Senator Murray Should Not Have Insisted Exclusively on SSRIs for Pregnant Women With Depression

DNC answers the call from their Pharmaceutical donors and stick their foot in their mouth. Tell an expectant mother you know to not listen to Murray for medical advice; she mispresents the science.

About 600,000 pregnancies involve depression per year in the U.S.; in Senator Murray’s world, that means 40,000 infants born in the U.S. with delayed neonatal adaptation syndrome, 105,600 infants experiencing broader symptoms classified under poor neonatal adaptation syndrome, 36,000 infants experiencing respiratory distress, and 41,400 infants experiencing tremors.

Yesterday, when Senator Patty Murray, who has a degree in physical education, argued that America deserves a Surgeon General “who can state plainly that selective serotonin reuptake inhibitors (SSRIs) are ‘safe’ for the majority of pregnant women”, she advanced a position that compresses a complex clinical decision into a political adjective.¹² The scientific and ethical obligation of a Surgeon General is not to simplify probabilistic trade‑offs into categorical assurances, but to describe the evidence architecture that governs treatment decisions in pregnancy.

The question is whether federal leadership should frame SSRIs as the default, imply that the evidence supports near universal use with no mention of risk of harm, and implicitly marginalize evidence‑based nonpharmacologic treatments.

This article evaluates that framing using the governing clinical guidelines and the highest‑quality evidence available. Let’s get into it.

What Does “Safe” Mean in Pregnancy?

The term “safe” is not a scientific endpoint. It requires specification along four axes:

1. Safe for whom? (severity of depression, recurrence history, bipolar spectrum risk, suicidality, comorbidities)

2. “Majority?” 51%? 99%? both are “majorities”

3. Safe compared to what? (untreated depression, psychotherapy, other medications)

4. Safe for which outcomes? (major malformations, miscarriage, preterm birth, neonatal adaptation, maternal relapse, suicide risk)

5. Safe during which gestational window? (first trimester vs late pregnancy exposure)

ACOG Clinical Practice Guideline No. 5 (2023) does not declare SSRIs “safe.” It provides graded recommendations on psychopharmacotherapy for perinatal mental health conditions, emphasizing individualized risk–benefit analysis.³

The issue here is discipline. A medication can show no detectable increase in one outcome while increasing risk for another. Global adjectives obscure outcome‑specific probabilities.

The Risk Ledger: Untreated Depression vs SSRI Exposure

Untreated major depressive disorder (MDD) during pregnancy is associated with adverse maternal and infant outcomes, including impaired prenatal care engagement, substance use, relapse risk, and suicide.⁴ A policy message that ignores these risks is incomplete.

At the same time, SSRI exposure carries measurable neonatal risks.

A 2013 systematic review and meta‑analysis reported a significant association between prenatal antidepressant exposure and poor neonatal adaptation syndrome (PNAS) (OR 5.07), respiratory distress (OR 2.20), and tremors (OR 7.89).⁵

A 2024 population‑based cohort study reported delayed neonatal adaptation in 11.2% of late‑pregnancy SSRI‑exposed infants versus 4.4% of unexposed infants (RR 2.52), with a dose‑dependent association after adjustment (aOR 2.14).⁶

While meta-analyses like Grigoriadis et al. (2013) highlight strong associations (e.g., OR 5.07 for poor neonatal adaptation syndrome), absolute risk differences from population-based cohorts provide crucial clinical perspective. Cornet et al. (2024) report that late-pregnancy SSRI exposure increases delayed neonatal adaptation incidence from approximately 4.4% (unexposed infants) to 11.2% (SSRI-exposed infants)—an absolute risk increase of roughly 6.8%, translating to one additional case per 15 exposed infants.

For every 15 mothers who take SSRIs in late pregnancy, about one more baby will experience delayed adaptation symptoms compared to babies whose mothers did not take SSRIs.

When applying absolute risk calculations to approximately 600,000 U.S. pregnancies annually affected by depression, SSRI use in late pregnancy could potentially lead to significant neonatal outcomes. Estimated annual cases include approximately 40,800 infants experiencing delayed neonatal adaptation syndrome, around 105,600 infants experiencing broader symptoms classified under poor neonatal adaptation syndrome (PNAS), about 36,000 infants experiencing respiratory distress, and roughly 41,400 infants experiencing tremors. While these estimates are illustrative and overlap substantially, they highlight the real-world magnitude and clinical importance of clearly communicating both relative and absolute risks associated with SSRI use in pregnancy.

This distinction between relative odds and absolute risk clarifies decision-making and patient counseling by accurately representing real-world impacts.

And that Senators should not give medical advice no matter how ardently they love their pharmaceutical donor monies.

These data do not justify panic. They do justify outrage at the free medical advice from Senator Murray that acts also as free advertising for SSRIs.

They also demand precision. Relative risk increases must be translated into absolute risk differences and explained alongside maternal relapse risk if treatment is withheld.

The appropriate federal message is not “SSRIs are safe.” It is: SSRIs may be appropriate for moderate‑to‑severe or recurrent depression after individualized counseling that includes quantified neonatal risk information.

Political anti-Make America Health Again grandstanding helps no patients.

Confounding by Indication: Why Observational Data Require Caution

Many pregnancy pharmacology studies compare medicated depressed patients to nondepressed unmedicated controls. Depression severity influences both medication use and adverse outcomes. This confounding‑by‑indication structure inflates apparent medication risk unless rigorously adjusted.

Wisner has argued that public discourse often asks simplified safety questions that ignore this causal architecture.⁴ A Surgeon General must explain this bias structure rather than implying that either “SSRIs poison babies” or “SSRIs are universally safe.”

The latter would be reckless.

Evidence‑Based Nonpharmacologic Treatments Exist

The Agency for Healthcare Research and Quality (AHRQ) published a 2024 comparative effectiveness review of 103 randomized controlled trials of nonpharmacologic treatments for maternal mental health conditions.⁷

For depressive symptoms, AHRQ found:

• Moderate strength of evidence: Cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), and exercise improve depressive symptoms versus treatment as usual.

• Low strength of evidence: Behavioral activation (BA) improves depressive symptoms versus treatment as usual.

This federal evidence synthesis directly refutes exclusivity framing.

Murray was told to cite “strong evidence”, but she does not know the full scope of the literature.

A. Psychotherapy Trials

Hankin et al. (2023) conducted an evaluator‑blinded RCT of brief IPT embedded in obstetric clinics (n=234). End‑of‑gestation MDD was 6.1% in IPT versus 26.1% in enhanced usual care (OR 4.99).⁸

Spinelli and Endicott (2003) reported higher recovery rates with IPT compared with parenting education in depressed pregnant women.⁹

These trials target diagnosed depression, not merely symptom screening.

B. Behavioral Activation

Dimidjian et al. (2017) randomized depressed pregnant women to BA versus treatment as usual. Remission occurred in 56.3% of BA participants versus 30.3% of controls (p=0.003).¹⁰

C. Exercise

Perales et al. (2015) randomized pregnant women to supervised exercise versus control. CES‑D scores and depression rates were lower in the exercise group at study end.¹¹

A 2021 meta‑analysis of RCTs reported a pooled effect size of −0.36 for exercise during pregnancy, with substantial heterogeneity (I² 80%).¹²

These data support exercise as an adjunct or preventive strategy, particularly in mild‑to‑moderate cases.

D. Complementary Interventions

Manber et al. (2010) randomized 150 pregnant women with DSM‑IV MDD to depression‑specific acupuncture versus controls. Response was 63.0% versus 44.3% (NNT 5.3).¹³

Bright light therapy trials show mixed results, including negative superiority findings in a 2020 randomized trial.¹⁴

Vitamin D supplementation has demonstrated symptom reduction in late‑pregnancy RCTs, but evidence does not support its use as a stand‑alone antidepressant for moderate‑to‑severe MDD.¹⁵

The correct categorization is not “natural cures.” It is “nonpharmacologic treatments with varying evidence strength.”

Severity Stratification

Clinical decision‑making in pregnancy must stratify by severity. Non-pharmacologic interventions deserve a mention well before any scripts are considered.

• Mild depression: Psychotherapy, exercise, behavioral activation as first‑line.

• Moderate depression: Psychotherapy ± pharmacotherapy depending on history.

• Severe/recurrent MDD or suicidality: Pharmacotherapy often warranted; psychotherapy remains essential.

• Bipolar spectrum risk: Antidepressant monotherapy may destabilize; diagnostic precision required.¹⁶

This scaffold reflects both ACOG guidance³ and the RCT evidence base.

Policy Implications

The exclusivity message creates a structural problem. If public leadership frames SSRIs as the politically and scientifically sanctioned option, insurance systems and health systems underinvest in psychotherapy integration within obstetric care.

The scalable alternatives already exist: brief IPT in OB clinics, behavioral activation delivered by trained allied providers, structured exercise programs.⁸¹⁰

A Surgeon General should communicate:

Depression during pregnancy requires treatment.

Evidence supports psychotherapy as first‑line for many cases.

Alternatives to non-pharmaceutical interventions have evidence of support in science.

SSRIs may be appropriate for moderate‑to‑severe or recurrent illness after individualized counseling that includes quantified maternal and neonatal risk discussion.

Health systems must expand access to effective nonpharmacologic care.

That message is scientifically accurate. It is also ethically responsible.

References

1. Murray P. Statement during Senate HELP Committee hearing. 2026. https://www.murray.senate.gov/

2. Murray P. At HELP hearing, Senator Murray grills nominee. 2026. https://www.murray.senate.gov/at-help-hearing-senator-murray-grills-trumps-unqualified-surgeon-general-nominee-casey-means-for-cynical-history-of-discrediting-birth-control/

3. American College of Obstetricians and Gynecologists. Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum. Clinical Practice Guideline No. 5. Obstet Gynecol. 2023;141(6):1262-1288. doi:10.1097/AOG.0000000000005202. PMID: 37486661.

4. Wisner KL. SSRI treatment during pregnancy: are we asking the right questions? Depress Anxiety. 2010;27(8):695-698. doi:10.1002/da.20729. PMID: 20694964.

5. Grigoriadis S, et al. The effect of prenatal antidepressant exposure on neonatal adaptation: a systematic review and meta-analysis. J Clin Psychiatry. 2013;74(4):e309-e320. PMID: 23656856.

6. Cornet MC, Wu YW, Forquer H, Avalos LA, Sriram A, Scheffler AW, Newman TB, Kuzniewicz MW. Maternal treatment with selective serotonin reuptake inhibitors during pregnancy and delayed neonatal adaptation: a population‑based cohort study. Arch Dis Child Fetal Neonatal Ed. 2024;109(3):294-300. doi:10.1136/archdischild‑2023‑326049. PMID: 38071585.

7. Agency for Healthcare Research and Quality. Nonpharmacologic Treatments for Maternal Mental Health Conditions. 2024. doi:10.23970/AHRQEPCCER271. PMID: 39571051.

8. Hankin BL, et al. Effect of Brief Interpersonal Therapy on Depression During Pregnancy: A Randomized Clinical Trial. JAMA Psychiatry. 2023;80(6):539-547. PMID: 37074698.

9. Spinelli MG, Endicott J. Controlled clinical trial of interpersonal psychotherapy versus parenting education program for depressed pregnant women. Am J Psychiatry. 2003;160(3):555-562. PMID: 12611838.

10. Dimidjian S, et al. A Pragmatic Randomized Clinical Trial of Behavioral Activation for Depressed Pregnant Women. J Consult Clin Psychol. 2017;85(1):26-36. PMID: 28045285.

11. Perales M, et al. Exercise during pregnancy attenuates prenatal depression: a randomized controlled trial. Eval Health Prof. 2015;38(1):59-72. PMID: 24872442.

12. Sánchez-Polán M, et al. Exercise During Pregnancy and Prenatal Depression: A Systematic Review and Meta-Analysis. Front Physiol. 2021;12:640024. PMID: 34262468.

13. Manber R, et al. Acupuncture for depression during pregnancy: a randomized controlled trial. Obstet Gynecol. 2010;115(3):511-520. PMID: 20177281.

14. Bais B, et al. Effects of bright light therapy for depression during pregnancy: a randomised, double-blind controlled trial. BMJ Open. 2020;10:e038030. PMID: 33115894.

15. Vaziri F, et al. A randomized controlled trial of vitamin D supplementation on perinatal depression. BMC Pregnancy Childbirth. 2016;16:239. PMID: 27544544.

16. American College of Obstetricians and Gynecologists. Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum. Clinical Practice Guideline No. 4. Obstet Gynecol. 2023;141(6):1232-1261. doi:10.1097/AOG.0000000000005200. PMID: 37486660.