Ep 1189 | SSRIs Are Rewiring Babies’ Brains — and Killing Their Moms | Guest: Dr. Adam Urato

Summary

Podcast Summary: Relatable with Allie Beth Stuckey Episode: 1189 | SSRIs Are Rewiring Babies’ Brains — and Killing Their Moms
Guest: Dr. Adam Jurado
Release Date: May 14, 2025
Host: Allie Beth Stuckey
Network: Blaze Podcast Network

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Introduction

In episode 1189 of Relatable with Allie Beth Stuckey, host Allie delves into a critical and timely topic: the impact of Selective Serotonin Reuptake Inhibitors (SSRIs) on pregnant women and their developing babies. Joining her is Dr. Adam Jurado, a Harvard-trained, board-certified obstetrician-gynecologist specializing in maternal-fetal medicine. The conversation navigates the complexities of SSRI prescriptions during pregnancy, shedding light on their potential risks and the broader implications for maternal and fetal health.

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Guest Background

[00:00] Allie introduces Dr. Adam Jurado, highlighting his expertise in maternal-fetal medicine and his focus on the increasing prescription of SSRIs during pregnancy. Dr. Jurado shares his professional journey:

[01:55] Dr. Jurado: “I’m a maternal-fetal medicine specialist in Framingham, Massachusetts. After completing my OB-GYN residency, I’ve dedicated 28 years to caring for high-risk pregnancies, primarily through ultrasounds, counseling, and deliveries.”

His passion for labor and delivery mirrors his athletic background, drawing parallels between medical teamwork and sports dynamics.

[02:29] Allie: “What is your favorite part about what you do? Is it the delivery?”

[02:32] Dr. Jurado: “I love labor and delivery—the excitement, joy, and adrenaline. It’s like working towards the Super Bowl every shift.”

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Evolution of Obstetrics: Increased Interventions

Over his nearly three-decade career, Dr. Jurado has observed a significant rise in medical interventions during pregnancy and childbirth. He expresses concern over the growing medicalization of what has been a natural process for millions of years.

[04:02] Allie: “What have you seen change in obstetrics over these 28 years?”

[04:11] Dr. Jurado: “There’s a trend towards more interventions—ultrasounds, medications, C-sections—often causing more harm than good by disrupting natural processes.”

He emphasizes that while interventions aim to prevent disasters like stillbirth, they frequently result in unnecessary procedures for the majority of women who might have had uncomplicated deliveries naturally.

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Focus on SSRIs in Pregnancy

Dr. Jurado shifts the discussion to his primary concern: the rising use of SSRIs during pregnancy and their impact on both mothers and babies.

[15:28] Dr. Jurado: “The increasing use of medications during pregnancy reflects broader societal trends. In the U.S., we use about 70% of the world’s pharmaceuticals, spilling over into pregnancy care.”

Understanding SSRIs and Serotonin

Serotonin is a crucial neurotransmitter involved in mood regulation and fetal brain development. SSRIs, designed to inhibit serotonin reuptake, inadvertently disrupt this delicate balance.

[20:32] Dr. Jurado: “Serotonin is vital for fetal brain development, acting like an engineer directing cellular growth. SSRIs interfere with this process, impacting fetal development significantly.”

[24:43] Allie: “Is SSRI short for Selective Serotonin Reuptake Inhibitor?”

[24:45] Dr. Jurado: “Yes, and the name itself indicates their effect—blocking serotonin receptors.”

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Effects of SSRIs on Pregnancy and Babies

Dr. Jurado outlines the myriad ways SSRIs can adversely affect both pregnancy outcomes and long-term child development:

• Early Pregnancy Risks:

  • Miscarriage and Birth Defects: Increased rates of miscarriage and specific birth defects, such as heart defects associated with drugs like Paxil.

• Late Pregnancy and Delivery:

  • Preterm Birth and Preeclampsia: Higher incidences of preterm births and preeclampsia, a condition marked by high blood pressure and proteinuria.
  • Postpartum Hemorrhage: Elevated risks of excessive bleeding post-delivery due to SSRIs’ impact on platelet function.

• Neonatal and Long-Term Effects:

  • Neonatal Behavioral Syndrome: Symptoms include agitation, irritability, feeding difficulties, and temperature regulation issues; reported in up to 85% of exposed newborns.
  • Long-Term Developmental Issues: Increased rates of depression, anxiety, speech delays, and even behaviors associated with autism in children exposed to SSRIs in utero.
  • Sexual Functioning in Adults: Animal studies indicate reduced sexual behavior in adults exposed to SSRIs during fetal development.

[34:53] Dr. Jurado: “Animal data clearly show that SSRIs lead to poor pregnancy outcomes. In humans, we observe increased miscarriages, birth defects, and behavioral abnormalities in children.”

[41:35] Allie: “It’s really sad how these studies imply long-term consequences for children.”

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Challenges in Medical Practice

Balancing maternal mental health with fetal safety presents a significant dilemma for healthcare providers. Dr. Jurado critiques the influence of the pharmaceutical industry and the medical establishment in perpetuating SSRI use despite the growing evidence of harm.

[30:00] Dr. Jurado: “The pharmaceutical industry is an 800-pound gorilla, shaping medical debates and influencing regulatory agencies like the FDA and CDC to promote their products over public health.”

He introduces the concept of “toxic empathy,” where the desire to alleviate a pregnant woman’s distress leads to the preferential promotion of medication over non-chemical interventions, often ignoring the associated risks.

[34:45] Allie: “Why aren't more doctors recognizing these risks?”

[47:05] Dr. Jurado: “They fear maternal mental health crises more than the long-term developmental issues caused by SSRIs. It’s a dangerous disconnect fueled by pharma’s influence.”

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Call to Action: Reform and Awareness

Dr. Jurado advocates for systemic changes, including updated FDA labeling to reflect the risks of SSRIs during pregnancy and increased public awareness.

[58:46] Dr. Jurado: “The FDA’s current labeling is inadequate. We need clear warnings about SSRIs altering fetal brain development to inform pregnant women and providers adequately.”

He also highlights his efforts to petition the FDA and encourages listeners to support dissenting voices in the medical community to foster a more transparent and truthful discourse.

[60:45] Dr. Jurado: “We must support the free flow of information and dissenting voices to uncover the truth, rather than succumbing to censorship and misinformation.”

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Case Study: Makena and Pharma Influence

Dr. Jurado recounts his opposition to the drug Makena, a synthetic hormone used to prevent preterm births. Initially promoted despite flawed studies, Makena remained on the market for 20 years due to pharmaceutical lobbying and misleading claims.

[62:53] Dr. Jurado: “Pharma used sales to fund medical societies, which then recommended Makena despite its inefficacy. It wasn’t until 2019 did follow-up studies reveal it didn’t work, leading to its market withdrawal in 2023.”

He criticizes the company’s argument to keep Makena on the market under the guise of racial equity, highlighting the unethical manipulation of medical narratives for profit.

[63:56] Dr. Jurado: “The argument for racial equity to keep an ineffective drug on the market is absurd and showcases pharma’s corrupt influence.”

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Conclusion

The episode underscores the urgent need to re-evaluate the use of SSRIs during pregnancy, advocating for informed consent, better regulatory oversight, and a shift towards non-chemical interventions for maternal mental health. Dr. Jurado’s insights challenge the status quo, urging both medical professionals and the public to critically assess pharmaceutical influences and prioritize the long-term well-being of both mothers and their children.

[67:36] Allie: “Thank you for being one of those dissenting voices and for speaking up when it would be easier to go with the flow.”

[67:46] Dr. Jurado: “Thank you. It’s crucial to support informed decisions and expose the truth.”

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Key Takeaways

• Increased SSRI Use: There has been a significant rise in SSRI prescriptions during pregnancy over the past 28 years, influenced heavily by the pharmaceutical industry.

• Serotonin’s Role: Serotonin is essential for fetal brain development, and SSRIs disrupt this process, leading to various negative outcomes.

• Risks Associated with SSRIs:

  • Higher rates of miscarriage, birth defects, preterm birth, preeclampsia, and postpartum hemorrhage.
  • Neonatal behavioral issues and long-term developmental and behavioral problems in children.

• Pharmaceutical Influence: The pharma industry exerts substantial control over medical practices and regulatory bodies, often at the expense of patient safety.

• Need for Reform: Updated FDA labeling, increased public awareness, and support for dissenting medical voices are crucial steps toward mitigating the risks associated with SSRI use during pregnancy.

• Non-Medical Interventions: Emphasizing psychotherapy, family support, exercise, and other non-chemical methods to address maternal mental health during pregnancy.

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Notable Quotes

• Dr. Jurado on Labor and Delivery:
  [02:32] “It’s like working towards the Super Bowl every shift.”

• On Medical Interventions:
  [04:11] “There’s a trend towards more interventions—ultrasounds, medications, C-sections—often causing more harm than good.”

• Pharma’s Influence:
  [30:00] “The pharmaceutical industry is an 800-pound gorilla, shaping medical debates and influencing regulatory agencies.”

• On SSRIs and Serotonin:
  [20:32] “Serotonin is vital for fetal brain development, acting like an engineer directing cellular growth. SSRIs interfere with this process.”

• Call for FDA Reform:
  [58:46] “We need clear warnings about SSRIs altering fetal brain development to inform pregnant women and providers adequately.”

• Critique of Makena:
  [63:56] “The argument for racial equity to keep an ineffective drug on the market is absurd and showcases pharma’s corrupt influence.”

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This comprehensive summary captures the essence of the podcast episode, highlighting Dr. Jurado’s concerns about SSRI use during pregnancy, the influence of the pharmaceutical industry, and the pressing need for informed consent and regulatory reform to protect maternal and fetal health.

Transcript

[Ally Stuckey]

Doctor Adam Jurado is a Harvard trained board certified obgyn who specializes in maternal fetal medicine. His focus is on the increase of the prescription of SSRIs, also known as antidepressants during pregnancy, the effect that that has on women, and the effect that that has on babies after they are born and long after they are born. This is an absolute, absolutely thousand fascinating conversation. We talk about much more than this subject. We talk about the intervention and pregnancy in general. You are going to learn so much. This episode is brought to you by our friends at Olive Know what is really in your food so you can make the best choices for your family. Go to the App Store and download the Olive app for free. Before we get into that conversation, let me remind you to sign up for Share the Arrows brought to you by our friends at EveryLife. It is going to be amazing, y' all. I am so excited. In case you missed it, yesterday we announced our two new speakers on our Motherhood panel. We've got Abby Halberstadt. She was there last year. That is M is for Mama on Instagram. A lot of you probably know who she is. And then Hillary Morgan Ferrer. She is the author of the extremely popular Mama Mama Bear apologetics books. She is incredible. I'm so excited, y' all. We've got Ginger Dugger Volo. We've got Elisa Childers, Katie F. Taylor Dukes and Shauna Holman. And then of course we will be led in worship by Grammy Award winning artist Franchesca Bastelli. I cannot wait. Get your tickets today. Go to share the arrows.com Dr. Yurado, thanks so much for taking the time to join me. Could you tell everyone who you are and what you do?

[Dr. Adam Jurado]

Well, first off, thanks for having me down here. I'm a maternal fetal medicine specialist and I work up in my hometown of Framingham, Massachusetts. Maternal fetal medicine is basically a specialization after ob GYN residency. So I did my ob GYN residency and then focus specifically on taking care of high risk pregnancies in maternal fetal medicine. So I take care of patients in the office. Most of what I do is ultrasound and counseling during the day and then I also do deliveries. I still, I still do deliveries and love doing them.

[Ally Stuckey]

Yeah. What is your favorite part about what you do? Is it the delivery?

[Dr. Adam Jurado]

I think probably. I mean, I love it all. I enjoy what I do. I enjoy the specialty. But there's a lot of excitement and fun and joy and adrenaline on labor and delivery and so, yeah, it's enjoyable.

[Ally Stuckey]

Yeah. Why did you go into that specialty?

[Dr. Adam Jurado]

It's a great question. When I came through med school, I think I was going, thought maybe I'd be an orthopedic surgeon. I grew up as an athlete and played baseball and basketball up through high school and a little bit into college. And I thought I was going to probably take that route. But then when I did my OB rotation, I got a real charge out of labor and delivery and in particular delivering babies. There's a lot of action there and there's a, there's an outcome which to me felt very much more, more like athletics than any other area of medicine where we're looking for an outcome. And there's also immediate gratification in it where you. I come on the shift and I've got maybe three pregnant patients and by the end of shift we've got deliveries.

[Ally Stuckey]

Yeah, you get a prize at the end, which is fun.

[Dr. Adam Jurado]

Yeah. I tell people, I don't know if they, I don't know if that makes sense to people, but it's almost like working with a team in a sports season. You're working with the mom, you're working with other people, you're getting through the season and then the end of the season is like the super bowl or the World Series as labor and delivery. And then you get the outcome and you in and you win most of the time. You get a good outcome most of the time in obstetrics.

[Ally Stuckey]

And how long have you been practicing now?

[Dr. Adam Jurado]

I became an MD in 97, so 28 years now.

[Ally Stuckey]

28 years.

[Dr. Adam Jurado]

28 years doing obstetrics.

[Ally Stuckey]

And what have you seen change in the world of obstetrics that almost 30 year period? Maybe for better and for worse.

[Dr. Adam Jurado]

I feel like we're seeing more intervention now progressively over time just in terms of the medicalization of pregnancy. And pregnancy and childbirth is something obviously that's been worked out in mammals for millions and millions of years. And so there's a lot to be said for trying to allow the natural process to proceed without a large number of interventions. And I've seen over time progressively that we're doing more and more, whether it's ultrasound or whether it's medications, which is the area that I focus on now, medication exposure in pregnancy or C sections for delivery, et cetera, sort of over intervention and sometimes causing more harm than good.

[Ally Stuckey]

Yeah. I'm wondering if you can tell me what, what is the thinking behind that? So like my first doctor, for example, when I got to 39 weeks, he started saying, okay, we need to just induce, we need to. I didn't have Any complications, healthy pregnancy, all of that. My baby wasn't measuring large or anything, but. Okay, we need to go ahead and set your induction date. I really don't let my patients go past 40 weeks, so. 40 weeks, five days. I was making no progress at all and scheduled the induction. Well, it. It didn't work. My body was not ready. She was not ready. And so he said, you know what, we're going to go ahead and just do a C section. You'll have a baby by lunch. And looking back, I didn't want to do that. I had never had surgery before, but my husband and I just didn't know. And when you have a doctor that's telling you this is what you need to do, and, you know, the baby's heart rate was fine. There was nothing wrong. It was just like, we just probably should do this. What is the thinking behind something like that? Because I've heard from many women that that's pretty common. Doctors pushing induction and pushing C section, even when it doesn't seem that the situation is calling for that.

[Dr. Adam Jurado]

Yeah, I think it's challenging. End of pregnancy care is challenging for moms and babies in the family and also for the. The OB providers, doctors, nurses, midwives, et cetera. And I think that they and all parties there, I think, mean well. I take care of a lot of home birth patients now, patients that plan a home birth, that want a minimum of intervention or they might have had a bad experience previously. And I'm sympathetic to what they're saying about feeling maybe forced into certain things, but I think my colleagues, my fellow doctors and midwives, et cetera, they want the best for the patients. But it's hard at the end of pregnancy trying to balance things. We tend to, as providers, want to avoid disaster, want to avoid the worst outcomes. So with end of pregnancy care, there's a lot of things that can go wrong at the very end of pregnancy. Things like preeclampsia, hypertension. Stillbirth is the one everyone worries about, stillbirth, which can. It's not common, but it's not terribly rare either. And so it can occur. So as we get towards the end of pregnancy, as we get to the due date, that's always kind of weighing on the OB provider's mind. And so there's an argument to be made, and some people are making this argument for delivery, excuse me, for delivery at 39 weeks, because that prevents any complications from happening beyond that. The problem with that approach, though, is that while it does avoid disaster by getting the babies out at 39. It really ends up being, in most cases, in the overwhelming majority of cases, over intervention, most women don't need to be delivered at 39 weeks. And the birth, the labor and birth experience will be much better if we just wait and let the woman go into her own natural labor. So if you stay, if you just keep your hands off and follow the mom, follow her closely and say, let her get to her due date and she goes into labor, she may be able to come into the hospital and have a labor and delivery that lasts on the order of eight, 10 hours or something like that. If you do the induction at 39 weeks, you may be looking at a 1, 2, 3, 4 day induction. And so that's a much more difficult birth experience for the mom. And so for an OB provider, it's trying to balance those things. In terms of cesarean, cesarean delivery, our rates are way too high. In the United states, it's about 1 in 3 now. It's about 33% cesarean delivery. Part of that problem is also the same dynamic, though, where if you're watching a woman in labor and you're watching the heart rate tracing and there's any question, any concern about it, the fault will always be failure to do a C section. That's the problem that would get the doc, gets the doctor in trouble. There's almost never, very rarely examples where doing the C section early leads to litigation, for example. And not that doctors are just focused on litigation, but they're also focused on good care of the patient and avoiding the very bad outcome. And so I think that's probably what's pushing it. Both early inductions and the move towards cesarean is the desire to avoid the catastrophic or the very bad outcome for the patient.

[Ally Stuckey]

Why do you think that has increased? The interventions have increased over the past 28 years, though. Is it just because there's more fear for some reason? Is there a justification behind the higher rates of intervention? Is it because patients are more litigious than they used to be? Like, why. Why do doctors now feel more so than they used to? That they've got to do something and induce?

[Dr. Adam Jurado]

Yeah, for. So as far as the area that I'm interested in particular now, which is medications, I think that the increasing use of medications in preg is just a reflection of the broader society. I heard a statistic the other day, I think this is accurate, that the United States population makes up about 2%, about 4.2% of the world, but we use about 70% of the pharmaceuticals, or 50 to 70%. So we're using a large number of medications anyway, background in society, and then that spills over into pregnancy. And so we're seeing more interventions, more medication use. And I think that's just a reflection of the broader society.

[Ally Stuckey]

Okay.

[Dr. Adam Jurado]

In terms of things like induction of labor, we're seeing, I think, less tolerance for watching those pregnancies late. And there's also been studies. A study came out called the ARRIVE trial. ARRIVE is an acronym that made people feel that it was a safer route to take the 39 week induction to prevent problems later. The group that got induced in that study had lower rates of hypertension, lower rates of complications, and naturally they're going to have lower rates if you do it in a widespread population basis, lower rates of stillbirth, et cetera, because you can't have a 40 or 41 week stillbirth if you've been delivered at 39. So when that trial came out, it pushed people in that direction towards. Towards more intervention.

[Ally Stuckey]

Yeah. It can be difficult for women to find doctors that are striking that balance because I can sympathize with how difficult it is. Obviously you want to care for the patient, you want to care for the little patient inside her womb. And the worst case scenario is that someone dies or someone, someone is catastrophic, catastrophically injured, for example, in like a vbac, you know, vaginal birth after cesarean. For those out there who don't know, there's a risk of uterine rupture, which I guess there's a risk of uterine rupture at, you know, for any pregnancy, but it's increased when you have that scar in your uterus. And I actually had a VBAC after two C sections. But it was very difficult for you.

[Dr. Adam Jurado]

Way to go.

[Ally Stuckey]

It was difficult to find a doctor who would allow that. And I understand because you're always trying to balance. And actually the doctor who agreed to take me on and do the VBAC after two C sections, he was not there for delivery. And the doctor who was on call, she was not pro vbac. She was very, very worried. But she did let me in the moment because I was very like, no, we're going to try this and I'm going to keep going. And I kept on, put, pushing off, having an epidural and I wouldn't get induced or anything. But anyway, it worked. And I went to almost 42 weeks pregnancy, which I guess I just have long pregnancies. But it was fin into labor naturally. You know, it was like probably eight hours and no complications. Praise the Lord and all of that. But I just say that to say that it was very difficult to find a team that would balance that, that obviously didn't want anything catastrophic to happen, but also, you know, trusted that childbirth is a natural process and that the risk of uterine rupture is very low and that it's okay to take that risk. So anyway, there are a lot of just moms out there that have a hard time finding the obs that will listen to them.

[Dr. Adam Jurado]

Sure. I give you credit for taking that route and doing it. Congratulations.

[Ally Stuckey]

That's terrific. Thank you.

[Dr. Adam Jurado]

Yeah. I think that with my patients, the main thing for me is to just inform them. Inform them accurately and then support them in the decisions that they make. But the big part of that, of informed consent, is making sure that the patients actually have the accurate information, which in particular in the area that I focus on with medication exposure, is a big one. In trying to make sure that. That. That women have accurate information so that they can make the decision that's right for them and then to try to support them in that process. It sounds like you got that information, you made the decision that you wanted to.

[Ally Stuckey]

Yeah.

[Dr. Adam Jurado]

And had a successful outcome.

[Ally Stuckey]

Yeah.

[Dr. Adam Jurado]

Terrific.

[Ally Stuckey]

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[Dr. Adam Jurado]

Yeah, I think what's happened over the years is that we've moved towards less caution with exposures in pregnancy. We've kind of moved away from the precautionary principle of thinking that medications and other exposures could be harmful unless they're proven safe. We've kind of turned that on their head and felt like, well, they're probably okay unless we can prove that they're harmful. And so I think we've moved away from that over time. Before I get into that, I just want to say, though, that it's important that I talk about safety of medications in pregnancy all the time. And I just want to make sure that people understand or don't misunderstand. It's not about pill shaming for women. It's not about not having compassion for them, for whatever the condition is that they're using the medication medication for. It's like none of that. I support my patients and I work in my hometown, and so I know many of my patients out there, neighbors. I'll see them at the coffee shop or at the breakfast place or whatever. So I'm taking good care of them. But the main issue that I'll talk, that I talk about is that the important compassionate care is what you want to provide, compassionate, loving care. But a big part of that compassionate care is giving patients the correct information, telling them the truth about what they're taking. And so that has become, over my career, more and more of a focus for me, especially as I've seen more and more use over time. And these are medications just in general, whether it's for nausea and vomiting early or whether it's for conditions late. The main one I'm focusing on currently is the use of antidepressants during pregnancy because we're seeing so much of that in the general population, but in particular in pregnancy as well. And I think the big thing I feel about it is the patients that I'm seeing just aren't getting the accurate information about what the actual impact of antidepressants, or in particular the SSRI antidepressants are on the pregnancy, on the developing baby.

[Ally Stuckey]

Okay, I have so many questions about that, but you mentioned all medications that you're not only talking about SSRIs. So the ant. What's the anti nausea medication?

[Dr. Adam Jurado]

Diclegia or Zofran.

[Ally Stuckey]

Zofran, that's the one. Okay. I have taken that, actually. Not pregnant. When I had like a stomach bug a couple years ago, it was a miracle. I have never taken a medicine that worked that quickly before we get into the SSRIs, because that'll be the longer conversation. Like, what is your thought about prescribing the anti nausea medication in the first trimester?

[Dr. Adam Jurado]

Well, I'm glad you got relief from your episode there. Yeah, I think that it's always for patients in this, in these scenarios, it's always a balance of, of risks and benefits and alternatives and just making sure that the patient's informed. So most nausea and vomiting of pregnancy is well tolerated by the mom. It may have some physiologic reason for being there in terms of avoiding exposures, avoiding toxins early while the. The embryo is developing. But some moms will get very severe forms of it where they'll. They'll move into something called severe hyperemesis.

[Ally Stuckey]

Gravidarum, where they Hg.

[Dr. Adam Jurado]

Hg. They'll lose a lot of weight, their electrolytes will become abnormal. And so it can vary. The rate of that is quite low compared to all background nausea and vomiting of pregnancy. So does it need to be treated? It really depends on the mom and again on the counseling. Any medication that a mom takes, virtually any medication that a mom takes is going to cross over, go into the mom and cross over to the baby. And I tell my patients that medications are chemicals. They're not naturally occurring substances. They're not like orange is growing on an orange tree. They're like, they're synthesized in a chemical manufacturing facility. So if you think about, if you like, look up how chemicals are synthesized, you'll see it's by a lot of steel tubes and workers wearing goggles and they're wearing masks because they're working with chemicals. That's what they're working with. So those come out of the chemical plants and then they get packaged in a little amber bottle and then they get ingested by the women. So those medications are going to cross over from the mom into the bab. A drug like Zofran has an impact on the serotonin receptors. Serotonin is a crucial cell signaling molecule. Serotonin is crucial for fetal development. So this discussion now also applies to the SSRIs right. Serotonin is absolutely crucial for formation of the baby. And these drugs, Zofran and then in particular the SSRIs, they really impact serotonin system. So if you just put A and B together, what I just said, the two things I just said, if serotonin is crucial for fetal development, which it is, and there's no scientific controversy about that.

[Ally Stuckey]

And what is serotonin exactly? I know people can take it to. It's like the precursor to melatonin that helps people sleep. So sometimes people take serotonin.

[Dr. Adam Jurado]

Serotonin.

[Ally Stuckey]

That's all I know about it.

[Dr. Adam Jurado]

Melatonin. Melatonin is taken for sleep. Serotonin is a naturally occurring neurotransmitter. It's naturally formed by the body. It's in all of us. It's a, it's a neur neurotransmitter and it's a cell signaling molecule that goes way back in evolution. This is a, a base, a basic chemical compound that helps to, for all of us, regulate our mood, regulate our behavior, regulate our sexual functioning. It, it plays a significant role for adults, for children, et cetera, at the fetal level. It plays a crucial role in cell signaling and in actually the formation of the fetus. And in particular the fetal brain, I compare it to like a molecule that's acting as a, as a direct, as a director, an engineer, a supervisor in the building of a building or a town, giving directions to the neurons, which way to go. The fetal brain has to go basically from 0 to like 100 billion neurons with a hundred trillion connections. And so what's orchestrating that serotonin and other cell signaling molecules telling the nerves how to grow, where to branch, how to develop. So it's this incredibly intricate, well developed, well preserved system that we find through mammals. We find it, you know, across the board. That's absolutely vital to the formation of a human baby. And so if you've got this delicate system, intricate system that relies on serotonin and other neurotransmitters like norepinephrine, dopamine, dopamine, that relies on those things, if you have that and you then disrupt it with chemicals like Zof, Zofran or like the SSRI antidepressants or other antidepressants, it's going to have an impact. It'll absolutely have an impact. And again, there's not really, there's not scientific controversy about what I'm saying with that. It's just there's a lack of information in patients understanding that.

[Ally Stuckey]

And so how does Zofran affect serotonin? I guess I just thought it was doing something to your stomach to make you not be nauseous. Is it communicating to your brain. Brain to tell your stomach not to be nauseous? Is that why it affects serotonin?

[Dr. Adam Jurado]

Yeah, I believe it's a serotonin receptor antagonist. So it blocks the receptor, and there's a lot of serotonin receptors. I think 90% of serotonin in humans is in the gut. So there's a lot of action there. And so it'll have impact that way in the gut and then in the brain. There are nausea centers in the brain, and so it'll have impact there. Okay, but you're raising a great point, which is that. That. And I tell patients this, it's that we think of the medications we take as going to the location where we're having a problem. So we think of Zofran. I'm taking that. It's going to make my gut feel better, so I won't be as nauseous. But Zofran is really actually going all throughout the body, into all the cells and affecting all of those serotonin receptors. And it's the same thing, for example, with the SSRIs. So. So patients are thinking that they're taking an SSRI antidepressant like Prozac or Zoloft or Celexa to try to address their depression, their anxiety, what's going on in their head. But in fact, that medication is going all throughout their body. And there's evidence, for example, that patients on antidepressants. On the ssri, antidepressants have increased rates of bleeding. And it's because another cell that plays a crucial role is the platelet, which is important for stopping patients from bleeding. And serotonin has a huge impact on platelet function. The other area that serotonin has a big impact on is the gut and also bone, bone strength and bone health. So patients that are on SSRIs have higher rates of fractures in their bones. They have higher rates of osteoporosis. So what we find is that these chemicals, this chemical ingestion that's going on, it's impacting not just that one system that patients are thinking, thinking it's going all throughout the body and basically impacting cells in a widespread fashion.

[Ally Stuckey]

Remind me what SSRI stands for?

[Dr. Adam Jurado]

Selective serotonin reuptake Inhibitor.

[Ally Stuckey]

Okay, so it's right in the name that it's inhibiting serotonin receptors. So, like you said, there's not any controversy over this scientifically. It's just a lot of people don't know what that actually means or why we even need serotonin. A lot of times you'll hear people say someone has depression because they have a chemical imbalance and the SSRI is bringing balance to the chemicals that are imbalanced in their brain. Is that an accurate way to describe what SSRIs do?

[Dr. Adam Jurado]

So this is the sort of story that's been told, but it's not accurate. That's not accurate. There's not evidence for that. That's sort of, I, I tell my patients that's sort of more like a commercial to get you to use the drug. Some other people call it profit driven propaganda. Basically what it is, it's a way of trying to sell the product to the public, sell the product to the patient. This notion that you're depressed because you've got low serotonin and then these medications like Prozac or Zoloft, that they work to correct that serotonin imbalance, that hasn't been shown, that hasn't been proven. What does occur is that it's a chemical exposure having a chemical effect which really, really creates an abnormal state. It really creates an abnormality in the brain. It's not solving one. But this, what you just described, Ali, this, this theory or this explanation is what many patients think. And they think it's like insulin for diabetes. They think I have a shortage of serotonin, just like I have a friend with a shortage of insulin. They take insulin to address their diabetes. They have better health outcomes. I take Prozac to develop low, to address my low circumflex. I've seen that comparison have better outcomes, but that's not in fact what's going on. Diabetes, you can address that with insulin in depending on the type of diabetes, there can be a mismatch between how much insulin, there's not enough insulin, and so that can address it. But with the SSRIs, there is no proven. And Joanna Moncrief addressed this in her paper a couple of years ago in her current book that she has on this. There is no evidence for a chemical imbalance that you're then addressing or correcting. What you're doing essentially is creating an altered mental state for people by, by virtue of taking the drug. And this is even more so for the developing baby because the developing baby has no issue going on. And now at the point where the developing baby needs to have the serotonin system functioning optimally to form the brain, to form the organs, to wire the brain. It's got this, this chemical, this synthetic chemical compound coming out of a chemical factory and going into its brain and essentially disrupting that development.

[Ally Stuckey]

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[Dr. Adam Jurado]

Yeah, I think there's two things pushing this. Basically. I think that the pharmaceutical industry is like the 800 pound gorilla in our lives in terms of how we provide medical care. And they're able to kind of shape the debate and shape the thinking around these topics. And so they're able to throw their weight through the, through finances and through sponsorship. And I can discuss more of that, how they influence medicine, how they.

[Ally Stuckey]

Sorry to interrupt, but does the chemical imbalance message that you just debunked, does that come straight from the pharmaceutical companies? Is that Basically just a marketing slogan.

[Dr. Adam Jurado]

I think of that as a marketing slogan, whether how it was introduced or how it was brought about in widespread fashion, probably through some combination of pharma and what I would call the medical establishment, where that message then took hold and the messages that the public hears, and this is an important lesson for people to understand, is that the messages you're going to get or hear sort of in mainstream media or through a lot of medical establishment sources are going to be messages that are pro pharma, that are pro drug, because of the disproportionately high influence that the pharmaceutical industry has. And this is across the board with what I would call the medical establishment. So the information. We have a real problem with information and regulation of pharmaceuticals, of drugs in our society. And a big part of that is because of how strong the pharmaceutical industry is. So the way the system should work is you've got a bunch of patients here who are trying to take care of their health, who need good information, information. You've got the pharmaceutical industry over here who wants to sell them products. But between the pharmaceutical industry and the patients you've got, you should have this great medical establishment that are working on behalf of the public, trying to protect them, trying to inform them. And that would be places like regulatory agencies like the fda, like the cdc, as well as institutions like our institutions of higher learning, all of the universities. Also in that middle area between patients and pharma would be experts, the experts in a given area, researchers. And then another aspect of that medical establishment would be the media trying to inform patients correctly, get out proper information on these things. So the model is you've got pharma here, you've got patients here, in between them. What we should have is a real protective layer, but that's not what we have in our society. Society has failed in this way for years. The fda, the cdc, the leading academic centers, even the media were all funded by pharma. So instead of playing that protective role, they're essentially playing role of salesmen. They're basically working for pharma to get the public to take the medications. And we see this again and again with various models, with the serotonin hypothesis, et cetera. And so that's one part of your answer why we're seeing more and more women using these. It's just the pure power of pharma and money that has allowed them to shape the message through pharma itself, but also through these other, what should be trusted sources who are basically, in a lot of ways, funded by Pharma and then parroting that message. The second reason, though, I think think gets to this notion of toxic empathy that you, that you talk about in your book, which is that we all want to help the pregnant woman who's struggling. Depression can be awful, and a woman in distress who's pregnant is. It's, it's very sad. And we want to help that woman. And so there's a human desire to tell that woman a story that's going to be shaped like. Like what pharma is actually trying to say, which is that the medication is okay. It's gonna be make you feel better. And by making you feel better, you're going to end up with better pregnancy outcomes for the baby, better development of the baby. But I would also call that like toxic empathy. That that's not what we need to be saying. We need to be telling the truth. As you very well point out, you need to tell the truth, which is telling a patient in that scenario that this is what the medication's risks are. And you can also review, for example, not going into withdrawal during pregnancy, which is part of the counseling, and then allowing that woman to make the best decision for herself and support her. But, but that second reason, I think, is how a lot of people in society, even if they don't want to be parroting pharma's propaganda, how they'll still end up doing that because they're trying to. To give a message to depressed pregnant women or depressed women of childbearing age that will be friendly to what they're doing currently.

[Ally Stuckey]

Can you tell me more about what S MRIs can affect when it comes to fetal development?

[Dr. Adam Jurado]

Sure. That's really the nuts and bolts of it. That's a great question. So early along in pregnancy. I will say when we look at animal data, the animal data is very clear. When we look at animal data, we see pregnancy complications. If you take a group of mice or rats or rabbits and you expose one group to SSRIs and the other group to a placebo, you see poor pregnancy outcomes in the SS exposed group. That's clear. When you do it in humans, it gets a little harder to study because you get into things like, are you going to, Are you going to look at. How are you going to tell that they were exposed? Are you going to look at prescriptions? If you look at prescriptions, maybe they didn't fill the prescription. Now you're calling them exposed, but they're actually not exposed. So the study in humans gets more difficult and there's some Mixed data. But overall, my take on the science is that we're seeing, just like we do with animal data, we're seeing increased rates of miscarriage, so the woman losing her pregnancy early, we're seeing increased rates of birth defects. It's been clearly shown with some of the drugs, things like heart defects. People usually know about Paxil or Paroxetine and heart defects, but other, other SSRIs and other SNRIs as well have been associated with birth defects. Then moving through the pregnancy, we see increased rates in preterm birth. We see increased rates in P. Prom, breaking your water early, having the rupture of the membranes. We see increased rates of low birth weight babies small for size, they didn't grow well, likely because of the impact of the drugs on the placenta. Late in pregnancy, we see an increase in the disease called preeclampsia, which causes high blood pressure in women and proteinuria, protein in their urine. We see higher rates of that in the women on the SSRI at the time of delivery, for sure. We see higher rates of postpartum hemorrhage. There's higher rates of women bleeding who are on SSRIs and hemorrhage because of.

[Ally Stuckey]

The platelet thing you talked about with serotonin.

[Dr. Adam Jurado]

That's exactly right. That's right. And we've seen that for years in other areas of medicine. After surgery, the surgeons have reported on that. But now it's becoming clear. In obstetrics and postpartum, hemorrhage is one of the leading causes of maternal morbidity and mortality. It's a. You want to make sure when you're delivering a baby that your coagulation system or your blood clotting system is functioning optimally. And as a surgeon, I myself am doing these surgeries. I was in the operating room the other night around three in the morning. And when the patient's bleeding, you're really hoping that her coagulation system is functioning optimally.

[Ally Stuckey]

Right.

[Dr. Adam Jurado]

And so this disrupts that, likely through its impact on platelets. Platelets, yeah. After delivery, what we see is for sure an increase in what's called newborn behavioral syndrome, or some people call it poor neonatal adaptation. The kids come out and they have trouble adjusting after birth. They're often agitated or irritable or restless. They'll have trouble feeding, they'll have jitteriness, they can have difficulty regulating their temperature, difficulty with feeding. The babies that come out after being exposed to SSRIs in utero definitely are showing an impact. And it's not a small percentage either. Ali. It's not. When the studies have looked at this, the studies quote rates as high as one textbook or one online textbook cites a rate as high as 85% for seeing some impact of the exposure to SSRIs during the pregnancy. So we see high rates of, of this, more likely to end up going into the nicu, more likely to have what's called a low APGAR score. The APGAR score is, is a way of assessing how the newborn's doing after birth. And babies that have been exposed to SSRIs in utero are more likely to have an APGAR at five minutes less than seven, which has been predictive of future problems. And that gets into the big area. Well, what are the future problems?

[Ally Stuckey]

That's what I was about to ask. Long term issues.

[Dr. Adam Jurado]

This is a great question and again harder to study in humans because of the difficulty with how are they being raised at that point? What other factors?

[Ally Stuckey]

There are a lot of other factors, absolutely.

[Dr. Adam Jurado]

But it looks like the offspring who are exposed to SSRIs prenatally have higher rates of depression, higher rates of anxiety, they have higher rates of neurobehavioral abnormalities, difficulties with motor skills. It depends on the study that's looked at it. But they've found difficulties in speech delays. And autism is the one everyone asks about. Several animal studies, numerous animal studies of exposure in utero or exposure during development show that the mice and the rats have what they call autistic like behaviors. We see this in terms of they're not socializing in the same way.

[Ally Stuckey]

Interesting.

[Dr. Adam Jurado]

And so people have said, well, this could certainly be contributing. When you start talking autism though, it gets very controversial and very murky because how that diagnosis is made, whether you're talking about just a personality difference versus profound autism, which is an IQ less than 50, lack of verbal skills, et cetera. You're talking about complexity in the diagnosis, but it looks like, without a doubt, from the reading of this literature, it looks like there's an impact for sure on the baby's developing brain. Brain that then shows up as they, as they grow up. A study just came out, actually, in fact last week. Zani is the lead author that looked at mice who were exposed during development and then how they responded, what their fear response was. So they had those mice exposed during development and then as they grew up they did a study where they exposed them to the stimulus's mountain lion urine, I think is what they used use because the scent of the mountain lion, who's their Predator. And they can see that the ones that were exposed to SSRIs during pregnancy have a different fear response as they, as they grow up. The same study was then done in humans where they looked at humans who had been exposed to SSRIs during pregnancy and then at age 11 to 13. So we're not talking newborn period, we're talking 11 to 13. They did MRIs on them, functional MRIs cry while showing them pictures to induce fear. And they.

[Ally Stuckey]

Sounds like a terrible study. It's really sad.

[Dr. Adam Jurado]

We shouldn't be scaring 11 to 13 year olds that way. Right. But they find a difference in the children or in the adolescents at that point who have been exposed to the SSRIs.

[Ally Stuckey]

Like less of a fear response. It's a suppressed fear response.

[Dr. Adam Jurado]

More of a fear response.

[Ally Stuckey]

More.

[Dr. Adam Jurado]

Okay, heightened fear response. And they show higher rates of depression and anxiety. This just came out from Columbia University Medical center and it's just, just out now. And so this. But this is not the first study showing this kind of thing. I've been following this literature now, the scientific literature for 20 plus years. And it's study after study is showing this, these effects on the developing fetus, in particular the developing fetal brain, of being exposed to SSRI antidepressants during pregnancy.

[Ally Stuckey]

Yeah.

[Dr. Adam Jurado]

The one I get asked about all the time is could there be an impact on sexual function functioning? And this is app has absolutely been shown in the animal studies. So if you expose a. Develop a mouse in development during the period that corresponds to third trimester human development, if you expose a mouse to an ssri, a male mouse or male rat, and then you study their sexual behavior in adulthood, their sexual function in adulthood is significantly different than. Than the mice or rats who weren't exposed to the SSRI during development. So different how they do these studies where they will look at the. They'll expose them during development at an early time and then look at them in adulthood. They present them to a female mouse or rat and then they look for activity, they look for mounting, they look for what they call intramission and they look for ejaculation population. And those rates are significantly different in the males that were exposed to SSRIs during. During development.

[Ally Stuckey]

Like less or more or just different?

[Dr. Adam Jurado]

They see less of that.

[Ally Stuckey]

Okay, less of that. That's what I was trying to understand. So it could be that these SSRIs are affecting the sexual function or desire of, you know, the future adults. Like once they become adults, if they were exposed to SSRIs in utero it is possible that affect their sexual desire and function later on.

[Dr. Adam Jurado]

That's right. This is again shown in the. In the rodents in the animal studies. It's interesting the way they do these studies though, that one of the early studies on this was by an author named Massiag M A C I A G in 2006. And that researcher writes in their methods, they say they. They put them there and they watch them for an hour under dim red light. I'm not sure. Yeah, I don't know why the TIM red light create the mood for the virus. I don't know if that was a joke. They put it there into their paper, but that's what they do. And then. And then they do the video and they see how often are the mice or rats mounting trying to procreate. You got it. Exactly. And then they look for that and they can compare the two sets of groups. So we're seeing this impact now. I think it's coming more to the fore because there are these questions in our own society of. Of sex and sexuality and gender issues and whatnot.

[Ally Stuckey]

Yeah.

[Dr. Adam Jurado]

And could the question I often get asked is, could the exposure in utero be affecting things like sexual identity or sexual behavior in the future? And I would say absolutely, yes, because those tracks get laid down during development of the brain. And so could it possibly have an impact? Absolutely.

[Ally Stuckey]

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[Dr. Adam Jurado]

You're raising a really good point. And it should certainly be more in the fore. I think of the OB providers minds that this is not necessarily the safe route because of this increase, this disruption of fetal development, the impact on bleeding, the problems after birth, all of those things need to come to the fore. But I think what many OB providers are concerned about is another catastrophe, which is a mom's mental health spiraling words and suicide, and that being the catastrophe that they're concerned about. And I would say here also that really this message, what I'm discussing, these risks that I'm discussing really need to be risks that are, are understood in women of childbearing age. And it's too late if you're having this conversation at 12 weeks when I often see patients, or at six or eight weeks, it's too late for a couple of reasons. One, the woman's already been exposed now for weeks during embryonic development. So it's too late in that sense. But it's also too late because it's a challenge coming off these medications. One thing that's become clear over time is that there's a real withdrawal syndrome that can occur, occur, and patients have an awful time coming off of these. So that gets thrown into the counseling, which is that the mom has to then weigh that as a risk to coming off of her medication during pregnancy. So this is a message, what I'm saying here today and in General about the SSRIs in pregnancy that really needs to get out to women of childbearing age and also providers and primary care providers. I see so many patients, patients in my office every day. And I do this every day. I'm a full time clinician. I'm taking care of patients. I'm delivering babies all the time. I'm taking, actually taking care of patients. And I see this all the time where they'll come into my office and they'll say, I was started on this during college, after a breakup or after some setback in my life. And then they were maintained on this. And at the Time they were started on it. I'm just guessing pregnancy wasn't on their radar or wasn't on their provider's radar. But now you get down the road 5, 8, 10 years that they've been on it for, and those patients can have a very difficult time getting off the medication. And now they're pregnant. And so this becomes a real challenge, which again is why it really needs to be a more a broader message that gets out to the public about the concerns with the use of these drugs in pregnancy.

[Ally Stuckey]

Okay, so if there is a pregnant woman, she's not on ssri, but for whatever reason she feels that she is depressed to a debilitating degree or she has crippling anxiety, what is the healthy suggestion for that woman?

[Dr. Adam Jurado]

Yeah, I think the important thing is that it's a case by case issue. The first thing is you treat her with love and compassion as their, as her family or as your, the provider, the OB provider. You want to take really good care of her, you listen to her, you find out where she, where she's at, what things are causing this, what's going on in her life. And then the discussion people often focus for treatment. The people that are more pro drug use will say it's either drug use or medication use or SSRI use versus no treatment. But that's not really the choice. There's other methods of treatment in terms of family support, psychotherapy, exercise, meditation. There's other methods that don't involve ignoring the pregnant woman. A lot of times people will present this as a choice between either staying on Zoloft or just ignoring the pregnant woman and making her feel guilty about medication and telling her to suck it up. Like that's not really what we should be doing. The other alternative for that patient you just presented is explaining what resources are available to her out there, what other options are out there. And that can include a discussion of medication, medication as well, going again into risks and benefits and alternatives with her and then allowing her to make the best choice and supporting her in that choice. Because again, from my perspective, I'm going to be seeing her multiple more times during the pregnancy. And I want her to know that, like I'm in her corner, I'm on her dream, I'm treating her compassionately. And then I'm going to see her after her deliveries, either in her next pregnancy. I've been doing this in my community for 20, 20 years, so I'm going to see her in her next pregnancy or I'm going to see her at the, at the coffee Shop. And I want her to know that I took good care of her, that I presented her correctly with the options and then supported her in the choices she made.

[Ally Stuckey]

Yeah. What about SSRIs that are prescribed to women postpartum? I feel like that would be a pretty common thing because postpartum can be difficult, and it, you know, so many hormones, so many things going on. I remember after my first pregnancy, I, I. It was like two weeks maybe after I got home, and I saw the cup that I brought home from the hospital, and I burst into tears. Okay. That's not typical for me. And so there's just a lot going on. And I look back and I think, wow, that was a very paranoid and anxious time for me. I didn't go on SSRIs or anything like that, but I can imagine what a woman would feel like if she was told, this SSRI is going to make postpartum easier for you. It's going to make you happier. It might even help your strained relationship with your husband, whatever. I think women are basically made to feel, in a lot of cases, that if you feel bad at all postpartum, something is wrong. You need to get on medication. How much do you see that happening? Obviously, not in your practice, but just across the board. And is that different? Like, is the calculation different after she's already had the baby?

[Dr. Adam Jurado]

Yeah, I think at that point, the postpartum time can be a challenging time, certainly with the hormones changing. And a major thing that goes on at that time is sleep. Sleep is so crucial for humans for regulating our mood, regulating so much about how our bodies function. And that's a disrupted time, a disrupted sleep time. And so we see that along with the hormonal changes as well as changes in the family during that time, a lot changes, obviously, during the postpartum period. In terms of what that counseling of the patient looks like, there's not exposure at that point to a developing fetus, but there can be exposure to a breastfeeding baby at that point. We look at impact of the SSRIs or other chemicals or medications on breastfeeding, and it looks like it does get into breast milk. The medications do get into breast milk. The medications do go across into the baby. Many of the studies have shown low levels, but the truth is, is we really don't know what even the impact of low levels are on the developing neonatal brain at that point, because the brain is still undergoing development. So it may look like a low level, for example, to. To an adult or checking a blood level but in terms of like receptor occupancy in the baby's brain, like how many of the receptors have become occupied by the medication, it may be substantial still. Yeah, so that's one consideration. The other consideration is on the mom, is her milk production. The ssri, again, chemicals have chemical effects. Does the breast have serotonin receptors? Yes. Can SSRIs impact milk and the brain has serotonin? Certainly. Can it impact milk production? Absolutely, it can impact milk production. So you've got these effects that need to be reviewed with the mom and then you're getting into a question about whether there's benefit. And the studies that have been done looking at the benefits of antidepressants versus placebo do not show a really significant or dramatic benefit benefit in that, in the use category. It just doesn't. I hear, you know, for my patients, I trust them, I take their word for it. They're telling me they feel that there's been some benefit. Some of them tell that to me. But when we look at the studies, when we do the studies, it looks like the evidence for benefit is very, very minimal. And so the question in that scenario would be, are there other ways to address what the mom is going through, through first that are non chemically based, that aren't going to expose her to a chemical and going to expose the baby to a chemical. Things like family support, things like better sleep. Are there other ways of addressing that so that there's not chemical exposure? And then the other question is, is that, does, does the serotonin system in the mom impact the way she bonds with her baby? Does it, does it affect how she's bonding? Does it affect that, like the way that serotonin system has been worked out for millions and of millions of years in mammals. Does, does that affect that bonding? And it probably does. Do you want to disrupt that with a chemical effect? And so I think all of that would be part of the counseling. But as I've said, at the end of the day, if my patients decide, when presented with their options, when, if they decide no, I want to be on this medication or that medication, then you, they started on it, you support them and you follow them up closely.

[Ally Stuckey]

Yeah. A lot of the symptoms, the outcomes that you listed earlier that you see in the newborn in particular, when the child has been exposed in utero to SSRIs, child agitation, difficulty, difficulty feeding and then postpartum difficulty with milk production, all of those things in just a, a mom who is not dealing with any kind of depression can cause anxiety and can make you sad if you feel like your child isn't bonding with you, if they're addicted, agitated, if there are things going wrong with them after they're born, if you're not supplying enough milk, like that already contributes to anxiety. So it actually seems like the SSRIs could potentially make things a lot worse and make women a lot more anxious and a lot sadder than they would have been otherwise.

[Dr. Adam Jurado]

Sure, I think that's exactly right. And. And as well, applied to pregnancy complications, a preterm birth, developing preeclampsia.

[Ally Stuckey]

It's traumatic, sick.

[Dr. Adam Jurado]

Absolutely.

[Ally Stuckey]

It's hard to recover from that, no matter what.

[Dr. Adam Jurado]

That's right. Yeah, absolutely. So can we be making a problem worth worse? Worse? Yeah, absolutely.

[Ally Stuckey]

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[Dr. Adam Jurado]

Absolutely. And I think the current labeling is just inadequate. And I think the time has come, or probably we're past the time where there's enough evidence that's accumulated showing that there's developmental harm, that's showing that it impacts development, that the FDA needs to look at this and really change the labeling and put a warning on there that's not presently on on there. Just. It can be simple. It can be as simple as antidepressants, alter fetal development, particularly fetal brain development, to let pregnant women, patients, and the public and providers know this so that it can be part of the conversation. I have so many women that come into my office and I ask them, how are they? How are you counseled about being on Celexa or Zoloft during your pregnancy. And they'll often say that they were just told that they, they were, they're safe and they don't affect the baby. Like that is, is sometimes the extent of the counseling that we've had on this, that they're safe and don't affect the baby. And that's like absolutely just crazy. Not the case.

[Ally Stuckey]

Not true.

[Dr. Adam Jurado]

Yeah, they, they affect, they have impact on, on the baby, they have impact on fetal development. So I'm working with a group right now to try to pull together a petition to the fda, to petition to the FDA to change the labeling so that there is a clearer warning about the impacts of the SSRI antidepressants on the developing fetus. And to try to make that clear. And then hopefully with that warning and with more public information about this, like coming on your show and talking to more people about this, hopefully with this, the word will get out, the word will spread so that young women of childbearing age, their PCPs, their psychiatrists and whatnot, will understand that being on these drugs, drugs, what challenges that have, if they can't get off of them and if they stay on them through the pregnancy, that, that will alter fetal development, that will disrupt fetal development with unknown or uncertain long term impacts.

[Ally Stuckey]

Yeah. We've had Dr. Marty Makary on the show and it seems to me like he would be sympathetic certainly to your argument, if not in complete agreement. Speaking of the fda, I just want to quickly talk about, about this kind of scandal or when you critiqued the FDA's handling of Makena, is that how you pronounce the drug or McKenna.

[Dr. Adam Jurado]

Some people call it McKenna, some people call it McKenna.

[Ally Stuckey]

Okay, so you criticized them basically saying that this drug is safe and we need to keep it on the market for the sake of racial equity. What was going on there?

[Dr. Adam Jurado]

Yeah, I, I, I try to tell people. I'm, I, I, I focus a lot nowadays on antidepressants, but my broader, my broader focus is on just medic forward in pregnancy. So Makena was a drug hormone, a synthetic hormone, 17 hydroxyprogesterone that we injected into pregnant women for 20 years. Basically from 2003 until 2023, we injected it into pregnant women with the idea that it could prevent a recurrent preterm birth from very early along though in the process, from the first study that came out in 2003, I thought that study doesn't look right. It had a lot of flaws in it. And I was opposed to the widespread use, widespread injecting synthetic hormones into pregnant women that might not work, but it was used for years and it had very high sales for a while that those sales were. Then again, getting back to my point about how the pharmaceutical industry can control the message and the information that the public gets the money from. The sales of McKenna was used to sponsor, for example, the professional medical societies like the American College of Ob gyn, the American Society for Maternal Fetal Medicine, who then recommended and promoted its use, the march of dimes, etc. So you end up with this system where the more use, the more money gets raised. The more money gets raised, the more they can pay experts and professional societies to recommend it. And the cycle continues. This went for. For 20 years.

[Ally Stuckey]

Yeah.

[Dr. Adam Jurado]

In 2019, the follow up study to the original one showed that it actually didn't work. And that was after several other observational studies were suggesting that it didn't work. So I had been making noise about this for years and then finally, fortunately it was pulled off the market in 2023. But one of the arguments that was being made at the time was that we needed to keep this drug on the market. Market because black women have a higher risk of preterm birth. This is the company making this argument. The company is making the argument that because black women have a higher risk of preterm birth, it's important from a racial equity standpoint to keep this drug on the market. Which just boggles the mind, essentially boggles the mind. But it's this whole idea of toxic empathy, of trans. Trying to get the pharmaceutical industry trying to craft a message, an empathetic message that will get people supporting their product. Really not for any reason other than to increase profits.

[Ally Stuckey]

Emotional manipulation.

[Dr. Adam Jurado]

Absolutely. To try to keep the drug on the market. For that reason. I wrote an editorial against that in Statin News. One of the editorial, one of the online medical sources and basically completely, arguably arguing against that. I think that the. Actually it got to the point where I think the NAACP actually wrote a letter in support of the drug. This is saying that in order to have racial equity we need to keep this drug on the market. The argument I was making, I still. I'm smiling, but I'm laughing. It's like how does injecting black women with an ineffective synthetic hormone, how is that going to help the black community? How is that going to provide racial equity? All you're doing is you're targeting a group that has a higher risk of preterm birth with an ineffective drug that's not going to work and lead to possible increased risks of harm to moms and Babies. Yeah, but this shows how strong the pharmaceutical industry is and how they're able to actually craft the message that gets.

[Ally Stuckey]

Out to the public, which is exactly right. It's just a good lesson for anything. Whenever we hear the defense of any drug that sounds a lot like marketing, we should at least, least ask ourselves, but is that true? And dig into who is actually saying it and why they're actually saying it. Also, a lesson that I was reminded of the whole time that you're talking is so often if a patient raises a concern, especially a mom, the doctor or a professional will say, there's no evidence to prove your point. But just because there's no data to prove something doesn't mean there's data to prove otherwise either. And very often that's used as kind of a mode of manipulation to make a patient kind of sit down and shut up and make them feel like they're stupid. But you've also proven that there is a lot of data when it comes to SSRIs and how they're affecting moms and babies. What can people do? Like, you're raising awareness about this. So people are listening to this. They're on fire about this. They want to do something. What can they do?

[Dr. Adam Jurado]

Well, I would say our petition should be coming out here in early summer. And so when that comes out, it allows the public to actually, like, piggyback on that and also to submit once a docket's open, opened. So that will be coming. That will be in the works. They can support that. They can also spread the word. Just talking, people talking to each other, watching your show, communicating. The other big thing I just wanted to point out about McKenna is that I was basically arguing against the conventional wisdom at the time. And I was making an argument that was, as you were just describing, sometimes patients do in the office. But it's so important that we support dissent in our society, because often that's where the truth is flies. And this whole move that we're seeing now towards censorship and towards cracking down on misinformation, that's really harmful to our society. And it's really harmful towards. Towards coming up with the truth and the right answers. Because what it really does is it's meant. Meant to silence dissent, whether it's in the doctor's office, when the doctor silences descent by saying, you don't have the information, or whether it was with me, I mean, I could have been silenced. I wasn't over McKenna, but I was saying things that were. Were against the conventional wisdom at the time. So it's very important for your, your, your listeners and viewers to support the free flow of information and support dissenting voices. This movement that we're having, I feel like in our society towards censorship and, and cracking down on misinformation or whatnot is really, it's really errant and really going to lead us down a bad path as a society.

[Ally Stuckey]

Well, thank you for being one of those dissenting voices and for speaking up when it would be a lot easier to just go with the flow. So I appreciate you so much. Thanks for taking the time to come on.

[Dr. Adam Jurado]

Sure. Thank you so much. I appreciate.