On July 21, 2025, the FDA convened an Expert Roundtable to evaluate the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. While we welcome national attention to the safety and efficacy of perinatal treatments, the discussion that followed felt alarmingly incomplete.

At Dowa, we know that no conversation about medication in pregnancy should happen without also naming the complex realities of maternal mental health. Psychiatric illness is one of the most significant and most overlooked drivers of poor maternal outcomes. Suicide and overdose are leading causes of death in the first year postpartum, and yet, these realities were barely acknowledged in the FDA’s panel discussion.

Instead, the focus remained almost exclusively on potential harms of SSRIs, without adequate attention to the risks of untreated or undertreated perinatal mental health conditions. This framing is not only imbalanced, it’s dangerous.

We also want to acknowledge an equally important truth: many women are overmedicated. Too often, psychiatric care for women begins and ends with a prescription pad, without integration of reproductive psychiatry expertise or attention to the hormonal, biological, circumstantial, and emotional changes that accompany pregnancy and postpartum. We’re hopeful that this moment leads to something better, not fear, but comprehensiveness. Not withdrawal, but integration.

Effective care should never be reduced to a binary: SSRIs or nothing. For many women, especially those with recurrent or severe illness, SSRIs are a necessary part of care. For others, non-pharmacologic interventions may be sufficient. Most need both. Medication, therapy, lifestyle support, community care, and informed consent—none of these should be pitted against one another. They work best together.

The conversation we need is one that trusts patients. One that empowers clinicians with the full range of evidence-based tools. One that understands that maternal mental health is not peripheral, it is central to pregnancy, to parenting, and to public health.

This includes recognizing that:

• Depression during pregnancy is not uncommon and does not typically resolve without intervention.
  
• Untreated illness can lead to preterm birth, impaired bonding, inadequate prenatal care, and increased risk of substance use and suicide.
  
• Discontinuing SSRIs during pregnancy, especially in severe or recurrent cases, dramatically increases the risk of relapse.
  
• SSRIs are among the most studied medications in pregnancy. When used appropriately, they do not confer the extreme risks often portrayed in sensationalized headlines.
  
• Risk is never zero, for any treatment or lack thereof. But minimizing, omitting, or distorting the risks of untreated maternal mental illness is not protective. It’s harmful.
  
  

We are particularly concerned that the FDA’s panel lacked sufficient representation from experts in reproductive psychiatry, an omission that reinforces the historical pattern of leaving pregnant and postpartum people out of the research, out of the conversation, and out of power.

We urge the FDA and all national institutions to center both the science and the lived experience. We urge providers to engage in shared, nuanced conversations with their patients, not driven by fear, but by facts. And we urge policymakers to remove the systemic barriers that prevent families from accessing integrated, culturally competent, and compassionate care.

As we continue to build Dowa, we will never stop advocating for maternal mental health that is whole-person, whole-system, and whole-hearted. Pregnant and postpartum people deserve care that sees the full picture, not a fragmented one.