Pregnant and Scared by the Headlines? What to Know About Tylenol, SSRIs, and Autism Risk | Ep. 455

Kimberley and Dr. Katie Unverferth clarify what the science really says about Tylenol and SSRIs in pregnancy—and how to manage anxiety while making confident, informed decisions.

In This Episode, You’ll Learn…

• Tylenol, autism, and ADHD—what association vs. causation really means (and why sibling studies are so reassuring). 
• When headlines spike anxiety: simple, therapist-approved steps to reality-check scary claims and choose reliable sources. 
• SSRIs in pregnancy: how “confounding by indication” skews studies—and why treating depression often reduces overall risk. 
• Skill toolkit: CBT/IPT strategies, mindfulness, and body-based supports (massage, acupuncture, movement) you can start today. 
• Personalized medication choices: why sertraline is common first-line—and when staying on what’s worked best is safest. 
• Stability for you = stability for baby: how protecting your mental health supports healthier pregnancy and postpartum.

Tylenol, SSRIs, and Pregnancy Anxiety: What the Latest Research Really Says

Featuring Dr. Katie Unverferth, Perinatal Psychiatrist
From the “Your Anxiety Toolkit” Podcast with Kimberley Quinlan

Sorting Through the Headlines

If you’re pregnant or planning to be, you’ve probably seen the headlines:

“Tylenol linked to autism!”
“Antidepressants unsafe during pregnancy!”

It’s enough to make anyone anxious — even without a history of anxiety or OCD.

In this episode, Kimberley Quinlan sits down with Dr. Katie Unverferth, a board-certified psychiatrist specializing in perinatal mental health, to separate fear from fact. Together, they explore how to make informed, empowered choices for both your mental health and your baby’s wellbeing.

Tylenol and Pregnancy: What the Research Actually Shows

The FDA recently responded to studies suggesting a link between acetaminophen (Tylenol) use during pregnancy and an increased risk of autism or ADHD. But as Dr. Unverferth explains, the story is far more nuanced.

Association vs. Causation

While some studies found an association, that doesn’t mean Tylenol causes autism. In fact, many people take Tylenol during pregnancy for fevers, infections, pain, or migraines — and those conditions themselves have been linked to developmental risks.

“When you look deeper,” says Dr. Unverferth, “it appears that it’s the underlying condition — not the Tylenol — that may increase risk.”

Sibling Studies Offer Reassurance

Large “sibling-controlled” studies — comparing different pregnancies within the same mother — found no increased risk of autism or ADHD with Tylenol use.
This suggests that the real drivers are genetic and environmental factors, not acetaminophen exposure.

 

How to Manage Anxiety About Medication Use

Even with the facts, anxiety can creep in — especially for those prone to health anxiety or intrusive worries.

Dr. Unverferth’s Guidance:

• Talk with your provider. Your OB-GYN or perinatal psychiatrist can offer data-based reassurance tailored to your situation. 
• Rely on reputable sources. Stick with medical organizations like ACOG or the Society for Maternal-Fetal Medicine. 
• Be gentle with yourself. Pregnancy comes with pressure to “do everything perfectly.” Remember: You’re doing your best with the information you have. 

“This is a difficult time to be pregnant,” Dr. Unverferth notes. “Mixed messages in the media make it hard to know who to trust — that’s why finding a provider you feel safe with is so important.”

 

Understanding the Role of SSRIs in Pregnancy

The FDA also revisited the safety of SSRIs (antidepressants) during pregnancy. Naturally, this raised alarm — but Dr. Unverferth emphasizes that context matters.

Confounding by Indication

Many studies that show risk fail to control for the effects of depression itself. Untreated depression and anxiety can:

• Increase the risk of preterm birth or low birth weight 
• Affect maternal health and immune response 
• Raise the likelihood of postpartum depression 

“Depression in pregnancy isn’t benign,” Dr. Unverferth explains. “But adding an SSRI doesn’t appear to increase those risks further.”

Why Treating Depression Matters

Treating depression or anxiety in pregnancy — whether through therapy, medication, or both — supports both maternal and fetal health.

Kimberley adds, “I’ve had so many clients who tried to muscle through pregnancy without medication. When they finally chose to start an SSRI, they often said, ‘I wish I had done this sooner.’”

 

Skills and Strategies for Managing Pregnancy Anxiety

Pregnancy is inherently uncertain. The key, Dr. Unverferth says, is flexibility and mindfulness — meeting each moment as it comes.

Evidence-Based Tools:

• Cognitive Behavioral Therapy (CBT) and Interpersonal Therapy (IPT) — proven to reduce anxiety and depression in pregnancy. 
• Mindfulness practices — learning to observe fears without judgment. 
• Body-based care: Massage, acupuncture, and gentle exercise have all shown benefits for prenatal anxiety. 
• Support systems: Lean on trusted loved ones, clinicians, and communities rather than social media. 

“When anxiety takes on a life of its own,” she says, “that’s the time to reach out for support.”

 

Medication Decisions: One Size Does Not Fit All

Every pregnancy — and every mental health journey — is unique.
For some, therapy alone may be enough; for others, SSRIs are a crucial part of staying well.

Common First-Line Options

• Sertraline (Zoloft) is often recommended as a first-line SSRI because of its strong safety record and low transfer to breast milk. 
• However, if another medication has worked best for you in the past, it’s often safest to stay with what’s effective. 

“The goal is always stability,” Dr. Unverferth says. “Stability in the mother predicts stability in pregnancy and postpartum.”

 

Empowered, Compassionate Decision-Making

There’s no shortage of anxiety-provoking information out there — and more data isn’t always more peace. The goal isn’t to know everything, but to build a team of trusted professionals who can help you interpret what matters most for you.

If you’re feeling overwhelmed:

• Step back from social media and sensational headlines. 
• Ask your OB-GYN or psychiatrist to walk you through your specific risks. 
• Remember: caring for your mental health is caring for your baby’s health.  

 

About Dr. Katie Unverferth

Dr. Unverferth is a board-certified psychiatrist specializing in perinatal mental health. She is the Director of the UCLA Women’s Life Center and runs a private practice in Santa Monica, CA.
Follow her on Instagram at @drkatiemd for educational clips and resources.

 

Listen to the Full Episode

Your Anxiety Toolkit Podcast – “Tylenol, SSRIs, and Pregnancy Anxiety with Dr. Katie Unverferth”
Available wherever you get your podcasts.

The podcast is made possible by NOCD. NOCD offers effective, convenient therapy available in the US and outside the US. To find out more about NOCD, their therapy plans, and if they currently take your insurance, head over to https://learn.nocd.com/youranxietytoolkit

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Transcription: Pregnant and Scared by the Headlines? What to Know About Tylenol, SSRIs, and Autism Risk

Kimberley: Okay.

 

If you are pregnant or planning to be, you’ve probably heard alarming headlines lately about Tylenol. SSRIs, the Risk of autism or A DHD. It’s enough to make anybody anxious, even without a history of mental illness. So today, cutting through all the confusion and the fear. I am joined by psychiatrist Dr. Katie Unfer. A board certified psychiatrist who specializes in perinatal mental health to discuss what we need to know and how you can make empowered, informed decisions for your mental health and your baby’s wellbeing. So thank you so much for being here again, uh,

 

Katie: Thanks for having me.

 

Kimberley: happy you’re here. Truly, this has been something that I look at and I listen to the news and I kind of start to look cross-eyed.

 

And so I need somebody who knows a lot more than I do.

 

Katie: Yeah. Happy to help.

 

Kimberley: Okay, so let’s get straight to it. ’cause um, I wanna sort of get to the point as fast as we can to help people manage this or, or at least be informed enough to make their own decisions. So let’s talk about the recent headlines around Tylenol. Um, what is happening there?

 

What is the FDA responding to with these sort of new labeling discussions?

 

Katie: Yeah, so I think what the FDA is responding to is that there have been some recent studies that have associated Tylenol with an increased risk of autism in pregnancy. Um, uh, so the FDA recently sent like an article or um, a letter. Two physicians sort of advising them that, um, you know, there were, there are some studies that show that there’s an association of Tylenol with autism and pregnancy, but it does say in that letter that it’s not a causal link, that a causal link has not. Then established. Um, I think that when we look at this, uh, data a little bit deeper, um, there are studies that show in association, but what complicates this is that we know that Tylenol use in pregnancy is often used for fever. It can be used for infection, it can be used for pain conditions, and it can be used for migraine. Those conditions have each been associated with negative neurodevelopmental outcomes like A DHD and autism. Um, and so not, while some studies might show an association. In my read of the data, it looks like it might be actually the conditions themselves that increase the risk rather than the Tylenol use. Um, there are a few studies that specifically look at this. So when we have these issues in the field, in the field of like perinatal um, medicine, what we try to do sometimes is we try to separate out, you know, kind of these environmental genetic risks versus the medication risk. One way of doing this is something called sibling controlled studies. Um, so what you do is you look at the same mom, two different pregnancies, and you compare the exposure in each of the pregnancies. So it’s sibling analyses. Um, and so they actually have done two very large studies like that with Tylenol. So same mom, and they looked, she used. More Tylenol in one pregnancy and maybe no Tylenol in another pregnancy. And what they found is in those studies, there was no increased risk of negative neurodevelopmental outcomes like autism or A DHD with Tylenol use. Um, what that tells me is that Tylenol use. Um, is more of a marker for an increased risk for autism, but that it’s not actually causing that increased risk of autism.

 

It’s much more likely to be related to genetic risk factors for autism, familial risk factors for autism, environmental risk factors for autism, um, but not really the medication

 

Kimberley: Right. That’s super helpful to to know. Um, one question, and, and this may also be my lack of knowledge, is why was it called Tylenol and why was it all over the news, the word Tylenol and not the actual name of the medication? Like in Australia, I think there’s two ways you can say acetaminophen and we would say Ace Tamen.

 

So.

 

Katie: Know.

 

Kimberley: Um, so, and I was surprised. So is there a reason why it was labeled Tylenol only? You know, why was it not? Was it not called, um, the more, or is that just because it’s easier to say?

 

Katie: I think it’s because it’s easier

 

Kimberley: Oh, okay.

 

Katie: I think it’s because in the US people use them interchangeably, so it’s Tylenol or acetaminophen.

 

Kimberley: Okay.

 

Katie: seen in some of the studies they call it paracetamol.

 

Kimberley: Yes.

 

Katie: I think, I think, I don’t think it’s specific

 

Kimberley: Okay.

 

Katie: brand name Tylenol. Um, I think it’s just, just people switching back and forth between generic and

 

Kimberley: I understand. I was like, wait, is there something specific about that brand? Like, are we, is there something I also didn’t know? Okay. Okay,

 

Katie: question. It’s a great question. Yeah.

 

Kimberley: so you’ve already sort of helped us to, um, understand this. Now we’re here talking about a mom who is pregnant and just wants to have a healthy baby

 

Katie: Mm-hmm.

 

Kimberley: In today’s age, there’s so much on the market and pushing and pressure to

 

Katie: Yeah.

 

Kimberley: eat well and breastfeed your baby, and you’ve gotta do, you’ve gotta kind of jump through hoops and it does feel like a lot of pressure that it’s our job to prevent

 

Katie: Mm-hmm.

 

Kimberley: scary things from happening to our children.

 

So in this case. Let’s say someone was coming to listen to this and they were more like, oh my God, I did take Tylenol, and you know, that’s scary. But now I’m understanding it’s not that. It’s more the fact that I had a fever or I had a headache or migraines. How might someone manage that as a pregnant woman?

 

Manage the anxiety of that, do you think?

 

Katie: Yeah, I think that’s a great question. I think speaking with. Your provider speaking with your OB gyn I think is always helpful. Um, I think that everybody’s doing the best they can to manage these things. Right. Um, I understand that there can be a lot of anxiety worrying about exposures. I think specifically with. Tylenol. I think that this isn’t necessarily a fear that’s based in reality, right? But I do see, and have seen in my practice how, you know, we’re saying that something that’s generally been considered so safe in pregnancy isn’t safe anymore, it can make people so worried about all of the other things they did during pregnancy, right?

 

So it just really can

 

Kimberley: Hmm.

 

Katie: worth when people are already so. Worried. Right. I think what’s really helpful is to, you know, stick to really reputable resources to get information. So I think, um, OB GYNs are really helpful. Perinatal psychiatrists can be really helpful. Family physicians can be really helpful.

 

You know, I think getting support from friends and family is helpful. Um, but I do think that this is an anxious time to, this is a. is a difficult time to be pregnant because there are so many like mixed messages in the media right now. There are so many mixed messages, you know, coming from, um, like the administration as well.

 

Um, and so I think, you know, finding, you know, finding an ob gyn that you trust and really relying on them to help you navigate it is important.

 

Kimberley: Yeah, thank you. I think back too is I’ve had two. Children.

 

Katie: Mm-hmm.

 

Kimberley: and I took Tylenol for both. Um.

 

Katie: Me too.

 

Kimberley: And, and I had a fever in my daughter as I remember, but I don’t think with my son, I had a series of like really bad like stomach flus and viruses and it was just like a crappy year. It actually like wiped out our whole Christmas, like everything of Christmas got ruined.

 

Katie: know.

 

Kimberley: And I’m hearing a lot of people online, even, even saying, I have one child with autism and one knot, and I didn’t have a fever or anything. That pregnancy. And so I think particularly for us anxious folks, we’re all like trying to calculate this like one, one fever check and you know, you know what I’m saying?

 

So what, what might, so now what do we know? Like, do we actually, are we starting to figure out the cause of autism and A DHD we get? Is that, is this about us now understanding more about the, the actual reason we have it? Or, or are we still a long way away?

 

Katie: I think, I think it’s very complicated. Unfortunately. I think that what we do know is that there are, what they’re starting to look at is like polygenic risk score. So it’s looking at sort of a variety of genes that interact to lead to the increased risk of like. Autism or A DHD? Um, I think when I said that, you know, migraines are associated, what it seems like is that migraines are sort of associated with this genetic risk factor,

 

Kimberley: Hmm.

 

Katie: um, for autism and A DHD, not necessarily that migraines cause autism or A DHD.

 

I think a lot of these things are associations. Um, pause. What did you, what was the question? I got distracted.

 

Kimberley: Um, what I was asking really is are we getting closer to understanding the cause?

 

Katie: Yeah. Okay. I do think will be good is that this administration is really shining a light on autism, and it sounds like they’re about to dedicate a lot more resources to really trying to figure out what the underlying causes of autism. What we know best at this point is that it does seem to be both genetic risk factors, so meaning genes that sort of cluster within families, um, that increases the risk for autism.

 

And then it seems like there are some environmental risk. Factors. Um, meaning like toxins, meaning pollutants, um, but also environmental risk factor could be like certain infections. Um, but is there a clear, you know, specific cause of autism yet I don’t think we know. Um, and more research is needed, so I do think that will be good.

 

Kimberley: Right. And so what advice would you give a pregnant mom or families who, uh, you know, have, you know, expecting? What advice might you give them in, besides speaking to their doctor, um, of navigating the anxiety of this sort of. New news and, and the way the media is handling it.

 

Katie: Yeah, that’s a great, that’s a great question. Um, I think therapy has a lot of evidence. In this situation too, right? Because having some anxiety around this is understandable, but what I always say is when it takes on a life of its own, that’s really when we know you need to seek treatment, right?

 

So it’s okay to have, you know, having some anxiety about Tylenol use right now is understandable if it then generalizes to every single decision you made in pregnancy or every decision you’re going to make moving forward. At that point, I really want you to work with a therapist to sort of help weigh. You know, these different intrusive thoughts you might be having. So in pregnancy, we know that cognitive behavioral therapy has a lot of evidence for treating anxiety and depression. Interpersonal therapy, IPT has a lot of evidence for treating anxiety and depression. Um, I think really focusing on mindfulness.

 

Um, I tell all of my pregnant women, I really want you to work on being flexible,

 

Kimberley: Hmm.

 

Katie: be flexible during pregnancy. Um, you know, because. The pregnancy experience is really different for everybody, and one of the best things you can do is sort of be present with whatever happens and however you feel. Um, there’s some evidence, I mean now we’re just kind of talking about more like treatments for anxiety and depression, but massage has some evidence. So sometimes, um, if people have resources or are able to, you know, getting intermittent prenatal massages can be helpful. Acupuncture has some evidence. Exercise can be helpful. These are all just sort of evidence-based things to manage anxiety in pregnancy. Um, but I think part of it is just understanding that there is going to be anxiety around decision making in pregnancy because there have been these messages recently that like you might have done something wrong. Um, and so understanding that, being present with that, accepting that, but then if it really does start to take on a life of its own seeking care from someone who specializes in that.

 

Kimberley: Yeah, absolutely. I remember like having anxiety about which car seat I bought. I mean, it was like, like.

 

Katie: strollers. There are so many

 

Kimberley: Yeah. Yeah. But feeling like, but you know, should I buy the, the $600 one? ’cause what if we got in an accident and you start to calculate, like, you know, it’s, it’s a whole thing. Um, what I think is interesting too, and I’m noticing an increase in my own practice, is sort of this general.

 

You know, we have health anxiety folks who have hypochondria worrying about themselves and sort of now this like health anxiety by proxy, like their health anxiety is around the child. What could impact the child, what, you know, and I think that it’s so hard, the messaging is so scary. Um, and it’s everywhere on social media.

 

So it, it, I, I’m sure for a lot of folks that sort of health anxiety has really. You know, increased.

 

Katie: Yeah.

 

Kimberley: Okay. So I feel good about that. Um, let’s, let’s shift because there’s two main topics I wanted to discuss today. So the next one is the FDA expert panel has revisited the safety of SSRIs in pregnancy.

 

Katie: Mm-hmm.

 

Kimberley: Can you tell, tell me.

 

I didn’t even know about this until you had reached out to me and said, let’s talk about this news. And so I was a little bit like, oh, I missed this. How did I miss this? So do you wanna share with me a little about what’s going on there?

 

Katie: Yeah, so the FDA panel was revisiting SSRIs in pregnancy and re-looking at their safety in pregnancy. Um, it was a panel of different people who. You know, regularly prescribe antidepressants, but there was only, there was one person who was a reproductive psychiatrist who really focused on using these medications in pregnancy and postpartum. Um, so what they were doing is they were sort of re-looking at a body of data, um. Unfortunately, it did seem like they, in kind of a similar way to the Tylenol studies, that they were looking at a lot of studies that showed increased risks with SSRI use. But it is a very similar story to Tylenol in that way, in that the studies that show increased risk with SSRI use are really failing to take into account. Both the increased risk of just being depressed in pregnancy and also familial genetic environmental factors that increase the risk for negative outcomes rather than the antidepressant itself.

 

Kimberley: Hmm. Okay. Let me unpack that. So I think what you’re saying, but please tell me if I’m wrong, is you’re saying the prevalence of having depression. Or anxiety, which is why you’re going to get that prescription.

 

Katie: Right.

 

Kimberley: be more the core. Like there’s, because there’s now we’re showing there’s genetics. It’s showing up that the child is more likely to have a, some sort of mental health because of that.

 

Katie: Um. No. So what I’m saying is that it’s, it’s called confounding by indication. So it means that the indication for which the medication is used causes the negative outcome. So

 

Kimberley: Yes.

 

Katie: with SSRIs, what we know is that depression in pregnancy. Has negative outcomes both for the mom themselves in terms of just, you know, the, the burden of being depressed, um, but for also the pregnancy and the developing infant.

 

Kimberley: Right.

 

Katie: so with the pregnancy, it leads to preterm birth. Um, low birth weight, preeclampsia, increased risk of emergent, um, C-section. Uh, also with the developing fetus, it can lead to low birth weight, which I already said. Um, also. Gathering my thoughts. Um, it can lead to negative neuro neurodevelopmental outcomes actually. Um, so there are some evidence that there are behavioral issues with children who are exposed to depression and pregnancy. Um, some changes in immune regulation, some changes in stress response. And so what we know is that. Depression in pregnancy isn’t benign.

 

Um, it leads to negative outcomes. It does not seem like adding an SSRI increases that risk further. Um, and so I think what can happen is you can find studies that will say SSRIs increase the risk, but often they’re not very well designed studies and they’re not controlling for the depression itself.

 

Kimberley: So let me break, let me understand this, and thank you for clarifying that because I, I think I was saying the same thing, but I didn’t articulate it very well, but

 

Katie: I

 

Kimberley: No, no, it’s. It’s, I’m trying to make sense of this in my head because I’m not a research, um, like I didn’t, I, I didn’t, I’m not a researcher. But wouldn’t that then mean that we want them to go on SSRIs because we wanna reduce the depression and the anxiety?

 

Like, ’cause my fear, my fear is someone might see that the SSRIs are these sort of like. They’ve associated it and that’s not good. So then I shouldn’t go on it. But isn’t it what you are saying, and maybe I’ve got this wrong, like we actually need to manage that anxiety and depression for those beneficial outcomes.

 

Katie: Yeah, I think. The what, what, what I will typically say is that stability predicts stability, right? So one of the best things we can do is kind of protect mom’s mental health the whole time, and that really begins before pregnancy, right? So the best thing we can do, having you go into pregnancy, is feel mentally well and stable.

 

That predicts that you’ll continue to feel that way during pregnancy, and that predicts that you’ll continue to feel that way in the postpartum. So certainly untreated depression and anxiety. Have negative outcomes. Right? What I will tell people and what people really resonate with, especially if they’ve had sort of severe depression or anxiety before, is that it’s an inflammatory state, right?

 

You feel off your heart is racing, you’re having all of these intrusive thoughts. It’s hard to function. It’s especially hard to like go to your therapist sometimes. It’s hard to make your appointments. It can be, uh, hard to like eat healthy, to exercise, to engage with friends and family, right? Um, so treating that. With an antidepressant can really have all of these benefits. You know, separate from just treating the depression, it can really improve some of the behaviors that we know are positive for a pregnancy. Um, what we also know is that untreated depression in pregnancy is the biggest risk factor for postpartum depression. Um, so sometimes I’ll see people in pregnancy who are. Depressed, clinically significant depression or anxiety. Um, and they don’t really want to take an antidepressant, which I understand, right? But then they’re so worried about postpartum depression. They’re like, but, but, but I’ll feel better in the postpartum, won’t I? And unfortunately, that doesn’t seem to be true, even though some people think they will. Most studies kind of show that there’s a continuation of the depression and maybe a worsening in the postpartum.

 

Kimberley: Yeah.

 

Katie: really I encourage people to sort of, let’s treat. Their, their depression or anxiety to remission.

 

Right. We really want to, to have them feeling well and healthy.

 

Kimberley: Yeah. And, and as a clinician, I, I, I mean, I’m not swaying listeners who are listening either way,

 

Katie: Yeah.

 

Kimberley: I can’t tell you how many times I see I’m have clients who are in the middle of pregnancy and they are musing through

 

Katie: Mm-hmm.

 

Kimberley: so hard to use the skills and practice the tools and doing their homework so that they don’t have to go on medicine.

 

And I, and, and with some benefit too, as you said, it’s CBT, exposure and response prevention are very highly successful treatments. Um, especially if for, for OCD, if we’re talking about exposure and response prevention, but, but hormonally and environmentally they’re struggling. And then when they do go on an SSRI or they sort of, you know, hit rock bottom.

 

They’re like, I wished I had have started earlier. There was such a stigma to medication, which I fear is gonna be even worse now.

 

Katie: Yeah.

 

Kimberley: Um, and have just said that helped me to cross the finish line and it was so helpful. Um, and so I sort of just wanted to share that for folks is I see it all the time, but. You know, it’s it, there’s a lot of pressure on moms to give up their own mental health for the wellness of their baby, and that’s what worries me.

 

Yeah.

 

Katie: starts in pregnancy. That that really intense pressure. Um. I think that makes a lot of sense. Right. What, what we do talk about, and to kind of help people weigh this a little bit more, is that we do talk about sort of this risk risk analysis, right? So we both talk about sort of the risk of untreated depression, anxiety, or even. Partially treated depression and anxiety, right? Someone who’s sort of muscling through and maybe getting like 30 or 40% better, maybe 50% better, but still having clinically significant, um, depression and anxiety. So we talk about the risk of that versus the risk of a medication, right? So we want to weigh those two things. What I see sometimes in my practice, sort of similar to what you see, is that I’ll see people who are really trying to stay on the lowest dose of antidepressant they can. But are still having a lot of depression anxiety in that setting. We would prefer to increase the antidepressant and decrease the symptoms because in that way we think about it as one exposure.

 

So we would rather have them not exposed to the depression, anxiety and just have them on the antidepressant. Um, and so I, that’s sometimes how I help people think about it to really encourage them to treat their symptoms instead of, you know, kind of, I agree. There’s this self-sacrificial. You know, understandable, um, mentality, but I actually think in pregnancy it’s a little bit misguided, right?

 

We

 

Kimberley: Hmm.

 

Katie: you to feel the best, and we know that that’s the best for your pregnancy.

 

Kimberley: Right. And would it be true too, that you would speak with your doctor about. Your genetic risks? Like is it, is it also like I think about me with, let’s say breast cancer, so I have breast cancer in my family. If you make a decision on whether to go on hormone replacement therapy or something, they’re asking you all of these risk factors like.

 

Katie: Yeah.

 

Kimberley: Is there a history of breast cancer and that helps them to determine the, the, the prescription. Is it like that with this as well, or, or is it more dependent on, like you said, the one, the one risk I think you said it was called, or the one,

 

Katie: Oh, the polygenic risk. Yeah. No, so mostly with this, what we’re looking at is we’re looking at symptoms.

 

Kimberley: symptoms.

 

Katie: yeah, so I think in psychiatry we almost exclusively look at symptoms and treat symptoms. Um, you know, hopefully in the next. 10 years, 20 years, we’ll be able to more specifically say like, oh, your cluster of genes means this, which

 

Kimberley: Yes.

 

Katie: we should use this medication, which means this is your risk and this is how you decrease it. You know, like this field, like precision medicine. I hope we get there, but we’re not there right now.

 

Kimberley: Yeah.

 

Katie: really what we do think about is, I guess it, it depends on what we’re talking about because if we are talking about. Risk for depression in pregnancy that there are certainly very specific risk factors for, but really thinking about like genetic risk.

 

Not necessarily if you had a family member, like if your mom or sister had dep, like severe depression in pregnancy, you’re at risk for that. If they had postpartum depression, you’re increased risk for that. Um, if you have a history of premenstrual dysphoric disorders, so like depression, anxiety, irritability, mood instability in the luteal phase, right?

 

That’s PMDD. That increases your risk for depression in pregnancy and postpartum. Um, if you have depression related to hormonal contraceptives, that increases your risk for depression and the postpartum. You know, what we sort of look for is. Um, a history of hormonal sensitivity, right? So we know that some people, um, have abnormal mood responses or have very intense mood responses to changing levels of hormones. Um, and that increases the risk for depression and pregnancy and postpartum.

 

Kimberley: Hmm. Okay. This has been so helpful. ’cause I feel like you’ve just given us a very level, uh, you know, a good understanding, a good education of what it, what it is and all, and all of these things. So, uh, okay. The, when it comes down to it. It’s almost like having more information is so helpful but also scary.

 

Katie: Yeah.

 

Kimberley: Um, which, you know, it’s sort of the same with when you have the amnio, what is it when you get the big needle? Yeah. It’s like, it’s so great that we have this, but it’s also so anxiety that provoking that you’ve gotta go have this test and, and get these results. So what advice would you give?

 

Generally to a mom who is overwhelmed. Would you encourage her not to be watching the news or would you encourage her to be watching the news? Would you be encouraging her to, um, get one or two doctor’s opinions, like, you know, to what degree should they be proactive versus also protecting themselves from all of this?

 

Katie: Yeah, that’s a great question. It’s a really. Difficult time. Um, I think, right? It’s like I am an academic and, and I do research and so I know about sibling control analysis and I understand, you know, how that matters and how that changes sort of the landscape of data. But no, I, we can’t really expect everybody to know that.

 

I do think, um, the data, like what I would rely on are like. Medical society guidelines. So for example, the American College of OB gyn, ACOG has said that they feel very comfortable continuing to use acetaminophen in pregnancy. Right. Um, the Society for Maternal Fetal Medicine has also issued a similar statement. Um, I do think that there’s a bit of a disconnect, um, from the messaging we’re seeing in the media at this time, and also the messaging we’re seeing from physician organizations. As a physician myself, I tend to follow what. Physician organization recommendations are making just because I trust that they have sort of the top experts, um, in the country making those recommendations.

 

And historically, those have really been in line with, um, how I understand the research, how, you know, the majority of physicians understand the research. Um, so I think that those are some good places to get information. I think, um, you know, choose your sources widely or wisely. Um, you know, there are. there is an online influencer who will say anything and you can find really the range of, um, different people.

 

And so I think, um, it’s tough, right? We’re all a little bit in our like, information silos, you know,

 

Kimberley: Yeah.

 

Katie: so trying to seek different opinions, trying to find sources you trust, um, trying to find physicians that you trust, um, is really important. But yes, it is. There’s no perfect way of doing it right now, and it is, it is a difficult time.

 

Kimberley: Yeah.

 

Katie: difficult time.

 

Kimberley: Amazing. Thank you. I’m so grateful for this. Really. I am. Because I, I mean, even as I’m thinking back, like it is so confusing. It is so scary. But I think what I, I think what you’re saying is, um. Go to your doctor, get very specific advice from them on what they think is best for you and your specific situation.

 

Um, and that it doesn’t mean you have to muscle through a fever on your own by, you know, with no assistance because that. Has, you know, that’s not helpful for anybody. Um, so I’m really grateful. Uh, one question, just to clarify as well, is, is the boards, the, um, you listed a couple of boards, are they also saying the same for the SSRIs?

 

What are they suggesting?

 

Katie: They are, yeah. The similar for SSRIs, it’s, it is across the board, recommended to treat depression in pregnancy, and SSRIs at this point have decades of safety data to really support their use.

 

Kimberley: Yeah. Thank you. And I think there are specific medications for pregnancy, um, that they recommend. We’ve done an episode on that once before, which I’ll link in the show notes. But, um, do you, do you wanna sort of share what those are? The pregnancy specific?

 

Katie: of course. And so, so it really depends on. In pregnancy, if this is a recurrent episode of depression for you or if this is sort of a first episode. So if it’s recurrent and you’ve tried multiple medications before and there’s one that works best for you, we would recommend restarting that in pregnancy if you were having depression in pregnancy. Um, if it’s the first time you’ve ever been depressed, you’ve never been depressed before, you’ve never tried medications before, um, typically people would start Zoloft. Or sertraline. Um, that’s because it has good safety data. It has low placental transfer, um, low levels in breastfeeding or low levels in breast milk with breastfeeding.

 

So it is a good option. But what I don’t want people to think is that that’s the only medication you can take in pregnancy or it’s the safest. So you have to, again. through, even if it’s not working well for

 

Kimberley: Yeah.

 

Katie: what the data supports is we want to use the medication that works best for you. Um, and across the board we have, you know, really sufficient safety data for almost all of the antidepressants at this point. Um, and so really kind of doing personalized care, working with someone who knows you, um, and who can help you sort of have, you know, like a personalized recommendation for your situation given the symptoms that you’re experiencing.

 

Kimberley: Amazing. Thank you.

 

Katie: Yeah.

 

Kimberley: Okay. Tell us where people can hear you, ’cause I’m sure they wanted to know or reach out to you. Where can people get in contact?

 

Katie: Oh yeah, of course. So people can look me up. I have a website, I have a private practice in Santa Monica. Um, I also am the director of the UCLA Women’s Life Center. So if people want one time consultations or to be seen, uh, for pre-pregnancy consultations, they’re welcome to reach out there. Um, I also have an Instagram where I post typically just clips of lectures I’ve given in the past.

 

That’s Dr. Katie md. Um, yeah. And hopeful. Hopefully we can connect.

 

Kimberley: Thank you. I’m so grateful. Again, this has been so timely and I think so important for people to hear, so I’m so grateful.

 

Katie: of course. Thanks for having me. Thanks for doing this.

 

Kimberley: All right.