Welcome to Two Truths—a best-selling newsletter by health journalist Cassie Shortsleeve and Motherspeak creator Kelsey Haywood Lucas. Two Truths explores the many facets of maternal health and living well in today’s world. It’s been named a “best parenting Substack” by Motherly, recommended by The Skimm, and featured in Today, Fast Company, The Bump & more.
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Today’s letter is reported by Cassie Shortsleeve and brought to you by Zenith—a female-founded maternal health platform—through the Two Truths Reporting Grant, which helps fund and unlock our original health reporting for all readers. Learn more about Zenith’s ‘Pregnancy Evidence Project’ below. 🌸
When Catherine Birndorf, MD, co-founder and medical director of The Motherhood Center in New York City, talks about feeling good in motherhood, she uses the term maternal euthymia. It’s a medical term that essentially means a stable mood—not depressed, not manic. It’s a “North Star” of sorts for reproductive psychiatrists like Dr. Birndorf who specialize in women’s mental health throughout the reproductive years. Maternal euthymia is a state where both a mother and an unborn baby avoid the harmful effects of untreated psychiatric disorders like anxiety and depression.
Never heard that term? I hadn’t either, and I’ve been reporting on maternal health for nearly a decade. There’s still so much we don’t know.
Lately, the conversation around perinatal mental health hasn’t been focused on maternal euthymia; it has been focused on fear-mongering around medication. Last July, the Food and Drug Administration (FDA), under Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., convened a panel of largely antidepressant-skeptical voices to discuss the safety of Selective Serotonin Reuptake Inhibitors (SSRIs) in pregnancy.
The event drew fierce criticism from the medical community (we covered it here). Nonetheless, as big-stage events have the capacity to do, it made people wonder: Should I be taking an SSRI while pregnant?
More than 1 in 7 American women takes prescription medication for depression, and SSRIs—which include medications like Zoloft, Lexapro, and Prozac—are the most prescribed class of antidepressants. Roughly 6 to 8 percent of pregnant women take one.
Most of us, though, are having the wrong conversation about them. Which brings me back to maternal euthymia. Dr. Birndorf and the two other reproductive psychiatrists I spoke to for this story—a piece about what to know about antidepressants and pregnancy—told me that even that framing of “Should I take an SSRI in pregnancy?” isn’t quite right. Treating perinatal mental health conditions, after all, is about reaching that state of well-being and, largely, about weighing risk—in this case, a well-studied, effective medication against the risk of untreated depression or anxiety.
So, for World Maternal Mental Health Day—a day meant to raise awareness about perinatal mental health disorders—Two Truths spoke to three leading physicians to answer common questions about SSRIs and pregnancy and explain what you actually need to know.
Our experts:
Catherine Birndorf, MD, co-founder and medical director of The Motherhood Center in New York City
Sarah Oreck, MD, a reproductive psychiatrist and co-founder and CEO of the virtual mental health platform Mavida Health
Anita H. Clayton, MD, chair of psychiatry and neurobehavioral sciences at the University of Virginia
First, let’s talk about the impact of untreated perinatal mental illness.
When we think about SSRIs in pregnancy, we tend to think a lot about the SSRIs. We worry that medication will have some kind of an impact on our growing baby—and that’s perfectly sound reasoning and worth wondering about. But here’s what we don’t always think about as much: What’s the impact of untreated depression on a fetus?
