that if you're using these drugs are going to be affecting the brain. The problem is, is that's not on the warning label. The problem is that there are, there are many women who don't understand that. And so it really needs to be something that's officially said or officially noted by the FDA that these drugs do.
- [49:39]
A
Have these effects for women who struggle with anxiety and depression and they are pregnant or looking to be pregnant soon and they're looking for safer alternatives. Are there any, like, are There any natural things that you recommend for those issues?
- [49:52]
B
Sure. There's a lot of approaches to mental health issues and mental health is challenging. One thing I try to always emphasize is that I treat my patients with compassion. I feel this way about the public as well. Patients that are suffering with mental health issues, they deserve good care, they deserve compassionate care and not to feel ashamed that they're feeling this way and not to be pill shamed and whatever else. That's not my message. My message is that they need to be actually properly counseled. Some of the alternatives in terms of mental health care are things like psychotherapy, exercise, improved sleep improvements, better relationships. People do various forms of counseling, of group counseling, of couples counseling. I mean, there's a number of different ways in terms of approaching mental health that don't necessarily involve taking medications. And so that needs to be incorporated in the counseling for pregnant women. That also raises the issue a lot of times what you're hearing from SSRI advocates, they're making the statement that untreated depression is associated with these poor outcomes. But I don't think anyone is arguing that we should be. That idea of untreated depression sounds like we're ignoring pregnant women. Ignore them, tell them to suck it up, make them feel awful. That's not what I think the most people are doing in their offices. That's not the message. The message isn't to leave it untreated. The message is to, to, to consider these other options and for each option to consider what the risks the, and alternatives are. And there are other, other options out there, as I was saying, including exercise, including improved diet, including improved sleep. These things are often not focused on as we just try to target things with a pill.
- [51:41]
A
You always say chemicals have consequences. What does that mean?
- [51:45]
B
The pharmaceutical industry has made their medications seem like these put a halo of goodness around them. And people need to remember that that biology, human biology is complex and that chemicals, when they go into the human body are going to have chemical effects. That's what chemicals do. Chemicals have chemical effects. And so if they're having chemical effects, they're going to have consequences. And it's important thing to always remember, not just in this topic about pregnancy and women of childbearing age, but really for our entire population, whether it's young people, children, or whether it's elderly patients, anyone needs to be thinking, whatever medication I'm taking is going to be having other effects in my body.
- [52:31]
A
There's no such thing as a risk free prescription.
- [52:33]
B
I agree with that. And the other element to this People need to keep in mind is that the prescriptions that they're getting, the medications that they're taking aren't just targeting one aspect of their, of their body, what they, what they're thinking about. For example, there's a phase famous drug, the asthma drug Singulair, that was approved for asthma. So patients taking that would be thinking, this is going to help me with my asthma. But what they found as more and more patients were using Singulair was that it was causing neuropsychiatric side effects.
- [53:05]
A
What?
- [53:06]
B
Yes, this is, this is something for you, Alex, and for your, your listeners, your audience to actually look into, to understand what I'm talking about. The drug was found to cause neurobehavioral issues in patients, in a number of patients.
- [53:22]
A
Like what does that mean?
- [53:24]
B
Suicidality, increased rates of violence. There was something going on with the way that drug was acting, not in the lungs, but in the brain that was causing these neuropsychiatric side effects. And we actually see this not just with Singulair, but we see this with other medications as well. Well, our brains are so complex and they're very complicated. The wiring and all of these chemicals that we're putting in them with many of these medications do have brain effects that have to be taken into consideration.
- [53:56]
A
Yeah, your eight year old son is like, oh, I can breathe better but I want to kill my mom.
- [54:01]
B
The stories are like that. Yeah, this was covered actually in, in major media out there outlets and the stories are very much like that. The example you just gave Alex, I think is a good one because it's just funny. But I mean, they showed the artwork from some of these kids when they were on the medications and the artwork is very dark, it's very violent. It becomes like, it's very scary what these, this medication was doing in the child's brain.
- [54:27]
A
Geez. Okay, so now is there a warning on Singular?
- [54:30]
B
Yes, I believe that the FDA did put a warning on Singular.
- [54:34]
A
That's so insane. I've never heard that story before. That's so interesting.
- [54:38]
B
I want you to go after our episode and read about Singulair to understand my point about chemicals and their impact and in particular the impact on the brain. Human biology is really complicated and we as a human society, we need to be more humble about how complicated our biology is, particularly our brain. And we can't be cavalier about what brains are going to, what, what medications are going into our bodies and going into our brains. And even more so in pregnancy when the baby's body and brain are under development.
- [55:10]
A
Are antidepressants that men are taking also affecting their sperm and their fertility?
- [55:16]
B
Yes, this has been shown in several studies. It's obviously not my main focus because I take care of females, pregnant women, high risk pregnancies. But I have looked at that literature and there's absolutely studies looking at the impact of SSRIs on developing sperm. There's a famous study by an author, Akashe, I believe he used or looked at Zoloft being used by men for premature ejaculation. And so it wasn't a depression study, it was use in another condition. And then they looked at the sperm of those males and the men that were on the ssri. Their sperm was, was different. It was, it was being affected by the Zoloft. There was less sperm motility, so they're not moving correctly. And there was more fragmentation, I believe, of the sperm or of the DNA that it was having absolutely having effects and that the concentration was lower. And so this has been shown with Zoloft by the Akasha study and also in Paxil and I believe in other ones as well. And again, this gets back to my comment about chemicals having consequences. If a, if a guy's taking an ssri, that SSRI isn't just going to, into his brain to affect his mood the way it's promoted in the commercials, the way it was originally promoted by the commercials. This, this, this serotonin deficiency hypothesis, it's not just doing that, it's going throughout his body, including into his testicles, and including affecting sperm development. We absolutely see that. And this is a point I also make about those studies with pregnancy. I mean, if these chemicals, the ssri, Zoloft, Paxil, if they're affecting sperm development, which is a rudimentary system, then what are they doing when they go across the placenta into the developing embryo and fetus? They're absolutely going to be affecting embryo, embryo, fetal development. And you can sort of, I think it's reasonable to make that jump and to think that that's what's going on.
- [57:14]
A
Should pregnant women avoid Tylenol at all costs? Costs?
- [57:17]
B
I wouldn't necessarily put it in those terms. I tell my patients that there is evidence with Tylenol of effects impacts on the developing baby. This is shown in the animal studies and we see this also in some of the human studies. There's been studies showing increased rates of asthma and lung, lung problems in the offspring exposed to Tylenol. But the bigger issue is neurobehavior behavioral problems in children that are exposed to Tylenol in utero, things like ADHD and other neurodevelopmental issues. And so it's important to weigh, again, the effect of the chemical on, to weigh that along with the benefit for the mom.
- [58:01]
A
What about an infant taking Tylenol?
- [58:04]
B
It's a developing brain. And so that there's going to be some impact, some effects. Once you, the listener, once your listeners unlock this, this, you understand that, like, it's the same recurring thing, which is the chemicals are going to have impact. And it's important to balance that or weigh that into any decision making about that. Whatever the drug is or whatever you're taking it for, it doesn't mean it can't be taken. It doesn't mean we as humans can't. We as a human community can't use medications, but that it means for each medication, the person needs to think about what are the risks here and know those risks and be thinking about, are there other unknown risks because human biology is so complex? Are there other unknown risks that we're not aware of that can happen when I take this chemical? What are the benefits and other alternative ways for me to address this?
- [58:53]
A
Are there things that women should know about taking seizure medications while pregnant?
- [58:58]
B
Absolutely. And the seizure medication issue is interesting because over time we've seen more and more study and it's becoming clear that the complications in pregnancy that we see with the seizure medications, that those complications do appear to be related to the seizure medications and not the underlying condition epilepsy. It doesn't mean that moms can't be treated for it, but that it means that they just need to be aware of these effects. But it's interesting because we're having the same debate now with antidepressants in pregnancy, which is, is it the, the complications that we're seeing with antidepressants in pregnancy? Is it the antidepressants that's causing them or is it the underlying depression? But it looks by putting together the basic science and the animal studies and the human data, that it's actually a chemical effect from the SSRIs. And we're seeing that now that with more discovery of the epilepsy medications that it looks like, yes, these epilepsy medications are causing pregnancy complications. Again, not saying that pregnant women should be stopping their epilepsy medications, but that it's important to recognize and be counseling about what the risks are and then have your, your management tailored accordingly by your neurologist or whatnot to try to use the, the, the, the better medication. Or the least medications, the lowest doses, the shortest periods of time, but while still taking proper care of the mom.
- [60:21]
A
Do you think that we are getting very close to living in a future where we look back at us allowing pregnant women to take SSRIs the same way we look at thalidomide and, and the anti morning sickness medication we handed out like Candy in the 50s and 60s?
- [60:35]
B
Yes, I think you're making a great point with that question. I think that's exactly what's going on. When we study this stuff in medical school, we often look at the past and think how did those blockheads do these things? Like DES was a hormone that we used in pregnant women from 1938 to 1971 and it didn't work and actually caused a lot of complications. The drug is called des for anyone that wants to look at added. But we all promised ourselves, oh, we'll never do that again. We'll never give synthetic hormones to pregnant women that don't work. But then we did it again with McKenna from 2003 to 2023. We repeat these same mistakes. And I think we're doing that now with the SSRIs is that we're, we're, we're again, we're taking our eye off the ball about chemical impacts during development and lack of adequate, lack of adequate warning. And is the. As more and more studies on this get done, Prozac was released in 1987. And as more and more studies on this get done, it's been 38 years. We're finding more and more studies, more and more research pointing in the same direction. We didn't have the MRI studies, for example, until relatively recently. Now we're seeing the MRI studies showing alterations. The fetal brain sizes are different on the MRI studies. The brain volumes are different, different. The connectivity is different. And it's different sometimes in dramatic ways. There's one study from Sal Wasdel looking, I believe that's how you pronounce his name. There's one study looking at the impact on the fetal brain of six different exposures. He looked at SSRIs, he looked at cigarettes, he looked at alcohol. He looked at opiates, marijuana and cocaine and said how do these drugs impact the developing brain? Brain. And he wrote in the comments, to our surprise, we found that the SSRIs had the largest effect on the MRI follow up that we did. And we're seeing this again and again with the MRI studies, with the EEG studies and with the development. So are we going to look back at this I think we will. We're going to look back and say that people were not being warned adequately about these medications during that period of time that we're using them.
- [62:44]
A
How can people become activists on this issue? Like, how can we be speaking up? How can we be putting pressure on the FDA to make sure that we're getting these warning labels on SSRIs?
- [62:54]
B
We're going to be submitting a petition, a citizen petition that we're in the midst of working on. Myself and a couple of others working on this that's going to be asking the FDA to strengthen their warnings on the SSRI medications use in pregnancy. Once that's submitted, there becomes an open docket where the public can comment on this. And it would be terrific to have your large viewing audience and listening audience audience jump in on this and support this petition to try to better label the SSRI antidepressants in terms of their impact on pregnancy complications and on the developing baby. Again, the message doesn't have to be, it's not that pregnant women can't take these medications or that they're not going to be available or that pregnant women who took them should feel guilty and be ashamed. It's none of that. It's about.
- [63:44]
A
Yeah, remember that NBC News, when you try to write an article about this.
- [63:46]
B
Episode, it's about getting the right information out to patients in the public. And I say that if anyone knows my history, my goal, I take care of patients in my home community, I work at the hospital I was born in, I'm still in the same community. And I'm taking care of these patients that I have for 20 years now. I need to make sure that I'm giving them the right information about all of these things in pregnancy so that 10 years from now or 20 years from now, they're not coming back to me and saying, why didn't you warn us about this? So that's why I'm active about these topics, whether it was McKenna for preterm birth or now with SSRIs. The. My motivation is to get the right information out to pregnant women in the public. It's not to, to take medication away from anyone or to attack anyone. That's not what this message is. And it's a message I think that we can all support and get behind proper information for people.
- [64:36]
A
Are you accepting new patients?
- [64:39]
B
Yes. I have a very busy practice right now. I'm fortunate to, to have a lot of, a lot of patients. And I'm grateful that I've been able to take care of the pregnant women in my community for for as long as I have been.
- [64:51]
A
Where are you for people that want you to be their doctor?
- [64:54]
B
I'm up in I'm up in Framingham, Massachusetts doing high risk obstetrics in my community. I'm a local community physician and in terms of this activism and being outspoken on these things, the best way to follow me is on Twitter Adamurado1. That's amurado1 and what I mostly do with my account is just put the ongoing research studies on there that are showing the effects of the SSRI antidepressants.
- [65:19]
A
I ask every single guest if you could offer one remedy to helicit culture, it could be physically, emotionally or spiritually, what would it be?
- [65:27]
B
I think to take good care of each other and to try to look out for each other. And in that I think a lot of people will find a lot of purpose which is something that can really heal a sick culture, the taking care of others and that giving that purpose for yourself I think is an important thing.
- [65:46]
A
Dr. Yarato, you're doing incredible things, important things for the next future of children and women. So thank you so much for everything that you're doing and for coming on Culture Apothecary to share it.
- [65:57]
B
Thank you so much for having me on your show and getting the word out on this.
- [66:04]
A
This episode is so crucial to share with young women who may be on or likely to be prescribed antidepressants or SSRIs. Please leave that five star review. Tell others which episode of Culture Apothecary they should start with if they've never listened. We're on a mission to heal a sick culture twice a week, Mondays and Thursdays at 6pm Pacific, 9pm Eastern, where expert guests bring their own unique remedy to do just that. Subscribe to Real Alex Clark on YouTube and follow me on Instagram at Real Alex Clark or the show. Welcome to the show at Culture Apothecary. I'm Alex Clark and this is Culture Apothecary.