Comment from Annika Jansson

I fully support the FDA petition to add a black box warning to SSRI antidepressants regarding the risks of pregnancy complications and potential adverse effects on fetal brain development. Under the precautionary principle, when there is a reasonable suspicion of serious or irreversible harm, inaction cannot be justified by the absence of complete scientific certainty. The comment issued by the American Psychiatric Association reflects a profound disregard for this principle and for the protection of human life. No one has the right to interfere with the brain development of a fetus when such interference may have lifelong consequences. There is substantial evidence that SSRI medications affect fetal brain development. These drugs influence serotonin, which is a critical developmental signaling molecule in the fetus. Serotonin regulates neuronal migration, synaptogenesis, and the organization of neural networks. SSRIs cross the placenta and reach the fetal brain, and because the fetal blood-brain barrier is still developing, exposure may be even more significant than in adults. I was prescribed an SSRI despite informing my physician that I was willing to discontinue the medication due to plans for pregnancy. During my pregnancy, I saw more than 20 physicians. Not one of them warned me about the potential risks of antidepressant use during pregnancy. I continued the medication throughout the entire pregnancy, with the doctors documenting each time that I was taking it. During pregnancy, I experienced partial placental abruption, a complication that has been associated with SSRI use. I was placed on strict bed rest due to the risk of extremely preterm birth. I was treated at what is considered one of the leading university hospitals in Finland and consulted numerous physicians. When I asked what had caused the placental abruption, none of them informed me that the antidepressant could be a contributing factor. Had I been told, I would have understood to discontinue the medication. As a consequence of SSRI exposure, my preschool-aged son is very significantly smaller than his peers. He did not receive the full supply of nutrients necessary for optimal fetal growth and development. Placental abruption is not the only possible explanation for his size, as SSRIs themselves have been associated with alterations in growth trajectories in children and adolescents. After birth, he may also have been affected through breastfeeding, as antidepressants have been associated with reduced protein concentrations in human milk. My child will likely be perceived primarily through the lens of his short stature, and this will follow him throughout his life. I believe these medications have also affected my child’s neurodevelopment. I will never know what my child might have been like had these medications not been prescribed and continued during pregnancy. The lifelong uncertainty itself is a profound harm. Because I was taking antidepressants during pregnancy, my emotions were numbed, and I was unable to fully experience the most meaningful event in life - the birth of my own child. I was not warned about this either. The fact that physicians prescribed this medication and stood by while the life growing inside me was exposed to these chemicals has also affected the size of my family. The bed rest, the fear of extremely preterm birth, and the challenges after birth ultimately led me to abandon my dream of having more children. I realized only later that the challenges were likely caused by the fact that my child was suffering from withdrawal effects. My son will carry the consequences of this exposure for the rest of his life. The American Psychiatric Association bears partial responsibility, as its positions influence clinical practice worldwide. The permanent harm of an unborn child is one of the gravest outcomes imaginable. I will never forgive the physicians involved, nor the medical establishment as a whole, for what they have done to my innocent and beautiful child.