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The Tudor Dixon Podcast: The Hidden Effects of SSRIs on Pregnancy with Dr. Tracy Beth Hoeg
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- [00:00]
Tudor Dixon
This is an iHeart podcast.
- [00:05]
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- [03:09]
Dr. Tracy Beth Hogue
Welcome to the Tutor Dixon Podcast. I'm excited. Today we have a senior advisor for Clinical sciences at the U.S. food and Drug Administration. We have Dr. Tracy Beth Hogue with us today. Dr. Hoag, thank you so much for joining me.
- [03:24]
Tudor Dixon
So great to be here. Tutor. Thanks for having me on the show.
- [03:27]
Dr. Tracy Beth Hogue
I feel like I cannot possibly have enough time with you because there's so much I want to talk about. But I was looking at your Twitter feed and I was watching some, I guess it was a panel on SSRIs. And so for people who don't know what those are, that's an antidepressant, is that correct?
- [03:43]
Tudor Dixon
That's correct, yes. Selective serotonin reuptake inhibitors. And they're mainly used as antidepressants. That's correct.
- [03:50]
Dr. Tracy Beth Hogue
So that conversation was about using them during pregnancy. And I found it fascinating because I think we as the public are constantly searching for why are we having some of these changes in our kids, why are we seeing higher rates of autism, why are we seeing different rates of brain development and development in children? And one of the doctors who was on there was saying, look, if you think that this isn't affecting the baby's brain, but it is affecting the mom's brain, then you're not really looking at the research. And that was shocking to me.
- [04:22]
Tudor Dixon
Yeah, exactly. And that was Dr. Adam Jurado who said that, and he is one of the world's leading experts in this topic. And he's also an obstetrician and sees patients daily who are on SSRIs and is very familiar with this topic. And it is really important for women to understand that, that if these medications are affecting the way we think and the way our brain works, then they would also, because they cross the placenta to the baby, they are also affecting the baby. And we know that serotonin plays a critical role in fetal development. And so if we're altering the serotonin and we would expect to find alterations in the development of the baby. And in fact, we do see this because we know One of the SSRIs has a well known safety signal. This is Paxil SSRI that it's listed on the FDA label that it causes heart malformations. Beyond that, we know that it can cause persistent pulmonary hypertension, which is another condition in the newborn. It increases risk of postpartum hemorrhage in the mother. And so we know that these SSRIs have impacts on both the mom and the baby. And just to get back to your question about autism and neurodevelopmental disorders, I agree this is a huge and important topic right now. Why are rates of autism increasing? Is it just a different threshold for diagnosis alone or is something else going on? And, you know, I think it's important to systematically look at this. And I certainly the, the point of the panel was not to say, look, SSRIs are causing autism, but to say, let's take a step back. So we know the SSRI that serotonin plays this crucial role in the development of the brain. And we know that over 5% of women in the United States when they're pregnant are on these medications. And what impact is it having? And we have some observational studies that show adverse effects on neurocognitive development and intellectual development. And so it's concerning enough to take a step back and say, you know, wait a minute, should we look more closely at this? And also to inform women of childbearing age, because it may be, you know, the development of the fetus happens so early in pregnancy. And SSRIs are medications that are very hard to come off of. And so this is really, that's why.
- [07:00]
Dr. Tracy Beth Hogue
He said you should think about it before, because he did say that in that panel. He said, if you're thinking of getting pregnant, you need to think about getting off of the SSRI before you get pregnant. That's why.
- [07:11]
Tudor Dixon
Oh, that's correct. And this is, I mean, it's a complex topic and discussion because obviously depression is an important problem. But this is a conversation that should be had where women are being fully informed about what we know about the potential benefits, but also the potential risks to their developing baby. And so one of the reasons we wanted to have this panel, and I was so excited that Dr. Makary wanted to have this panel, is to bring attention to this issue, which I don't think has received enough attention. And so also that, you know, women who are of childbearing age, they don't wait until they're pregnant. To look into this. So it's something that, you know, our society really has a good understanding of, so that women of childbearing age just know to ask their doctor and to have this conversation before they become pregnant.
- [08:02]
Dr. Tracy Beth Hogue
Well, let me tell you why I felt like as I was watching that it was so important right now, because I think that, that as a community, as a country, we have come out of this pandemic and we've started to go, gosh, do we trust the cdc? Do we trust the fda? Do we believe what they're saying? And we've never had. It seems like in my lifetime, we've never had an FDA that's come out and said, hey, even though these things are approved, maybe we need to look deeper. Maybe we need to talk to the public about it. It was always, like, behind closed doors, like, you know, the wizard of Oz. It was something we weren't allowed to know about and to see. See Dr. Yarado sit and talk about this and to say, you know what? I'm going to be honest with you. In rats, we've seen different behaviors and that. And even on ultrasounds and human ultrasounds, we've seen different movements of the baby. In 12 studies. I mean, I thought it was amazing. He said, 12 studies show us that these SSRIs alter the fetal brain. And he, and. But he. He was clear. Like, we don't know that this is causing. There's a cause and effect, but we do know that. That the, that the effect is autism. But we do. There is some effect. And that we've seen babies that have been born jittery and babies that have been struggling with their pulmonary abilities and whatnot. But he said, I think that we need to be more upfront with informing the public. And to me, just the panel was a huge step that we have not seen.
- [09:28]
Tudor Dixon
Yes. Well, thank you so much for saying that. And I have to say that's one of the reasons I absolutely love working at the FDA right now, because I feel like things are changing, because Dr. Makary has really made it one of his top priorities to be transparent and also to challenge the current dogma and to ask questions that maybe have not been asked in the past and to hear from different voices. And so we don't always want to just take for granted something that we've been told for many years in a row. We want to hear from researchers on the cutting edge and people who really know the most current data, like Dr. Jurato and like many of the other experts in the panel and say, what have we been? What have we learned recently in the best studies that we have now? And you're right. I'm glad that you brought up the jitteriness, too, because that is also in the newborn, because that is also a well established side effect of these medications that I've heard and read around. Even up to 80% of babies that are born with moms that are on SSRIs have this basically have a withdrawal syndrome when they're born. So we absolutely know these medications are affecting the babies. And grateful that this information is now getting out to the public. And I will tell you, I have had so much positive feedback from friends and colleagues and family members just calling me to say thank you. I had no idea that. And this is actually, like I said, well established on the label of one of the SSRI products. So we're constantly discussing how do we change things? What can we do better at the FDA to inform the public about what we do and don't know about, you know, the risks of these products during pregnancy?
- [11:18]
Dr. Tracy Beth Hogue
Well, Ann, it's a time when, I mean, my kids are older now. My youngest two are 12. But that, I mean, I clearly remember the time of being pregnant. And it is a time where you are just consuming as much information as you can because first of all, you have no idea what you're about to embark on. And you're like, what is this? You know, so you're learning what your body is doing and then you're learning what the baby is going to be doing when you have the baby. And, and I had never seen anything about, outside of Advil. It was like, don't take Advil while you're pregnant. Take Tylenol. Now I think they're saying, don't take Tylenol. So I, at the time, that was the only thing I had ever seen. And so I was listening to this and I'm like, wow, that is extremely powerful and such a great opportunity for. Because there is such a massive consumption of information at that time with parent magazines and parent websites and you have the, you know, every week you get an email. This is what's happening in your body. And this is what's happening in the baby's body. Wow, that's. There are so many resources to get this information to moms. So I'm excited to see that it's starting to happen.
- [12:24]
Tudor Dixon
Yeah, absolutely. And I agree with you. And I mean, I think women are very much, when they become pregnant, they really want to do everything they can to have a healthy baby. And I remember, too. I think we both have four children. And if I read correctly.
- [12:40]
Dr. Tracy Beth Hogue
Yes, yes, I do.
- [12:42]
Tudor Dixon
We can relate. Although two of mine are stepchildren, I will say I can definitely relate to that. You know, that all women really want to do the best with their pregnancies so that they have healthy children. And, you know, I remember reading all sorts of things like, you don't want to be exposed to too much heat. You know, you want to watch your mercury intake. You don't want to clean the litter box. And now it's like, we have all of these medications, our society is so highly medicated, and vaccine recommendations, the different medications that women may be on for different purposes when they become pregnant. And it's like we have a different standard. We're not asking those same questions as we were about, like, changing the litter box and should I be out in the heat for a prolonged period of time and how much coffee should I drink? And it's like, why do we have a different standard for pharmaceutical products? We really should be looking into the safety of these medications and vaccines that women take during pregnancy. And so I hope that we can move the needle on that issue so women are better informed.
- [13:46]
Dr. Tracy Beth Hogue
So I think historically it has been that we have anything medical we have believed, okay, this isn't a bubble. That is not our expertise, and someone's telling us it's okay, and therefore I won't research it anymore. And generally that's not the stuff out there. But you're right. It's like, don't eat sushi and don't eat this and take this supplement. And for some reason, we believe all of that, but now even more so, you have a lot of influence on social media, and some of that is good and some of that is bad. I mean, I remember being young and it was like, do not ever eat an egg. An egg is going to give you high cholesterol to disaster. And then suddenly that all changed. And that's kind of so. So with that being said, I feel like that's sort of been hormone therapy for women, too. If we go to menopausal women, so we go from childbirth to menopause, and it's like my life journey here if we do that. But you. You talk about hormone therapy, and I think hormone therapy got a really bad rap. But then I saw Dr. Makary saying, actually, we're finding out that if you don't have it, you're at a higher risk of heart disease.
- [14:48]
Tudor Dixon
Right? So this is such an interesting contrast because it's like on the one hand, you want people to be informed about the harms, potential harms of, you know, medications and in this case, you know, hormone replacement. But you also don't want to inappropriately scare people. And so that's where the hormone replacement therapy conversation fell into that category. And so actually, Dr. Makary's book blind Spots, which if anyone hasn't read it, is wonder really I think opened a lot of people's eyes to sort of the dogma around hormone replacement therapy and how women have really been misled about the risks for cancer, for cardiovascular disease. And he goes through the evidence there. And then we also had this expert roundtable recently about hormone replacement therapy where the experts really went through the data and discussed that if you start hormone replacement therapy within the first 10 years of menopause, that really what we're seeing in the studies is we're seeing benefits especially related to taking estrogen in terms of cardiovascular disease all cause mortality. And that the increase in breast cancer that we saw, that doesn't pan out, it never translated to increase in cancer mortality risk. And we don't see that when women take estrogen alone or if they start it early in the first ten years after menopause. And so I think women had a lot of questions answered about that. They were more reassured that if you're experiencing symptoms of menopause that it may be a net benefit for you as an individual to take the hormone replacement therapy. Some of the data showing benefits in terms of cardiovascular disease and reducing all cause mortality and also bone health. And I was glad that we got into testosterone as well. And I know it came up that we really need some sort of a testosterone preparation for women too. That that kind of was brought into the conversation with hormone replacement therapy.
- [17:06]
Dr. Tracy Beth Hogue
What do you mean by that? Because women are, are low in testosterone.
- [17:10]
Tudor Dixon
So yeah, so for women, the testosterone level also decreases with age. And so that wasn't covered in depth during the panel, but I think that's something that there should be ongoing discussions about as well. And also in terms of bone health and osteoporosis in women.
- [17:31]
Dr. Tracy Beth Hogue
Let's take a quick commercial break. We'll continue next on the Tudor Dixon Podcast.
- [17:37]
Ice Cube
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Tudor Dixon
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- [22:24]
Dr. Tracy Beth Hogue
So I will say I, I don't know if I have different types of doctor's appointments because I am a breast cancer survivor. And so every time I go to my appointment, they're like, oh, there's nothing we can do for you. You have, I have hormone receptive cancer. So, so. Or we can't do anything for you. But I wonder, like, is it going to be common for women to have their hormones tested? I mean, is that Something, maybe it's already been done, and they just don't do that for me. I don't know. I'm just curious about that.
- [22:57]
Tudor Dixon
I mean, that's a good question. And, you know, there are a lot of providers who are now getting certified in hormone replacement therapy. And I think that women should really, you know, know, try to seek out physicians who have a specific certification in this specialty so that they get the best advice and not always settle for, you know, there's nothing we can do. Because I don't, you know, I'm a. I'm a practicing physician myself, and I know I always try to avoid saying that. It's like, you know, either I'm going to try. I would try to find the information, or I'm going to send you to someone who I know can get you the information. So there is at least.
- [23:34]
Christina Quinn
Least.
- [23:35]
Tudor Dixon
So we at least have things we can try and look into to help you, you know, to help people with their symptoms.
- [23:41]
Dr. Tracy Beth Hogue
I mean, that is interesting, because I feel like maybe I have fallen back into. I told myself I would never fall into the trap of taking the first bit of information from a doctor if it didn't sound like it was the best possible, because when I did have cancer, I went to multiple different places, ultimately ended up at Johns Hopkins with actually a friend of Dr. Makary. So it was. And I had a. A great experience there. I mean, as great as you can have when you have cancer, but, you know, you want to have good health care. And I had great doctors. But now you make such a great point, because I'm thinking, gosh, you know, I did go into just my general practitioner, and they were literally like, hey, there's nothing you can do. You can go on an SR I. And I was like, that's. That's not for me. I'm not going to do that. So there's nothing I could do.
- [24:30]
Tudor Dixon
But I didn't look any further, and.
- [24:33]
Dr. Tracy Beth Hogue
Now I'm, like, shaming myself.
- [24:35]
Tudor Dixon
Well, you shouldn't shame yourself or feel guilty. But that's so interesting because obviously that didn't get to the root cause of the problem, which is also one of the things we're really interested at the FDA is root causes of health problems and prescribing an SSRI for a problem that's related to hormones that could be addressed with hormone replacement therapy. It's really a shame that we default to something that sort of masks the symptoms rather than trying to solve the problem.
- [25:03]
Dr. Tracy Beth Hogue
Do you think that that happens too often? And how can that be changed. Because I'm looking at again on your Twitter feed, I think I saw that one in five people is on an SSRI in the country. And it seems like, gosh, it's like such a massive push to get you on something. And this is like, oh, this has nothing to do with. This is the effects of like hot flashes. This will change that. Put that, we'll put you on an ssri. And I'm like, I don't want to be on a massive antidepressant for something that I'm like, I' just take a layer of clothing off, you know, like, this is. It seems crazy to think that it's immediately pushed. And in the past I would have just been like, oh, great, a medication that will fix this. Yes, I want that. And I think too often we think that there is a quick fix and people are just going on a massive amount of medication. Are we over medicated as a country?
- [25:56]
Tudor Dixon
Yeah, I mean, absolutely. I mean, I do think that there are so many examples of medications, SSRIs being one of them, where it really isn't the fix to the problem. And I think it may help with symptoms. But the issue is that we have been told the medical profession and the public alike that there's some sort of a serotonin deficiency or some sort of imbalance in the brain that means the SSRIs are what's gonna solve the problem. But one of the expert panelists, and now it's actually, she knows very much about this, has published a lot about this, Dr. Moncrief, and it's really been exposed over time that that's not. There's not actually a serotonin chemical imbalance in the brain. And really what the medications the SSRIs are doing is sort of dulling the way you feel and masking the symptoms, but not getting to the root cause of the problem, which as you pointed out, it may be that you're going through menopause and hormones are changing and maybe any number of things. Like there are many different causes of depression. And really going back full circle, it's really important to have that conversation and get to the cause of the depression and try and treat that rather than masking it with the medication. But yes, I absolutely think that we as a society are over medicated. And as someone. I used to practice medicine in Denmark and I'm a dual citizen Danish American. And it's a very different approach to medicine there, which has given me an interesting perspective, because they do not default to medications to solve Problems like we do in the United States. And I don't know if they, if that's a result of sort of the pressure of the pharmaceutical industry direct to consumer advertising. But there's something very different in our society that we tend to look to medical solutions, surgeries, drugs first, rather than finding out how can I solve this through what I do, the way I live, and alternative sorts of treatments.
- [28:05]
Dr. Tracy Beth Hogue
I have had many people in my life in, and I don't know if this is something that is like Michigan based or what, but in the medical system here, for you to go to a therapist, the therapist almost so a psychologist, they almost always say, well, you need to be prescribed something and then you have to go to the psychiatrist. And so you have, it's like a schedule. You go to the psychiatrist once a month, you have, but then you have to have the two appointments with the psychologist for the psychiatrist to prescribe. It's like this, that's how the system works. So you have to pay for three appointments every month because you have to see both of these people and then you have the prescription. And it almost seems like there's, it's like when you heard, oh, dentists have a number, a quota they have to get for cavities, like, do you have a quota of patients you have to have that are on a medication? But I really do think there's such a push for medication. And I think what you said is interesting because I, I think probably most of the people that are listening who have had a loved one who has gone on one of these medications has seen that where they may see that there is less depression, there is less feeling overall and that can be really hard for the person around the people around them.
- [29:25]
Tudor Dixon
Yeah, absolutely. And so I do think that it's also just in the United States, it's, there's a very limited amount of time that doctors have with patients. Like the visits are also very quick and prescribing a medication is really sometimes the easiest thing to do rather than saying, okay, so let's go through this, what's going on? Let's go through all the medications you're taking. Let's go through your overall health and how things are going at home. What do you enjoy doing, these sort of background questions that can give insight into what might be the cause of the depression. It may even be another medication that they're on. And so, you know, it's, I think, you know, if there's one, I would really love to see a shift in our society to focusing. You know, you know more on the root causes of the problems and less on seeing medications as a quick fix. And I think that this current fda, you know, that that's something that we're prioritizing, which, which is really cool because it's different than in the past, but also really focusing on how to get effective cures quickly to patients with serious diseases, especially where there's unmet needs. So it's like there has to be a balance of the two things. But over medicating and not getting to the root cause of problems, of common problems, is certainly not the answer that we're looking for.
- [30:58]
Dr. Tracy Beth Hogue
For this has been, honestly, I've, I've so enjoyed talking to you. And I think this is the beauty of what we see with the Maha movement and with this administration in general. I think there's a lot more freedom to have these discussions. I know a lot of people we've had some experts on who have even said they want to do some studies on how these medications are affecting teens. And if they have been involved in any of these mass shootings where teens suddenly, for some reason and something trips in their brain and they decide that they're going to go in and shoot up a school and is there a way to research that? And I think that so many of us feel like we've been screaming into a vacuum for so long that there's nobody, just a black hole. And it is a breath of fresh air to have you all in there and focused on this. Thank you for coming on and talking to us. Thank you for being willing to share this with the public here. And I think these are the moments where we continue to engage with the public and educate. And like you reminded me, you don't always have to take that first bit of advice from a medical professional. You can, you are in the United States of America. You can go ask someone else.
- [32:09]
Tudor Dixon
That's right. Thank you so much for having me on. I, I, I really enjoyed this discussion as well. So thank, thank, thank you for asking these very excellent questions.
- [32:20]
Dr. Tracy Beth Hogue
Well, you know, it's, it's interesting when you're going through some of these things on your own, you know, and you're like, if I'm doing it, most people, other people are dealing with this and to hear. So Dr. Tracy Beth Hogue, thank you so much for being here.
- [32:34]
Tudor Dixon
Thank you, tutor.
- [32:35]
Dr. Tracy Beth Hogue
Absolutely. And thank you all for joining us on the Tutor Dixon podcast. For this episode and others, you can go to the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts or watch it on rumble or YouTube. Uterdixon thank you so much and have a blessed day.
- [32:50]
Ice Cube
Iheart presents the Big three Playoffs this Sunday. The remaining four teams battle to make the championship in the most physical, fierce and competitive basketball league in the world. The action starts with the Big three Monster Energy Celebrity Game, then Dwight Howard and his Ellie Riot take on Montrez Harrell and Dr. J Chicago triplets. The finale will see popular Miami 305 with stars MVP Michael Beasley and Lance Stevenson take on Nancy Lieberman's Dallas Power who will make it to the Big Three championship. The no holds barred action starts Sunday at 3pm Eastern, 12 Pacific only on CBS.
- [33:20]
Christina Quinn
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- [34:21]
If you eat too many ultra processed foods, you could be starving your gut microbes and they'll get hangry. That's one of many things I learned after working on a new audio course about the gut microbiome. You can learn how to keep your gut happy by listening to Try this from the Washington Post I'm Christina Quinn. I host Try this. Dig in with me on practical advice for life's common challenges. Follow Try this right now, wherever you're looking, listening. Seriously, try it.
- [34:50]
Vizio Representative
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- [35:18]
Lisa Booth
Visit vizio.com today oral health goes beyond just aesthetics. It's deeply connected to your general health and well being. That's why preventing oral health problems before they start is so important. When you use the Colgate Total Active Prevention System, you're not just helping to prevent oral health problems like cavities and gingivitis, you're laying the groundwork for overall wellness. Colgate Total's three product routine includes a reformulated toothpaste, an innovative toothbrush, and a refreshing antibacterial mouthwash that all support a healthy mouth. In fact, the three products were designed to work together to be 15 times more effective at reducing bacteria buildup in six weeks starting from week one compared to a non antibacterial fluoride toothpaste and flat trimmed toothbrush. Take control of your oral health and get the Colgate Total Active Prevention System today so you can be dentist ready. Visit shop.colgate.com total.
- [36:13]
Christina Quinn
This is an iHeart podcast.