SSRIs in pregnancy: the risk to weigh is untreated depression

The edition in brief

Today's psychiatry edition leads on perinatal depression. A JAMA Psychiatry review (1 October) concludes that, once the effect of the drug is separated from the effect of depression itself, SSRIs appear to carry little or no risk of serious adverse outcomes in pregnancy, and that stopping them in moderate to severe depression has documented harms. It recommends a structured shared decision that weighs untreated illness alongside drug exposure. A global meta-analysis of 207 studies and 134,071 trans and gender diverse adults found pooled prevalences of 40.1% for depression and 43.1% for past-year suicidal ideation, with 9.3% reporting a suicide attempt in the past year; estimates varied widely by method and setting. A review of the RECOVER trial of adjunctive vagus nerve stimulation in markedly treatment-resistant depression reports that the primary outcome was negative, while several secondary measures favoured active stimulation and most responders kept their gains to two years. On the regulatory side, FDA recorded a supplement to a generic olanzapine application — an administrative change, not a safety finding. The pearl is the antipsychotic metabolic check at baseline and twelve weeks.